Efficacy of a light convex appliance and mouldable ring in an early postoperative stoma with effluent leakage

Abstract

Aim: This study aimed to analyse the impact of using both a light convex appliance and mouldable ring in the early postoperative period on leakage frequency, peristomal skin health and quality of life after discharge. Methods: This prospective non-randomised study was performed in patients with a digestive stoma experiencing effluent leakage during the early postoperative period. Evaluation was performed at baseline (V1) during admission and at 2–3 weeks after discharge (V2). The outcomes measurements were: number of leaks per day; satisfaction (0 to 10 VAS scale); DET score evaluating discolouration (D); erosion/ulceration (E) and tissue overgrowth (T); stoma morphology and NANDA International nursing diagnosis, which measures anxiety, fear and image deterioration as well as insomnia. NANDA International diagnosis were evaluated as a percentage of cases with the diagnosis and categorically according to several dimension scores. Signed rank, McNemar, chi-squared and Bowker's tests were used for comparison. Results: Of 257 patients screened, 244 completed the study. The mean number of leak episodes using the light convex appliance and mouldable ring in the early postoperative period decreased from 3.4±5.2 (V1) to 1.3±2.3 (V2) (p<0.0001). Mean discolouration, erosion and tissue overgrowth (DET) score decreased from 3.3±3.3 (V1) to 1.6±2.3 (V2) (p<0.0001). Mean self-reported satisfaction with the appliance increased from 5.1±2 (V1) to 7.2±1.7 (V2) (p<0.0001). The proportion of patients with a retracted peristomal area changed from 27.9% to 21.7%, while that of patients with protruded stoma increased from 32.9% to 40% (p=0.025). Regarding NANDA International diagnosis, anxiety reduced from 36.5% to 9.5% (p<0.0001), fear from 40.6% to 4.9% (p<0.0001), image deterioration from 19.2% to 10.9% (p=0.002) and insomnia from 39.3% to 2.5% (p<0.0001). All the categorical dimensions evaluated for each NANDA International diagnosis improved (p<0.0001). Conclusion: Patients with an ostomy and effluent leakage in the early postoperative period clearly benefited from the use of both a light convex appliance and mouldable ring. This approach had a positive impact on number of leakages per day, peristomal skin status and patient satisfaction, as well as meeting several NANDA International nursing diagnosis criteria.