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Einleitung: die Anlage eines Enterostomas ist für die Betroffene in dem persönlichen und sozialen Leben eine sehr große Veränderung. Die Patient*innen müssen sich an der Enterostomaanlage anpassen und ein normales Leben trotz der Enterostomaanlage führen können. Es ist von dem diplomierten Gesundheit- und Krankenpflege das Erkennen der Bedürfnisse, Herausforderungen und Schwierigkeiten der Enterostomaträger*innen sehr wichtig, um sie besser betreuen und unterstützen zu können. Methodik: In dieser Bachelorarbeit handelt es sich um eine Literaturanalyse. Es wurden 12 Studien nach der Recherche in den wissenschaftlichen Datenbanken wie CINAHL, SpringerLink, PubMed und MedLine ausgewählt und analysiert. Ergebnisse: Das veränderte Körperbild, psychische Herausforderungen und Belastungen aber auch die Veränderungen der Aktivitäten des täglichen Lebens gehören zu den Auswirkungen, welche die Enterostomaanlage auf das Leben der Betroffenen hat. Daher sollen die Stomaberat*innen nicht nur die Bedürfnisse der Patient*innen mit dem Enterostoma erkennen können, sondern auch auf diese besonderen Bedürfnisse eingehen und reagieren können. Schlussfolgerung: Schlussendlich zeigen die Studien in dieser Bachelorarbeit, dass nicht nur die Versorgung des Enterostomas und die Körperliche Betreuung von den Pflegenden bei den Enterostomaträger*innen wichtig sind, sondern auch die psychische Unterstützung und Beratung in den verschiedenen Aspekten des täglichen Lebens. Introduction: Enterostomy is a very big change in the personal and social life of patients. Patients have to adapt to the enterostomy and be able to lead a normal life despite the enterostomy system. It is very important for the nurses to recognize the needs, challenges and difficulties of the patients with enterostomy to be able to better care for and support them. Methodology: This bachelor thesis is a literature review. 12 studies were selected and analyzed after searching the scientific databases such as CINAHL, SpringerLink, PubMed and MedLine. Results: body image change´s, psychological challenges and stress, but also the changes in activities of daily living are the effects that the enterostomy has on the lives of patients. Therefore, the ostomy nurse should not only be able to recognize the needs of the patients with the enterostomy care, but also be able to respond to special needs in the other aspects of their life. Conclusio: Finally, the studies in this bachelor thesis show that not only the care of the enterostomy and the physical nursing care of the patient are important, but also the psychological support and counseling in the various aspects of daily life.

Darmkrebs ist weltweit die dritthäufigste Krebsart und war für rund 10% der Krebs-sterbefälle verantwortlich in Österreich. Es wurden 20.631 an dem Dickdarm und 6.121 am Dünndarm Operationen durchgeführt in Jahr 2020 in Österreich. Nicht nur Darmkrebserkrankungen sind für ein künstlicher Darmausgang verantwortlich. Morbus Crohn und Colitis ulcerosa sind die häufigsten chronisch-entzündlichen Darmerkrankungen und in Österreich sind etwa 60.000 bis 80.000 Menschen betroffen, davon tragen etwas um 12.000 ein Stoma. Derzeit ist eine Heilung ist nicht in Sicht und die medizinische und pflegerische Behandlung konzipiert sich auf die Bekämpfung der Symptome, die bestmögliche Vermeidung von Komplikationen und die Verbesserung der Lebensqualität für die Betroffenen beschränken. Die Anpassung an das Leben mit einem Stoma beinhaltet eine Reihe von physischen und psychischen Herausforderungen und folglich die Angebote und die Unterstützung einer Stoma Care Nurse. Colorectal cancer is the third most common cancer worldwide and accounted for about 10% of cancer deaths in Austria. There were 20,631 colon and 6,121 small bowel sur-geries performed in 2020 in Austria. Not only colorectal cancers are responsible for an artificial bowel outlet. Crohn's disease and ulcerative colitis are the most common chronic inflammatory bowel diseases and in Austria about 60,000 to 80,000 people are affected, of which something around 12,000 carry a stoma. Currently, there is no cure in sight and medical and nursing treatment is designed to combat symptoms, prevent complications as best as possible and improve the quality of life for those af-fected. Adjusting to life with an ostomy involves a series of physical and psychological challenges and, consequently, the services and support of an ostomy care nurse.

