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

              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
              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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