I l e o s t o m a t e s in Israel * A. HALEVY, M.D.,~ Y. ADAM, M.D., + J. ESHCHAR, M.D.w From the Department o~ Surgery "A' and Institute of Gastroenterology, Asaf Harofe Hospital, Tel-Aviv University Medical School, and Israel Ostom.y Association
TABLe 1. Distribt~Hon by Age and Sex at Operation
CREATION OF" A STOMA has a formidable
effect on its bearer. Besides the multitude of medical problems, there is a massive emotional factor. Although the majority of patients are free of their primary disease, the stoma itself creates new probleras, m a n y of them difficult to overcome. During the last two decades proctocolectomy became an almost standard procedure in the surgeon's a r m a m e n t a r i m n . T h e contributions of BrookeS and T u r n b u l P 6 in the early 1950's helped to overcome many difficulties at the stomal site, thus diminishing markedly previously existing problems. These developments made internists and gastroenterologists less reluctant in recommending p e r m a n e n t ileostomies to their patients. Nevertheless, the still existing hesitation originates in part from lack of satisfactory rehabilitation of some ostomates. An ileostomate should be a healthy individual who is capable of conducting an entirely unrestricted life, provided all available resources for his rehabilitation are being utilized. With these facts in mind, the results of a survey of Israeli ileostomates are presented in this paper.
Age (Years)
Male
Female
6-2O 21M0 41-60 61 or more
4 12 8 1
2 16 4
TOTAL
25
22
Material and Methods T h e 56 ileostomates known to the Israeli Ostomy Association (I.O.A.) were each invited for a personal interview. Nine (16 per cent) of the ostomates did not cooperate. A total of 47 ileostomates was interviewed. A detailed questionnaire was filled out during the interview, but documents pertaining to the medical history were not available. T h e ileostomates kne~v, however, whether they had had inflammatory bowel disease, such as mucosal or transmural colitis, or non-inflammatory disease, mainly familial polyposis. Results T h e r e were 22 female and 25 male patients. Distribution by age and sex at the time of operation is shown in T a b l e 1. Forty-one patients (87 per cent) were operated u p o n for inflammatory disease and six (13 per cent) for familial polyposis. Of the patients who had inflammatory disease, 71 per cent were of E u r o p e a n or N o r t h
* Received for publication December 6, 1976. j-Resident, Department of Surgery. 2 Chief, Surgical Service. w Chief, Institute of Gastroenterology, Asaf Harofe Hospital; Honorary Chairman, Israel Ostomy Association; Assistant Professor of Medicine, Sackler School of Medicine, University of Tel-Aviv. Address reprint requests to Dr. Eshchar: Asaf Arofe Hospital, Zerifin, Israel.
482 Dis. Col. &Rect. Sept. 1977
Volume 20 Number 6
Volume 20 Number 6
ILEOSTOMATES IN ISRAEL
American origin, and 29 per cent were from Mideastern countries. A m o n g the small group having familial polyposis there were three patients each in both ethnic groups. T h e average duration of symptoms preoperatively was 6.4 years, ranging from six months in six patients to 25 years in two patients. T h e time lapses from operation to interview averaged 6.5 years (Table 2). T h r e e of the 4l (7.3 per cent) patients who had in,fiammatory disease and two (33 per cent) of the patients with familial polyposis had cancer of the colon found at operation. Of these, only one of the patients with inflammatory' disease is still alive. Late complications, according to information from the ostomates, are described in T a b l e 3. None of the 11 patients operated on prior to the formation of the I.O.A. in 1972 was visited by a volunteer ostomate. However, 24 of the 30 patients operated on later, as well as the six patients operated on abroad, were visited by volunteers. Of the 17 unvisited ostomates, ten had irritation and 7 had excoriation of the skin. Among the 30 visited, 20 had irritation of the skin and only three had excoriation. T h e appliance was changed from twice daily to once every 2l days, with an average of once every 4.6 days. T e n ileostomates did not know about skin adhesives, and all ten suffered severe, constant cutaneous excoriation. Six patients emptied their bags three times daily; two did it eight times a Duration oJ Symptoms Preoperatively and Length of Postoperative Period
TABLE 9,
Duration of Disease Preoperatively Number of Years Pa tier~ts D,1 1-5 6---10 t 1-15 16.--20
20
1 I-5 6-10
13 21 3
7
1 t-15
5
B 2
16-20 20
TABLe 1. Distribt~Hon by Age and Sex at Operation
CREATION OF" A STOMA has a formidable
effect on its bearer. Besides the multitude of medical problems, there is a massive emotional factor. Although the majority of patients are free of their primary disease, the stoma itself creates new probleras, m a n y of them difficult to overcome. During the last two decades proctocolectomy became an almost standard procedure in the surgeon's a r m a m e n t a r i m n . T h e contributions of BrookeS and T u r n b u l P 6 in the early 1950's helped to overcome many difficulties at the stomal site, thus diminishing markedly previously existing problems. These developments made internists and gastroenterologists less reluctant in recommending p e r m a n e n t ileostomies to their patients. Nevertheless, the still existing hesitation originates in part from lack of satisfactory rehabilitation of some ostomates. An ileostomate should be a healthy individual who is capable of conducting an entirely unrestricted life, provided all available resources for his rehabilitation are being utilized. With these facts in mind, the results of a survey of Israeli ileostomates are presented in this paper.
