Creation of an ostomy can have a detrimental effect on a patient’s quality of life leading to depression, social isolation, and body image issues. While construction of a well-sited, well-made stoma without complications is the basis of good function, perioperative education is an essential part of maximizing postoperative satisfaction. Perioperative education should start with a detailed assessment of all aspects of the patient’s life, a basic introduction to the structure and function of stomas, and a realistic description of how their life is likely to change. Preoperative marking and education by enterostomal therapists not only improves patient satisfaction and quality-of-life scores, but decreases hospital length of stay and stoma-related readmission rates.
Patients undergoing end colostomy for rectal or anal cancer and those with temporary stomas are two groups with particularly low postoperative quality-of-life scores. Some of these patients may be missing the preoperative planning sessions as the decision to create a stoma may be made intraoperatively. Not only do these groups warrant active preoperative education if the possibility of stoma creation exists, but they may benefit from support groups and enhanced postoperative care, despite the fact that their stoma is temporary.
Importantly, patients who are sick from a disease process, such as those with medically refractory ulcerative colitis, often have improvement in quality-of-life scores after surgery, with or without an ileostomy. In other words, removal of the severely symptomatic colon is more important than reconstruction.
The keys to maximizing the quality of life in patients with a stoma are good function, minimal complications, and sensitive support. Preoperative recognition of patients at high risk for problems can prevent some issues, while providing patients with reliable postoperative support can make the difference between living and just surviving.
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Wilson TR, Alexander DJ. Clinical and non-clinical factors influencing postoperative health-related quality of life in patients with colorectal cancer. Br J Surg. 2008;95:1408–15.PubMedCrossRefGoogle Scholar
Siassi M, Weiss M, Hohenberger W, et al. Personality rather than clinical variables determines quality of life after major colorectal surgery. Dis Colon Rectum. 2009;52:662–8.PubMedCrossRefGoogle Scholar
Holzer B, Matzel K, Schiedeck T, et al. Do geographic and educational factors influence the quality of life in rectal cancer patients with a permanent colostomy? Dis Colon Rectum. 2005;48:2209–16.PubMedCrossRefGoogle Scholar
Pittman J, Rawl SM, Schmidt CM, et al. Demographic and clinical factors related to ostomy complications and quality of life in veterans with an ostomy. J Wound Ostomy Continence Nurs. 2008;35:493–503.PubMedCrossRefGoogle Scholar
Bass EM, Del Pino A, Tan A, et al. Does preoperative stoma marking and education by the enterostomal therapist affect outcome? Dis Colon Rectum. 1997;40:440–2.PubMedCrossRefGoogle Scholar
Colwell JC, Gray M. Does preoperative teaching and stoma site marking affect surgical outcomes in patients undergoing ostomy surgery? J Wound Ostomy Continence Nurs. 2007;34:492–6.PubMedCrossRefGoogle Scholar
Chaudhri S, Brown L, Hassan I. Preoperative intensive, community-based vs. traditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48:504–9.PubMedCrossRefGoogle Scholar
Haugen V, Bliss DZ, Savik K. Perioperative factors that affect long-term adjustment to an incontinent ostomy. J Wound Ostomy Continence Nurs. 2006;33:525–35.PubMedCrossRefGoogle Scholar
Power M, Harper A, Bullinger M. The World Health Organization WHOQOL-100: tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychol. 1999;18:495–505.PubMedCrossRefGoogle Scholar
McLeod RS, Cohen Z. Quality of life with a stoma. In: Anonymous intestinal stomas: principles, techniques, and management. New York: Marcel Dekker, Inc; 2004. p. 91–109.CrossRefGoogle Scholar
Revicki DA, Kaplan RM. Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Qual Life Res. 1993;2:477–87.PubMedCrossRefGoogle Scholar
Grant M, Ferrell B, Dean G, et al. Revision and psychometric testing of the City of Hope Quality of Life-Ostomy Questionnaire. Qual Life Res. 2004;13:1445–57.PubMedCrossRefGoogle Scholar
Kiran RP, Delaney CP, Senagore AJ, et al. Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn’s disease. Am J Gastroenterol. 2003;98:1783–9.PubMedCrossRefGoogle Scholar
Karadag A, Mentes BB, Uner A, et al. Impact of stomatherapy on quality of life in patients with permanent colostomies or ileostomies. Int J Colorectal Dis. 2003;18:234–8.PubMedGoogle Scholar
