The WeChat subscription account of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine [Surgery Garden] column, pushed every Saturday! The articles in this column are written or directed by famous surgical experts from the hospital. The content i

WeChat subscription number of Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital [ Surgery Garden] column, pushed every Saturday! The articles in this column are written or guided by famous surgical experts from the hospital. The content involves popular science explanations and prevention suggestions for many common surgical diseases. They are practical and authoritative! stay tuned!

Important suggestions for patients with ileostomy

Medical guidance: Anorectal department Chief Chinese medicine practitioner

Pictures/Anorectal department Zhao Yongchang attending Chinese medicine practitioner

In the past 10 years, with the promotion of laparoscopic minimally invasive surgical technology, the use of various digestive tract anastomosis devices, and the guidance of the concept of total mesrectal resection (TME), the radical and anal conservation rate of rectal cancer surgery have been significantly improved. A large number of patients who had to remove the anus and permanent colostomy can now retain the anus while curing the tumor, but what followed was a temporary, protective ileostomy (see Figure 1) transfer to the feces to protect the fragile rectal anastomosis.

Figure 1 Ileotomy double-cavity stoma

Protective ileostomy is an effective means to prevent serious complications such as intestinal anastomotic fistula and abdominal infection. It is generally performed ileostomy closure about 3 months after the operation to restore intestinal integrity. patients with ileostomy are prone to dehydration due to excessive stoma discharge in the early stage after surgery, electrolyte disorders , and even severe renal function damage. Therefore, scientific hydration, diet and inlet and exit monitoring can effectively prevent and treat the above complications. It is recommended to pay attention to the following points within at least 30 days after the operation:

. Monitor the inlet and outlet of liquid every day. The discharge volume of the stoma is 300-500ml (paste) and urine volume >1200ml in 24 hours is best. If the stoma discharge volume is > 1200ml or the urine volume is <>. Ensure the total liquid intake per day > the total liquid discharge + 500ml. It is recommended to drink no less than 1000ml of rehydration salt solution every day (match: oral rehydration salt Ⅲ 1 bag + 250ml of warm boiled water); it is not recommended to drink glucose water, juice, tea, soda water , etc.

3. To ensure balanced nutrition, it is recommended to eat less and more meals, eat high- carbohydrate , high-protein, easy-to-digestible diet (fish, meat, eggs, intestinal nutrition powder, whey protein powder, etc.), high-sodium food (salty pickled vegetables, etc.), high-potassium food (banana, spinach, potatoes, etc.); reduce the consumption of greasy and difficult-to-digestible foods (such as glutinous rice products, etc.), and high-dietary fiber foods (dragon fruit, beans, cabbage, etc.) to avoid the occurrence of complications such as diarrhea and abdominal pain.

4. Regular outpatient review: It is recommended to return to your surgeon's outpatient clinic for the first, second, fourth, eighth and 12 weeks after discharge (the specific follow-up time is subject to the doctor's advice), and perform blood analysis, electrolytes, liver and kidney function tests; if there are symptoms such as diarrhea, oliguria, abdominal distension and abdominal pain, obvious fatigue and even drowsiness, palpitations, chest pain, , etc., please contact the doctor in time and follow up.

Foreign research data show that the incidence of high displacement (HOS) of ileostomy (23.8%-30%), secondary renal impairment (9.5%-17%) may be permanent, affecting long-term prognosis. In order to effectively prevent the above complications, the medical team of the Anorectal Department of , the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine recently designed a path-based perioperative diet education, stoma self-care related theoretical and practical training, and a high-displacement traditional Chinese and Western medicine prevention and treatment plan for ileostomy. We have established a WeChat group for follow-up of ileostomy patients after discharge to facilitate patients to receive continuous sexual health guidance provided by professional medical staff within one consecutive month after discharge. Through the implementation of the above measures, our team has achieved good results in stoma care, high ileostomy displacement and secondary renal injury and other stoma complications prevention and treatment.