Einleitung: Die Anlage eines Enterostomas ist für Betroffene ein einschneidendes Ereignis und hat physische, psychische und soziale Auswirkungen. Die Selbstpflege spielt eine zentrale Rolle in der Anpassung an das Enterostoma. Diese Arbeit hat das Ziel, psychosoziale Auswirkungen eines Enterostomas auf Betroffene zu beschreiben und beeinflussende Faktoren auf die Selbstpflege darzustellen. Methodik: Es wurde eine systematische Literaturrecherche in ausgewählten Datenbanken durchgeführt und zwölf Studien zur Beantwortung der Fragestellungen dieser Arbeit eingeschlossen. Die Ergebnisse der Studien wurden zusammengeführt und miteinander verknüpft. Ergebnisse: Betroffene haben überwiegend negative Gefühle wie Angst, Scham und innere Unruhe. Die Lebensqualität ist verringert und das veränderten Körperbild wird negativ wahrgenommen. Betroffene erleben Einschränkungen in ihrem sozialen, persönlichen, sexuellen und beruflichen Leben. Ein erhöhter Body-Mass-Index, Depression, innere Unruhe, Stress und Komplikationen wirken negativ auf die Selbstpflege. Autonomie als Ziel, hohes Bildungsniveau, Unterstützung des sozialen Umfelds, Berufstätigkeit und Schulung zur Enterostomaversorgung durch Pflegepersonen wirken positiv auf die Selbstpflege. Die Ergebnisse verdeutlichen die belastenden psychosozialen Auswirkungen des Enterostomas und einen Mangel an Schulung zu Enterostoma, die für das Erreichen von Selbstpflege eine tragende Rolle spielt. Schlussfolgerung: Gesundheits- und Krankenpflegepersonen haben eine wichtige Rolle in der patientenorientierten Unterstützung und Edukation von Betroffenen mit Enterostoma, um Einschränkungen durch das Enterostoma zu verringern sowie eine positive Sichtweise und Selbstpflege zu fördern. Introduction: The creation of an enterostomy is a drastic event for affected individuals and brings along physical, psychological and social effects. The self-care plays a central role in the adjustment to the enterostomy. The aim of this thesis is to describe the psychosocial impact of an enterostomy on affected individuals and to present influencing factors on the self-care. Methodology: To answer the questions of this thesis, a systematic literature search was conducted in selected databases and twelve studies were included. The results of the studies were combined and linked. Results: Affected persons have predominantly negative feelings such as fear, shame and anxiety. The quality of life is reduced, and the altered body image is perceived negatively. Affected individuals experience limitations in their social, personal, sexual and professional lives. Increased body mass index, depression, anxiety, stress and complications have a negative impact on self-care. Autonomy as goal, high level of education, support of social environment, occupation and training on enterostomy care by nurses have a positive effect on self-care. The results of this thesis highlight the burdening psychosocial impact of enterostomy and a lack of training on enterostomy care, which plays a supporting role in achieving self-care. Conclusion: Nurses play an important role in patient-oriented support and education for people with enterostomy to reduce limitations due to the enterostomy and to promote a positive outlook and self-care.

Kurzfassung Einleitung: Darmkrebs ist eine der häufigsten Krebserkrankungen in Österreich und der Hauptgrund für den Großteil der Stomanlagen. Die Operation verringert zwar die Krankheitslast, geht jedoch mit vielen Veränderungen einher, welche die Lebensqualität negativ beeinflussen. Neben der präoperativen Vorbereitung spielt auch die postoperative Nachsorge eine bedeutende Rolle für die Lebensqualität der Betroffenen. Methodik: Für die Beantwortung der Forschungsfragen wurde von November 2021 bis April 2022 in folgenden Datenbanken eine Literaturrecherche durchgeführt: CINAHL, PubMed und u:search. Dafür wurden im Voraus Ein- und Ausschlusskriterien und Schlüsselwörter definiert. Zwölf Studien, die den Kriterien entsprachen, wurden für die vorliegende Arbeit herangezogen. Ergebnisse: Die Anlage eines Stomas wirkt sich auf alle Bereiche des Lebens aus. Es kommt zu physischen, psychischen und situativen Veränderungen und schränkt die Patient*innen in ihrem alltäglichen Leben stark ein. Folglich zeigt sich eine verringerte Lebensqualität. Durch präoperative Markierungen und postoperative Telefon-Nachsorge, welche von speziell geschulten Pflegepersonen durchgeführt werden, lassen sich die Probleme der Betroffenen eindämmen und verbessern die Lebensqualität. Schlussfolgerung: Patient*innen mit einem Stoma leben mit vielen Einschränkungen und Problemen, die aufgrund der Operation auftreten und ihre Lebensqualität verschlechtern. Umso wichtiger ist es daher für das Pflegepersonal, die Betroffenen ganzheitlich zu betrachten, um eine angemessene Behandlung in allen Lebensbereichen gewährleisten zu können. Der Tätigkeitsbereich der Pflege ist breit gefächert und erlaubt verschiedenste Ansätze zur Behandlung der Patient*innen. Neben den präoperativen Stoma-Markierungen wirkt sich auch die Telefon-Nachsorge positiv auf die Lebensqualität aus. Dieser Art der Nachsorge sollte mehr Beachtung geschenkt werden und die Wirksamkeit noch genauer erforscht werden. Schlüsselbegriffe: Enterostoma, Lebensqualität, Stoma-Markierung, Telefon-Nachsorge Abstract Introduction: Colorectal cancer is one of the most common cancers in Austria and the main reason for the majority of ostomies. Although surgery reduces the burden of the disease, it is accompanied by many changes that negatively affect the quality of life. In addition to preoperative preparation, postoperative follow-up also plays a significant role in the quality of life of those who are affected. Methodology: To answer the research questions, a literature search was conducted from November 2021 to April 2022 in the following databases: CINAHL, PubMed, and u:search. For this purpose, inclusion and exclusion criteria and keywords were defined in advance. Twelve studies that met the criteria were used for the present work. Results: The creation of a stoma affects all areas of life. It leads to physical, psychological and situational changes and severely restricts patients in their daily lives. Consequently, a reduced quality of life is evident. Pre-operative markings and post-operative telephone follow-up, which are carried out by specially trained nurses, can help to contain the problems of those who are affected and improve their quality of life. Conclusion: Patients with a stoma live with many restrictions and problems that occur due to the operation and worsen their quality of life. It is therefore all the more important for the nursing staff to view the patients holistically in order to be able to guarantee appropriate treatment in all areas of life. The area of activity of nursing care is broad and allows a wide variety of approaches to the treatment of patients. In addition to preoperative stoma markings, telephone follow-up has a positive effect on the quality of life. More attention should be paid to this type of follow-up and its effectiveness should be researched in more detail. Keywords: Enterostomy, quality of life, stoma marking, telephone follow-up