Age (Years)
Male
Female
6-2O 21M0 41-60 61 or more
4 12 8 1
2 16 4
TOTAL
25
22
Material and Methods T h e 56 ileostomates known to the Israeli Ostomy Association (I.O.A.) were each invited for a personal interview. Nine (16 per cent) of the ostomates did not cooperate. A total of 47 ileostomates was interviewed. A detailed questionnaire was filled out during the interview, but documents pertaining to the medical history were not available. T h e ileostomates kne~v, however, whether they had had inflammatory bowel disease, such as mucosal or transmural colitis, or non-inflammatory disease, mainly familial polyposis. Results T h e r e were 22 female and 25 male patients. Distribution by age and sex at the time of operation is shown in T a b l e 1. Forty-one patients (87 per cent) were operated u p o n for inflammatory disease and six (13 per cent) for familial polyposis. Of the patients who had inflammatory disease, 71 per cent were of E u r o p e a n or N o r t h
* Received for publication December 6, 1976. j-Resident, Department of Surgery. 2 Chief, Surgical Service. w Chief, Institute of Gastroenterology, Asaf Harofe Hospital; Honorary Chairman, Israel Ostomy Association; Assistant Professor of Medicine, Sackler School of Medicine, University of Tel-Aviv. Address reprint requests to Dr. Eshchar: Asaf Arofe Hospital, Zerifin, Israel.
482 Dis. Col. &Rect. Sept. 1977
Volume 20 Number 6
Volume 20 Number 6
ILEOSTOMATES IN ISRAEL
American origin, and 29 per cent were from Mideastern countries. A m o n g the small group having familial polyposis there were three patients each in both ethnic groups. T h e average duration of symptoms preoperatively was 6.4 years, ranging from six months in six patients to 25 years in two patients. T h e time lapses from operation to interview averaged 6.5 years (Table 2). T h r e e of the 4l (7.3 per cent) patients who had in,fiammatory disease and two (33 per cent) of the patients with familial polyposis had cancer of the colon found at operation. Of these, only one of the patients with inflammatory' disease is still alive. Late complications, according to information from the ostomates, are described in T a b l e 3. None of the 11 patients operated on prior to the formation of the I.O.A. in 1972 was visited by a volunteer ostomate. However, 24 of the 30 patients operated on later, as well as the six patients operated on abroad, were visited by volunteers. Of the 17 unvisited ostomates, ten had irritation and 7 had excoriation of the skin. Among the 30 visited, 20 had irritation of the skin and only three had excoriation. T h e appliance was changed from twice daily to once every 2l days, with an average of once every 4.6 days. T e n ileostomates did not know about skin adhesives, and all ten suffered severe, constant cutaneous excoriation. Six patients emptied their bags three times daily; two did it eight times a Duration oJ Symptoms Preoperatively and Length of Postoperative Period
TABLE 9,
Duration of Disease Preoperatively Number of Years Pa tier~ts D,1 1-5 6---10 t 1-15 16.--20
20
1 I-5 6-10
13 21 3
7
1 t-15
5
B 2
16-20 20
