Page 15 - Tina van Loon
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General introduction
Outline of the thesis
The scope of the current thesis was to investigate the clinical aspects and “real‐
world” analyses of stoma use in colorectal surgery, in an effort to help stoma
patients and to improve stoma‐related morbidity. In part I we focus on
postoperative results in stoma patients after benign and malignant colorectal
surgery, critically appraising the added value of stomas and their effects in
postoperative results. In part II we analyze the effect of easily implementable
stoma pathways and their effectiveness in reducing readmissions and home care
nursing services after discharge in new stoma patients, in an effort to reduce some
of these well‐known stoma‐related problems. In part III we focus on the
consolidation of the single port technique in stoma reversal surgery, exploring
European experiences and highlighting its value compared to already existing
techniques.
Part I ‐ Use of stomas in colorectal surgery
The Hartmann’s procedure has long been the mainstay for treating complicated
diverticulitis. Complicated diverticular disease is defined as diverticulitis with
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associated abscess, phlegmon, fistula, obstruction, bleeding, or perforation. Due
to solid research in the past decades, other treatment options have been added.
Tailored to the stage of the disease, several options are available, ranging from
conservative treatment with observation and antibiotics, to primary anastomosis
with or without deviating ostomy, to the original Hartmann’s procedure. 10‐13
Nevertheless, the debate on the optimal surgical treatment of complicated
diverticulitis with peritonitis and sepsis is still not closed and the roles of
laparoscopy, lavage as treatment and formation of anastomosis with or without
ileostomy in emergency surgery are still under investigation. 10,14‐16 Chapter 2
investigates a decade‐long single center experience of emergency surgery in
complicated diverticulitis with its focus on laparoscopic Hartmann’s procedures.
Here we report “real‐world” data in a field with conflicting results and where
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