Postoperative complications after the creation of an intestinal stoma have a considerable impact on the patient's quality of life. The accurate surgical technique is very important for their prevention and requires profound surgical knowledge as well as sufficient experience. The importance of the preoperative consultation as well as the postoperative care by stoma therapists is clearly proven. Depending on the severity of the complication, outpatient conservative treatment is initially indicated. A surgical local revision or laparotomy should only be considered if conservative treatment is no longer sufficient, whereby the indications for surgery should be set very cautiously. This article provides an overview of the current evidence regarding the prevention and treatment of postoperative stoma complications.Postoperative Komplikationen nach Anlage eines Enterostomas haben einen beachtlichen Einfluss auf die Lebensqualität der Patienten. Die akkurate operative Technik steht bei deren Prävention im Vordergrund und setzt fundierte aktuelle chirurgische Kenntnisse sowie ausreichende Erfahrung voraus. Eindeutig nachgewiesen ist die prophylaktische Bedeutung der präoperativen Konsultation sowie perioperative Betreuung durch einen Stomatherapeuten. Je nach Schwergrad der Komplikation sollte zunächst eine ambulante konservative Behandlung eingeleitet werden. Ist die konservative Behandlung nicht mehr ausreichend, kommen eine operative lokale Revision oder die Laparotomie infrage, wobei die Indikation sehr zurückhaltend gestellt werden sollte. Dieser Artikel gibt eine Übersicht der aktuellen Evidenz hinsichtlich Prävention und Behandlung postoperativer Stomakomplikationen.

Einleitung: Die Anlage eines Stomas stellt für Betroffene eine Veränderung der bisherigen Lebensumstände dar und kann zu Herausforderungen und Belastungen für den Betroffenen führen. Damit die betroffene Person sich auf die neue Lebenssituation einstellen und den Alltag gut bewältigen kann, benötigt es Beratung und Aufklärung durch ein multiprofessionelles Team. Die Beratung, Schulung, Aufklärung und Unterstützung durch das Pflegepersonal ist von hoher Relevanz, um die Lebensqualität und das Wohl-befinden der Stomaträgerinnen und Stomaträger zu stärken. Methode: Im Rahmen der Bachelorarbeit I wurde eine umfassende Literaturrecherche im Zeitraum von Oktober 2018 bis April 2019 in den elektronischen Datenbanken Academic Search Elite, PubMed und Cochrane Library durchgeführt. Zusätzlich konnte anhand der Berry Picking Methode weitere relevante Literatur gefunden werden, welche durch die Ein- und Ausschlusskriterien, sowie durch Filtermethoden eingegrenzt wurde. Die gesamte Suche wurde anhand eines Flussdiagramms und die zentralen Ergebnisse in tabellarischer und deskriptiver Form dargestellt. Nachfolgend wurden die Ergebnisse im Rahmen einer Synthese zusammengefügt und anschließend diskutiert. Ergebnisse: Anhand der Literaturrecherche konnten fünf Studien in die Arbeit aufgenommen werden. Die Ergebnisse der Studien zeigen, dass die Anlage eines Enterostomas für die Betroffenen weitreichende Veränderungen in ihrem täglichen Leben mit sich bringen. Die Veränderungen sind in physischer, psychischer und sozialer Hinsicht erkennbar. Leckagen, unangenehmer Geruch und Gase gehören zu den größten Problemen der Betroffenen und führen dazu, dass sie sich isolieren. Eine umfassende Betreuung durch den gehobenen Dienst ist wichtig, um den Stomaträgerinnen und Stomaträgern Unabhängigkeit und Wohlbefinden zurückzugeben und die Lebensqualität zu erhöhen. Diskussion: Die Anlage eines Stomas erfordert von den Betroffenen einen Prozess der Anpassung, um das tägliche Leben bewältigen zu können. Der gehobene Dienst bietet Beratungs- und Edukationsangebote, die sich vor allem an die physischen Aspekte der Betroffenen richten, vernachlässigen jedoch oft die emotionale und soziale Ebene. Dadurch kommt es zu einer Minderung der Lebensqualität Betroffener, da sie sich oft nicht ausreichend verstanden und akzeptiert fühlen. Introduction: The creation of a stoma has a significant impact on the life circumstances of those affected and can cause many challenges and burdens. About 14,000 people in Austria are affected by stomata and the changes and problems caused by it. The adaptation to new everyday life needs to be assisted by multiprofessional team. Nursing care, counseling, education and support are indispensable to improve the ostomates’ quality of life as they facilitate the return to daily routine. Methods: As part of Bachelor thesis I, a comprehensive literature search was carried out in the period of October 2018 to April 2019. The electronic databases Academic Search Elite, PubMed, Cochrane Library were used, as well as the Berry Picking Method to find literature in journals, which was limited by inclusion and exclusion criteria as well as by filter methods. The search was presented in form of a flow chart prisma and central results in tabular and descriptive order. Furthermore, the results of the included studies were synthesized and finally discussed. Results: Based on the literature research, five studies were included in the thesis. The results of the studies clearly show that the creation of an enterostomy leads to far-reaching changes in the patient’s daily lives, such as reduction in the quality of life and well-being. Those changes are physically, psychologically and socially identifiable. Unpleasant occurrences like leaks, odors and gases are among the biggest problems of those affected and cause the need to isolate and withdraw. Comprehensive care implemented by health professionals is important in order to restore the independence and well-being of the stoma bearers, thus improving the quality of life. Conclusion: The installation of a stoma demands a process of adaptation of the affected person in order to be able to cope with daily life. The health care offers counseling and education services that are primarily focused on the physical aspects of the condition, however it often neglects the emotional and social level. This leads to a decrease in the quality of life of those affected, since they often do not feel sufficiently understood and accepted.

