Page 17 - Tina van Loon
P. 17

General introduction

              Teaching patients how to perform stoma care before and during their admission in
              which  the  stoma  was  created  may  lead to  improved  independence  in  their  own
              stoma  care  and  decrease  of  their  need  for  home  care  nursing  services  after
              discharge. Whether this in‐hospital educational stoma pathway is not only easily
              implementable  in  one  pioneering  hospital  but  also  in  others  and  whether  the
              beneficial effects are reproducible is evaluated for the Dutch setting in chapter 7.

              Part III ‐ Use of single‐port laparoscopy in stoma reversal surgery

              Stoma  reversal  surgery  of  a  left‐sided  colostomy  is  considered  technically
              challenging, associated with a high risk of morbidity and even mortality. For these
              reasons and despite the introduction of modern surgical techniques, stoma reversal
              surgery  is  often  not  attempted  or  pursued  by  patients  and  their  surgeons.
              Especially  stoma  patients  who  suffer  from  a  complex  abdominal  wall  defect  are
              frequently discouraged in their wish for stoma reversal or hernia repair surgery due
              to the high rates of postoperative morbidity. Single port surgery is a technique that
              might  limit  the  procedure  to  a  confined  compartment  of  the  abdomen  limiting
              unnecessary dissection and risks and facilitating the minimally invasive approach.
              First data have emerged suggesting its feasibility and safety.
              After these first promising results, the single‐port technique was implemented and
              standardized  as  primary  approach  for  reversal  of  left‐sided  colostomy  in  our
              hospital.  These  results  of  the  biggest  cohort  known  to  date  are  evaluated  in
              Chapter  8.  In  chapter  9  we  evaluate  the  experience  of  using  this  approach  in
              multiple  centers  in  Europe  and  offer  an  overview  of  the  available  literature  on
              single‐port reversal of left‐sided colostomy procedures. Chapter 10 discusses the
              feasibility  and  results  of  using  this  approach  for  stoma  reversal  in  patients  with
              concomitant complex abdominal wall defects. Specifically, this type of patients can
              benefit  from  the  approach  when  the  wish  for  stoma  reversal  exists  without  the
              specific need for hernia repair.
              The  thesis  is  concluded  with  a  general  summary  and  a  vision  on  future

   12   13   14   15   16   17   18   19   20   21   22