Gatt M, Reddy B S, Mainprize K S
Scarborough Colorectal Team, Department of Surgery, Scarborough General Hospital, Woodlands Drive, Scarborough Y012 6QL, UK.
Surgeon. 2007 Jun;5(3):143-7. doi: 10.1016/s1479-666x(07)80041-2.
The National Health Service (NHS) Modernisation Agency has identified ten high impact changes for health organisations to adopt in order to improve their service. Top of this list is increasing day-surgery rates. The basket of interventions offered as short-stay procedures will have to increase to achieve this target. The aim of this study was to investigate whether it is feasible to offer fashioning or reversal of loop stomas as a short-stay procedure.
Consecutive patients needing stoma fashioning or reversal were offered surgery as a day-case. All were recruited from a single colorectal consultant's caseload. Patients scheduled for stoma formation were taught how to manage the stoma by a specialist nurse prior to hospital admission. The stoma nurse then visited all patients at home one day after discharge. Laparoscopic-assisted techniques, opiate avoidance and early mobilisation were included in the management protocol. Data relating to patient demographics, length of stay and complications were collected prospectively. Results of continuous variables were presented as median and interquartile ranges (IQRs).
All patients offered day-surgery accepted it readily. A total of twelve patients (M:F, 5:7) with a median (IQR) age of 70 (63-74) years were recruited. Seven had laparoscopically assisted loop ileostomy formation while five underwent loop stoma reversal (four loop ileostomies, one transverse colostomy). Four out of twelve patients were discharged the same day and 11/12 patients were home within 23 hours of admission. One patient needed admission for 72 hours for social reasons. None of the patients required readmission, and there were no observed complications associated with early discharge.
With the appropriate supportive set up, 23-hour stoma surgery is indeed feasible. Day-case procedures are possible in some, however, as with all short-stay surgery, careful patient selection is required.
英国国家医疗服务体系（NHS）现代化机构已确定了健康组织为改善服务而应采用的十项高影响力变革措施。其中首要措施是提高日间手术率。为实现这一目标，作为短期住院手术提供的干预措施范围将不得不扩大。本研究的目的是调查将袢式造口塑形或还纳作为短期住院手术是否可行。
连续需要进行造口塑形或还纳的患者接受日间手术。所有患者均来自一位结直肠专科顾问的病例。计划进行造口形成的患者在入院前由专科护士教授如何管理造口。造口护士在出院后一天到所有患者家中进行访视。管理方案包括腹腔镜辅助技术、避免使用阿片类药物和早期活动。前瞻性收集与患者人口统计学、住院时间和并发症相关的数据。连续变量的结果以中位数和四分位数间距（IQR）表示。
所有接受日间手术的患者均欣然接受。共招募了12名患者（男:女，5:7），中位（IQR）年龄为70（63 - 74）岁。7例行腹腔镜辅助袢式回肠造口术，5例行袢式造口还纳术（4例回肠造口，1例横结肠造口）。12名患者中有4名在同一天出院，11/12的患者在入院后23小时内回家。1名患者因社会原因需要住院72小时。没有患者需要再次入院，也没有观察到与早期出院相关的并发症。
在适当的支持设置下，23小时造口手术确实可行。部分患者可行日间手术，但与所有短期住院手术一样，需要仔细选择患者。