Einleitung: Durch die operative Anlage eines Enterostomas verändert sich das Leben der Betroffenen maßgeblich. Sie werden mit physischen und psychosozialen Belastungen konfrontiert. Um den Anpassungsprozess an das Leben mit Stoma und den Genesungsprozess gut zu bewältigen, benötigt es umfassende Beratung, Schulung, Aufklärung und individuelle Unterstützung durch ein multiprofessionelles Team. Das Pflegepersonal spielt sowohl präoperativ als auch postoperativ eine zentrale Rolle in der Betreuung und Pflege von Stomapatientinnen und Stomapatienten. Methode: Im Rahmen der Bachelorarbeit II erfolgte im Zeitraum von November 2019 bis März 2020 eine umfassende Literaturrecherche in den elektronischen Datenbanken Cochrane Library, PubMed, CIHNAL und Science Direct. Die wissenschaftlich relevante Literatur wurde durch die Verwendung von Filtermethoden sowie durch Ein- und Ausschlusskriterien eingegrenzt. Die gesamte Literatursuche wurde in einem Flussdiagramm dargestellt und die zentralen Ergebnisse wurden sowohl tabellarisch als auch deskriptiv beschrieben. Anschließend wurden die Ergebnisse im Rahmen einer Synthese zusammengeführt und abschließend diskutiert. Ergebnisse: Anhand der Literaturrecherche konnten insgesamt vierzehn Studien in die Arbeit aufgenommen werden. Hiervon erforschten acht Studien von welchen psychosozialen Belastungen Stomaträgerinnen und Stomaträger betroffen sind. Häufig genannt wurden Belastungen in den Bereichen, Beruf, Alltags-, und Freizeitaktivitäten, Sport, Ernährung, Familie, Körperbild, Sexualität und Anpassung. Sechs der gefundenen Studien untersuchten und bewerteten mögliche Pflegeinterventionen. Die umfassende und individuelle Betreuung und Unterstützung der Betroffenen durch das Pflegepersonal besonders wichtig sind, um den Genesungs-, und Anpassungsprozesses zu erleichtern, die Unabhängigkeit wieder zu erlangen und das Wohlbefinden zu verbessern. Schlussfolgerung: Die operative Anlage eines Enterostomas verändert das gesamte Leben der Betroffenen. Um das tägliche Leben und den Anpassungsprozess zu bewältigen, bietet der gehobene Dienst der Gesundheits- und Krankenpflege umfassende Beratung und Edukation an. Diese Angebote richten sich hauptsächlich an die physischen Aspekte der Betroffenen, die emotionale und soziale Ebene wird häufig vernachlässigt. Um den Anpassungs-, und Genesungsprozess zu erleichtern und, das allgemeine Wohlbefinden zu fördern, damit sich Betroffene ausreichend verstanden und akzeptiert fühlen, muss jede Patientin, jeder Patient als Individuum betrachtet werden. Introduction: The surgical creation of a stoma significantly changes the life of those affected, as they are often confronted with additional physical and psychosocial burdens. Patients will require comrehensive advice, training, education and individual support from a mulit-professional team to adapt to life with a stoma and recover from it. The nursing staff plays a central role in the care and nursing of ostomy bearers both preoperatively and postoperatively. Methods: Between November 2019 and March 2020 a comprehensive literature search in the electronic databases of Cochrane Library, PubMed, CINHAL and Sience Direct took place within the framework of this thesis. The scientifically relevant literature was narrowed down by the use of filter methods and by inclusion an exclusion criteria. The entire literature search was presented in a flow chart an the central results were described both in tabular an descriptive form. Subsequently, the results were summarized in an synthesis an finaly discussed. Results: On the basis oft he literature search, a total of fourteen studies could be included in the work. Seven of these studies investigated the psychosocial stress in the areas of work, everyday and leisure activities, sports, nutrition, familiy, body image, sexuality and adaption. Seven oft the studies found, investigated and evaluated possible nursing interventions. The results showed that comprehensive and individual care and support of the affected persons by the nursing personal is particulary imtportant in order to facilitate the recovery and adaption process, to regain independence and to improve well-being. Conclusions: The surgical creation of an stoma changes the whole life of the affected person. In order to cope with daily life an process of adaptation, the higher service of health and nursing care offers comprehensive counselling and education. However, these offers are mainly directed at the physical aspects of the persons concerned, the emotional and social level is often neglected. In order to facilitate the process of adaption and recovery, to promote the general well-being of those affected and to make them feel sufficiently understood and accapted, each patient must be considered as an individual. The individual needs of those affected should determine the range of care available. Both physical and psychosocial effects of the stoma must be considered.