Bekkers MJ, van Knippenberg FC, van den Borne HW, et al. Psychosocial adaptation to stoma surgery: a review. J Behav Med. 1995;18:1–31.PubMedCrossRefGoogle Scholar
Wade BE. Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not. J Adv Nurs. 1990;15:1297–304.PubMedCrossRefGoogle Scholar
Camilleri-Brennan J, Munro A, Steele RJ. Does an ileoanal pouch offer a better quality of life than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg. 2003;7:814–9.PubMedCrossRefGoogle Scholar
Grumann MM, Noack EM, Hoffmann IA, et al. Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer. Ann Surg. 2001;233:149–56.PubMedCrossRefGoogle Scholar
Ko CY, Rusin LC, Schoetz DJ, et al. Using quality of life scores to help determine treatment: is restoring bowel continuity better than an ostomy? Colorectal Dis. 2002;4:41–7.PubMedCrossRefGoogle Scholar
Seidel SA, Newman M, Sharp KW. Ileoanal pouch versus ileostomy: is there a difference in quality of life? Am Surg. 2000;66:540–6; discussion 546–7.PubMedGoogle Scholar
Jimmo B, Hyman NH. Is ileal pouch-anal anastomosis really the procedure of choice for patients with ulcerative colitis? Dis Colon Rectum. 1998;41:41–5.PubMedCrossRefGoogle Scholar
Weinryb RM, Gustavsson JP, Liljeqvist L, et al. A prospective study of the quality of life after pelvic pouch operation. J Am Coll Surg. 1995;180:589–95.PubMedGoogle Scholar
McLeod RS, Lavery IC, Leatherman JR, et al. Factors affecting quality of life with a conventional ileostomy. World J Surg. 1986;10:474–80.PubMedCrossRefGoogle Scholar
Burnham WR, Lennard-Jones JE, Brooke BN. Sexual problems among married ileostomists. Survey conducted by The Ileostomy Association of Great Britain and Ireland. Gut. 1977;18:673–7.PubMedCrossRefGoogle Scholar
Rolstad BS, Wilson G, Rothenberger DA. Sexual concerns in the patient with an ileostomy. Dis Colon Rectum. 1983;26:170–1.PubMedCrossRefGoogle Scholar
Berndtsson I, Oresland T. Quality of life before and after proctocolectomy and IPAA in patients with ulcerative proctocolitis – a prospective study. Colorectal Dis. 2003;5:173–9.PubMedCrossRefGoogle Scholar
Nilsson LO, Kock NG, Kylberg F, et al. Sexual adjustment in ileostomy patients before and after conversion to continent ileostomy. Dis Colon Rectum. 1981;24:287–90.PubMedCrossRefGoogle Scholar
Nessar G, Fazio VW, Tekkis P, et al. Long-term outcome and quality of life after continent ileostomy. Dis Colon Rectum. 2006;49:336–44.PubMedCrossRefGoogle Scholar
Kohler LW, Pemberton JH, Zinsmeister AR. Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch, and ileal pouch-anal anastomosis. Gastroenterology. 1991;101:679–84.PubMedGoogle Scholar
Ojerskog B, Kock NG, Nilsson LO, et al. Long-term follow-up of patients with continent ileostomies. Dis Colon Rectum. 1990;33:184–9.PubMedCrossRefGoogle Scholar
Engel J, Kerr J, Schlesinger-Raab A, et al. Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003;238:203–13.PubMedGoogle Scholar
Yau T, Watkins D, Cunningham D, et al. Longitudinal assessment of quality of life in rectal cancer patients with or without stomas following primary resection. Dis Colon Rectum. 2009;52:669–77.PubMedCrossRefGoogle Scholar
Krouse R, Grant M, Ferrell B, et al. Quality of life outcomes in 599 cancer and non-cancer patients with colostomies. J Surg Res. 2007;138:79–87.PubMedCrossRefGoogle Scholar
Bartha I, Hajdu J, Bokor L, et al. Quality of life of post-colostomy patients. Orv Hetil. 1995;136:1995–8.PubMedGoogle Scholar
Dehni N, Schlegel RD, Cunningham C, et al. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg. 1998;85:1114–7.PubMedCrossRefGoogle Scholar
Guenaga KF, Lustosa SA, Saad SS. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis. Acta Cir Bras. 2008;23:294–303.PubMedCrossRefGoogle Scholar
Camilleri-Brennan J, Steele RJ. Prospective analysis of quality of life after reversal of a defunctioning loop ileostomy. Colorectal Dis. 2002;4:167–71.PubMedCrossRefGoogle Scholar
Gooszen AW, Geelkerken RH, Hermans J. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum. 2000;43:650–5.PubMedCrossRefGoogle Scholar
Siassi M, Hohenberger W, Losel F, et al. Quality of life and patient’s expectations after closure of a temporary stoma. Int J Colorectal Dis. 2008;23:1207–12.PubMedCrossRefGoogle Scholar
Marquis P, Marrel A, Jambon B. Quality of life in patients with stomas: the Montreux Study. Ostomy Wound Manage. 2003;49:48–55.PubMedGoogle Scholar
Piwonka MA, Merino JM. A multidimensional modeling of predictors influencing the adjustment to a colostomy. J Wound Ostomy Continence Nurs. 1999;26:298–305.PubMedGoogle Scholar