Ultra-low rectal cancer preservation surgery is one of the important challenges in the work of all colorectal anal surgeons and one of the main research directions of our team. The medical team of the Anorectal Department of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine has always been committed to applying the highest level of standardized diagnosis and treatment technology of colorectal and anal surgery in Chinese and Western medicine in the clinical process, refining each diagnosis and treatment link, so that patients can obtain the maximum possible long-term survival time, reduce perioperative complications, and improve patients' quality of life.

Warm reminder: Anorectal department dressing room on the fifth floor of the outpatient building of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine has experienced professional stoma nurses to visit the clinic. If you or your relatives and friends have problems with stoma care, you can visit the hospital on a normal working day, contact number 020-36591301.

★

Main references:

.Jeremy M D Nightingale,et al.How to manage a high-output stoma[J] Frontline Gastroenterology 2022;13:140–151.

.Debbie Miller,et al.Executive Summary: Enhanced Recovery After Surgery Best Practice Guideline for Care of Patients With a Fecal Diversion[J] J Wound Ostomy Continence Nurs. 2017;44(1):74-77

3.Deborah Nagle,et al,Ileostomy Pathway Virtually Eliminates Readmissions for Dehydration in New Ostomates[J]Dis Colon Rectum 2012; 55: 1266–1272

4.Jeremy M D Nightingale,et al,How to manage a high-output stoma[J]Frontline Gastroenterology 2022;13:140–151.

5.Jonathan Lacey, et al,A multidisciplinary consensus on dehydration:definitions, diagnostic methods and clinical implications[J] Annals of Medicine, 51:3-4, 232-251

Expert profile

Sun Feng, chief physician, professor, doctor of surgery, and master's supervisor at the Department of Anorectal Department of First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. Visiting scholar at St. Mark's Hospital in the UK; famous doctor in Lingnan; outstanding young medical talent in Guangdong Province.

Social post: Deputy Chairman of the Intestinal Health Branch of Guangdong Health Association; Editorial Committee of the Chinese Journal of Gastroenterology Surgery; Communication Editor of the Chinese Journal of Colorectal Diseases; Editorial Committee of the Journal of Colorectal Surgery; Editorial Committee of the National Youth Committee of the Chinese Colorectal Surgery (CSCRS); Member of the Youth Professional Committee of the Anorectal Branch of the Chinese Medical Association; Young Member of the General Surgery Professional Committee of the Chinese Society of Integrated Traditional Chinese and Western Medicine; Standing Committee of the Guangdong Branch of the China NOSES Alliance; Young Member of the Guangdong Branch of the Guangdong Medical Association; Young Member of the Colorectal Anal Surgery Branch of the Guangdong Medical Association; Member of the Colorectal Anal Committee of the Guangdong Society of Integrated Traditional Chinese and Western Medicine.

visit arrangements: Monday and Wednesday morning; 5th floor of the outpatient building of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.

Author Profile

Zhao Yongchang, chief Chinese medicine practitioner of the Department of Anorectal, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.

Main research direction: Combination of traditional Chinese and Western medicine for large intestinal anus and pelvic floor diseases.

is good at: Combined with traditional Chinese and Western medicine to treat severe hemorrhoids, anal fissures, anal fistula, perianal abscess, rectal prolapse, rectal vaginal fistula and other anorectal diseases; laparoscopic minimally invasive surgery to treat benign and malignant colorectal tumors; traditional Chinese medicine to treat chronic constipation, enteritis, etc. There is rich experience in skin transplantation treatment for sacral and coccyx sinuses, large-area perianal suppurative hedgedenitis and other complex perianal complex and difficult-to-heal wounds. The surgical style is exquisite and focuses on perioperative painless management.

Social position: Deputy Chairman of the Anorectal Professional Committee of Guangdong Grassroots Medical Society, Youth Committee Member of the Anorectal Professional Committee of Guangdong Society of Traditional Chinese Medicine, Member of the Gastroenterology Surgery Committee of Guangdong Society of Integrated Traditional Chinese and Western Medicine, Standing Committee Member of the Anorectal Health Branch of Guangdong Health Association, etc.

visit arrangements: Wednesday and Thursday afternoon; Anorectal clinic on the 5th floor of the outpatient building of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.

Warm reminder

Editor: Liu Qingjun

Review: Zheng Xiaoying, Yang Yan Editor: Zhong Tianshuo