Hintergrund: Diese Arbeit beschäftigt sich mit der Pflege von Menschen mit einer Enterostomie oder Urostomie. Für die professionelle Gesundheits- und Krankenpflege ist es wichtig, pflegerische Tätigkeiten, Interventionen, Programme oder Schulungen zu erarbeiten, um das Selbstmanagement und die Lebensqualität von betroffenen Patientinnen und Patienten zu fördern. Nur so kann das Pflegepersonal diesem Personenkreis die passende Betreuung bieten. Ziel: Ziel dieser Bachelorarbeit ist das Eruieren von Faktoren, welche eine Auswirkung auf die Lebensqualität von Menschen mit einem Enterostoma oder Urostoma haben. Weiters sollen durch diese Arbeit Maßnahmen, Interventionen oder Schulungen erarbeitet werden, welche die professionelle Gesundheits- und Krankenpflege durchführen kann, um das Selbstmanagement und die Lebensqualität zu steigern. Methodik: Es wurde eine systematische Literaturrecherche in verschiedensten Datenbanken durchgeführt. Die Studien wurden anhand des Bewertungsbogens von Brandenburg, Panfil und Mayer auf ihre Qualität geprüft. Ergebnisse: Telefon-Follow-ups, transtheoretisch modellbasierte Interventionen, Schulungen, Stoma-Care-Teams, geplante Gruppeninteraktionen, Patientenschulungen/Patientenausbildungen oder Stoma-Care-Nurses wirken sich positiv auf Menschen mit einem Stoma aus. Schlussfolgerung: Die Zusammenführung der Ergebnisse der Studien zeigt, dass bereits einige Maßnahmen, Interventionen oder Schulungen zur Förderung des Selbstmanagements und zur Verbesserung der Lebensqualität mit der Unterstützung der professionellen Gesundheits- und Krankenpflege erforscht wurden. Objectives: This thesis deals with the care of people with an enterostomy or urostomy. For professional health care and nursing it is important to develop nursing activities, interventions, programs or training courses in order to encourage the self-management and quality of life of affected patients. This is the only way the nursing staff can offer the appropriate care to this specific group of people. Aim: The aim of this bachelor thesis is to determine factors that have an impact on the quality of life of people with an enterostomy or urostomy. Furthermore, this work is intended to develop measures, interventions or training courses that professional health care and nursing can carry out in order to improve self-management and quality of life. Methods: A systematic literature research was carried out in various databases. The quality of the studies was checked by using the Brandenburg, Panfil and Mayer evaluation sheet. Results: Telephone-follow-ups, trans-theoretical model-based interventions, trainings, stoma-care teams, planned group interactions, patient training or stoma-care-nurses have a positive effect on people with a stoma. Conclusion: The pooling of the results of the studies shows, that some measures, interventions or training courses to encourage self-management and to improve the quality of life have already been researched with the support of professional health care and nursing.

After formation of a permanent terminal stoma by enterostomy, parastomal hernia (PSH) occurs in up to 80% of cases and leads to a wide variety of symptoms and complications with a high rate of emergency operations due to incarceration (ca. 15%). Consequently, greater consideration should be given to PSH prevention even as early as the time of enterostomy and generously applied indications for elective repair of manifest PSH. The aim of this article is to summarize and evaluate the current evidence for PSH repair and prevention. Poor postoperative results after attempted repair of manifest PSH with slit meshes in different layers of the abdominal wall shift the focus onto stoma lateralization (sandwich and Sugarbaker techniques) or 3‑dimensional tunnel-shaped implants with meshes to cover the stomal edges. To date, the best strategy for PSH prevention has still not been defined and techniques with slit meshes show different results. Nevertheless, 10 prospective randomized trials, meta-analyses, a Cochrane review and guidelines from the European Hernia Society (EHS) about various slit-mesh devices in sublay, onlay and intraperitoneal positions confirmed significantly reduced rates of PSH after mesh augmentation compared to conventionally sutured enterostomy without morbidity associated with the implanted material. Despite the positive data situation PSH prevention is seldom performed in daily practice, which is due to uncertainty surrounding the most suitable surgical strategy, the necessity to spend additional time at the end of a demanding operation, the aversion to implanting meshes into a contaminated operative field and the lack of remuneration of preventive surgical procedures. Future trials should, therefore, no longer compare standard enterostomy techniques with one prevention method in general but should have a new focus on techniques providing adequate results in PSH repair (Sugarbaker, sandwich and 3‑D tunnel meshes), probe the advantages and evaluate the differences in outcome between these strategies.

Hintergrund Da Darmkrebs an erster Stelle der Ursachen eines Enterostoma steht und ein drastischer Eingriff dieser Art das eigene Selbstbild der Betroffenen stark verändern kann, werden in der vorliegenden Arbeit die Auswirkungen des Enterostoma auf die Akzeptanz des eigenen Körperbildes, bearbeitet. Ziel Ziel der Arbeit ist es, auf die Körperbildveränderungen und die damit verbundenen psychosomatischen Folgen und die verändernde Lebensqualität des kranken Menschen aufmerksam zu machen. Methode Bei der vorliegenden Arbeit handelt es sich um eine Literaturarecherche, die in Online- Datenbanken wie PubMed, Wiley und Google Scholar stattgefunden hat. Ergebnisse Als eines der zentralen Ergebnisse dieser Literaturrecherche ist hervorzuheben, dass die Akzeptanz des Enterostomas in direkter Verbindung mit dem eigenem Körperbild steht. Erst wenn der Betroffene seine verloren gegangene Autonomie wiedererlangt und sein neues Ich akzeptiert, können höhere Gefühle des Vertrauens in sich selbst und das wiedererlangen von Kontrolle beobachtet werden. Schlussfolgerung Die gewonnenen Erkenntnisse bezüglich Autonomie und Selbstwirksamkeit sollte verdeutlichen, dass die Kernkompetenz der Pflegenden darin besteht das Ausbildungsniveau der Patienten*innen zu erhöhen, damit sie trotz der Hindernisse in ihrem täglichen Leben nicht auf ein aktives Leben, Arbeit und Unterhaltung verzichten müssen um sich weiterhin an ihrem Leben erfreuen können. Background Since intestinal cancer is the primary cause of enterostoma and a drastic intervention of this kind can greatly change the self-image of the affected person, the effects of enterostoma on the acceptance of one's own body image are dealt with in this paper. Goal The aim of the work is to draw attention to the changes in body image and the associated psychosomatic consequences and the changing quality of life of the sick person. Method The present work is a literary research that has taken place in online databases such as PubMed, Wiley and Google Scholar. Results One of the central findings of this literature research is that the acceptance of the enterostoma is directly linked to one's own body image. Only when the affected person regains his lost autonomy and accepts his new self can higher feelings of trust in himself and the regaining of control be observed. Conclusion The knowledge gained about autonomy and self-efficacy should make it clear that the core competence of carers is to increase the level of education of patients* so that they do not have to do without active life, work and entertainment despite the obstacles in their daily lives in order to continue to enjoy their lives.

Complications following the creation of permanent intestinal ostomies are common and lead to serious problems in the stoma care of affected patients. The aim of this prospective, single-centre follow-up study was to record the rate of late complications in our own patient group and to identify potential risk factors.All patients who received a permanent intestinal ostomy in our clinic within the period 2006 - 2016 were included in the study. 50 patients gave their informed consent and participated in our follow-up (14 female [28%], 36 male [72%]). The analysis of stoma-associated complications was performed by review of medical records and a systematic follow-up (standardised questionnaire, clinical examination, and ultrasound of the abdominal wall).Indications included malignancy (n = 27; 54%), anastomotic leakage (n = 10; 20%), acute diverticulitis (n = 7; 14%), IBD (n = 5; 10%) and rarer indications. The top 3 late complications were peristomal skin irritation (n = 25, 50%), parastomal hernia (n = 14; 28%) and prolapse (n = 9; 18%). Acute diverticulitis resulted in increased stomal retraction (p = 0.012). Double-barreled stomata were associated with increased herniation rates (p = 0.044) and prolapse (p = 0.047). Ileostomies were associated with peristomal skin irritation (p = 0.021). Age, sex or emergency stoma creation did not constitute independent risk factors for the development of late complications in our group of patients.Professional pre- and postoperative stoma therapy and care includes preoperative marking of a stoma site and structured stoma-specific follow-up by stoma therapists, surgeons and general practitioners, as well as stringent and early treatment of structural complications. This can prevent and mitigate late complications of permanent intestinal stomata. Interestingly, stoma placement was not an independent risk factor for late complications in an emergency situation.EINFüHRUNG: Komplikationen nach Anlage permanenter intestinaler Stomata sind häufig und führen zu gravierenden Problemen in der Stomaversorgung betroffener Patienten. Ziel dieser prospektiven, unizentrischen Nachbeobachtungsstudie war es, Spätkomplikationen im eigenen Patientenkollektiv zu erfassen und potenzielle Risikofaktoren herauszuarbeiten.Sämtliche Patienten unserer Klinik mit einer permanenten intestinalen Stomaanlage im Zeitraum 2006 – 2016 wurden in die Studie eingeschlossen. 50 Patienten haben einer Nachuntersuchung zugestimmt (14 weiblich [28%], 36 männlich [72%]). Es erfolgte die Analyse stomaassoziierter Komplikationen im Rahmen einer systematischen Nachuntersuchung (standardisierter Fragebogen, klinische Untersuchung, Sonografie Bauchdecke).Das Indikationsspektrum beinhaltete Malignome (n = 27; 54%), Anastomoseninsuffizienzen (n = 10; 20%), akute Divertikulitiden (n = 7; 14%), chronisch entzündliche Darmerkrankungen (n = 5; 10%) sowie seltenere Indikationen. Die 3 häufigsten Spätkomplikationen waren peristomale Hautirritation (n = 25; 50%), parastomale Hernie (n = 14; 28%) und Stomaprolaps (n = 9; 18%). Akute Divertikulitiden führten zu vermehrten Stomaretraktionen (p = 0,012). Doppelläufige Stomata wiesen vermehrt Hernien (p = 0,044) und Prolabierungen (p = 0,047) auf. Ileostomata sind bezüglich peristomaler Hautirritationen problematisch (p = 0,021). Patientenalter, Geschlecht oder eine Stomaanlage im Rahmen einer Notfalloperation stellten in unserem Kollektiv keine unabhängigen Risikofaktoren für das Auftreten von Spätkomplikationen dar.Die professionelle prä- und postoperative Stomatherapie/-pflege inklusive präoperativer Stomamarkierung und strukturierter stomaspezifischer Nachsorge durch Stomatherapeuten und Chirurgen sowie Hausärzte, ebenso wie eine stringente und zeitnahe Behandlung struktureller Komplikationen, können Spätkomplikationen permanenter intestinaler Stomata vorbeugen und mildern. Interessanterweise war die Stomaanlage im Rahmen einer Notfalloperation kein unabhängiger Risikofaktor für das Auftreten von Spätkomplikationen.

The impact of surgery in the treatment of inflammatory bowel disease (IBD) is considered as secondary whereas conservative treatment remains the first choice. Surgery is designated for a complicated or refractory disease course. Furthermore, there seems to be prophylactic aspects as well, such as ileocecal resection in Crohn's disease and prophylactic restorative coloproctectomy for intraepithelial neoplasia associated with ulcerative colitis.This review evaluates the impact of surgery in the treatment of Crohn's disease and ulcerative colitis in view of existing data in the literature.The results in the literature are reviewed and retrospective data from this institution are presented.The manifestation of Crohn's disease is mainly ileocecal, colorectal, enteric and anorectal. The role of surgery is discussed according to the localization, extent of the disease and the clinical course. The emphasis is on longstanding Crohn's proctitis with fistulas and stenosis which are still challenging. The results indicate that intersphincteric rectal resection with pull through of the rectum and hand-sewn anastomosis represents a good option in up to 67 % of cases to avoid permanent stoma in highly selected patients. In addition, this procedure provides high rates of fistula healing as well as low recurrence rate of the anorectal stenosis. Pouch surgery in ulcerative colitis can be offered in high volume centers with low morbidity and functional results remain stable over time. Postoperative quality of life seems to be good with regard to general and disease-related quality of life.Interdisciplinary approaches should increasingly focus on prophylactic aspects of surgical options while conservative treatment will be enhanced by new therapeutic agents.

After stoma formation, parastomal hernia develops in 30-50% of patients, with one-third of these require operative correction. Recurrence rates are very high after suture repair of parastomal hernias or relocation of the stoma. Open or laparoscopic mesh repairs have resulted in much lower recurrence rates. Long-term follow-up of the various techniques for parastomal hernia repair is lacking, as are randomized trials. A prophylactic prosthetic mesh placed in a sublay position at the index operation has reduced the rate of parastomal hernia in randomized trials. A prophylactic mesh in an onlay position, a sublay position, and an intraperitoneal onlay position has also been associated with low herniation rates in non-randomized studies. Although several questions within this field still have to be answered, it seems obvious that use of a mesh represents a suitable measure for the prevention of parastomal hernia as well as parastomal hernia repair.

Creation of a stoma is related with up to 50% complications. Two main causes are recognised: stomacare and positioning of the stoma. During the first few weeks the diameter of the stoma may shrink by 1/3. In this phase without the professional aid by a stomatherapist the risk of skin problems increases with time. Late complications as prolapse, parastomal hernia and stenosis are often the result of a too lateral positioning of the stoma or of early complications as necrosis, dehiscence, retraction and parastomal abscess. If conservative treatment does not solve the problem surgical procedures are warranted. Beside local corrections replacement of the stoma may be needed. However this is a major operation. Therefore, replacement should be the last option to resolve stoma complications.

The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

In our division, highly qualified enterostomal therapists treat approximately 300 patients each year Patient care consists of extensive preoperative information, localization of the ideal stoma position and providing patient-education in stoma handling. A regular ambulatory consultation allows early recognition of typical stoma related complications and their effective treatment in a timely manner. Another important issue of our consulting service includes patients concerns, such as social integration and physical independence. The creation of a specialized center provides an efficient and continuous care of enterostomy patients and their relatives. Thus, initial fears and emotional crisis can be addressed and minimalized. It is our goal to provide individual and comprehensive service in order to accommodate our patients needs.

In addition to psychological stress, stomas may lead to metabolic consequences. Colostomies normally cause only minor physiological problems; however, patients with ileostomies are at risk for severe metabolic disturbances. The small intestine essentially manages the balance of water and electrolytes and the absorption of nutrition. In special circumstances such as or short-bowel syndrome, dangerous consequences like kidney disorders may arise. Basic therapeutic strategies such as enteral or parenteral substitution are discussed.

After formation of a stoma patients quality of life can be compromised. This includes body image, capacity to work, leisure time and sexual activity. After leaving the hospital it is essential, that stoma patients are supported by professionals on the long run. This can be achieved by a network of stoma-care nurses, social workers and psychology professionals.

If the sole aim of an operation is to empty the bowel, we are presented with an indication for laparoskopic enterostomy. This intervention is technically simple, safe and may be performed with little or no complications. In comparison to the conventional technique, laparosopy offers important advantages concerning the patients' postoperative comfort. Laparoscopic stoma creation is recommended in current literature as an alternative to the conventional procedure.

The aim of the study is to analyse the benefits and risks of PEE in patients, cared for by a team with many years experience.From 16. 2. 1988 until 31. 12. 1993 246 PEEs (229 gastrostomies, 6 duodenostomies, 7 jejunostomies, 4 attempts) were performed on 234 patients (56% male, 44% female, mean age 68.3 years). 117 patients had tumorous and 117 neurological diseases. We used the pull technique with the Fresenius Freka PEG-system. Analysis was performed using a standardised documentation sheet which was filled out until the end of tube feeding. In total, we registered 39,678 days of tube feeding, 4513 of which were in hospitalized patients.The mean intubation time was 192.6 days (maximum 1496). In 8 cases, the tube could be explanted before the patient was discharged; 68 patients were discharged to a nursing home and 71 patients were allowed to go home. The tube-independent hospital lethality was 36.64%. A PEE-specific lethality had not been registered. Complications arose in a total of 37 patients (15.04%), 4 of which were severe (1.63%) Fifty-nine patients (25.43%) reported short-term feelings of ill health (vomiting, diarrhoea, pain).PEE is an effective and low-risk method of long-term nutrition. The advantages are simple insertion, safe handling by patients and relatives/nursing staff and the low cost.

Complete correction of malformations in the first hour or days of life has always been the target of pediatric surgeons. The possible halt of palliative operations involving the application of stomata in the trachea, esophagus, stomach, bowels and at the diverting urinary tract is to lighten the situation for parents and neonatologists. Requirements for a definitive primary surgical correction are an accurate diagnosis and careful selection of the child. Criteria include not only age and bodyweight, but also the presence of co-existing malformations, diseases and complications. Thus it is also possible to correct complex malformations primarily in one operation and to withdraw the use of stomata.

An 83-year-old woman, largely bedridden since a stroke 2 years before, was hospitalized because of upper abdominal pain, nausea and obstipation. She had regularly been taking laxatives of the anthraquinone type. She had a fever of 38.6 degrees C and leukocytosis (14,900/microliters). Radiological examination revealed volvulus of the sigmoid colon with ileus. As she vehemently refused an operation, it was attempted to reduce the volvulus endoscopically. At the first coloscopy the volvulus was untwisted. At that time there were already areas of necrosis in the rectosigmoid and descending sigmoid portions. As the volvulus recurred three days later, another coloscopic derotation was performed, this time with fixation of the sigmoid by three gastrostomy tubes for 20 days. The further course was uncomplicated, the patient had regular bowel movements and became free of fever and symptoms. The white cell count returned to normal and the intestinal mucosa healed histologically without scarring. There has been no recurrence for 10 months. The conventional treatment of volvulus of the sigmoid is decompression followed by sigmoid resection. This case describes for the first time the nonoperative treatment by percutaneous endoscopic colopexy.

121 patients with acute necrotizing pancreatitis were treated according to a surgical regimen of necrosectomy, drainage by laparostomies and repeated revisions. Changing the protocol from revisions on demand to scheduled reexplorations resulted in an improvement of mortality from 53% to 28%. The high incidence of gastrointestinal fistulas (30%) associated with this regimen could be decreased to 5% by a more individual protocol with longer intervals of revisions in the later course. Mortality was 21% following this regimen.

During a period of 25 months 11 newborns treated at the children's university hospital of Münster (0.8%) underwent laparotomy for necrotizing enterocolitis (NEC). The cases appeared sporadically without forming "clusters" typical of infectious etiology. 10 of 11 cases were premature infants (median birth weight 1280 g) stressing the predisposing role of immaturity. Ischemic events occurred in all patients prior to the onset of symptoms. The introduction of surfactant-therapy during the study period did not influence the incidence apparently. Ultrasonography was superior to radiology with regard to detection of extraluminal gas. We differentiated two types of clinical courses (3 acute and 8 protracted). In 5 cases we noticed a relapse of clinical symptoms after uptake of oral feeding. 3 newborns died with septic shock. The median hospitalisation time was 88.5 days in the 8 survivors. Enterostomy was replaced by definite anastomosis after 67.5 days (median). Median daily weight gain was 16.6 g. Late complications like permanent stenoses of short bowel syndrome were not observed. Early surgical intervention according to the general rules of abdominal surgery seems important even in very low birth weight infants.

In intestinal anomalies, preventive surgical procedures include gastrostomies and enterostomies as well as some special operations such as ligature of the cardia and associated appendectomies. General indications for enterostomies are seen in life-threatening circumstances, i.e. prematurity, surfactant deficiency, major associated malformations and complications. Preventive surgical procedures are necessary in certain cases of esophageal atresia, complicated small bowel atresia, meconium ileus, anorectal malformations, Hirschsprung disease, neuronal intestinal dysplasia and necrotizing enterocolitis. Prophylactic surgery requires detailed knowledge of the definitive therapeutic procedure.

During the last decade the industry has developed material to improve the quality of life of patients with an enterostomy. Patients are better informed and prepared before operation. Postoperative advising by professional nurses help the patient to maintain an odorless, leak-proof and continent stoma. Most of the patients today with enterostomies are able to have a socially integrated life with minimal psychological and physical handicaps.