Insights – Page 4 – Fistula Solution

Nurse Discount for Abdominal Wall Reconstruction Conference

Discounted registration is available for nurses who want to attend the upcoming Abdominal Wall Reconstruction Conference. Nurses can use the special promo code AWRN20 to receive $100 off registration fees.

MedStar Georgetown University Hospital’s 12th Annual Abdominal Wall Reconstruction (AWR) Conference is a comprehensive symposium providing an in-depth understanding of the complexity of AWR and repair techniques. Education includes abdominal wound management and alternative resources in abdominal wall reconstruction. This is a unique opportunity for attendees to network with colleagues in their field and interact with expert faculty. The agenda includes:

Live lectures, presentations, panel discussions and interactive Q&A sessions
Poster abstract authors’ session
Multiple symposia
Gloves-on cadaver workshop

The 2020 conference will be June 4-6 at the Mandarin Oriental in Washington D.C. Visit the AWR website to see the full conference agenda.

Hernia Surgery Summit in March

Columbia Comprehensive Hernia Center's 11th Annual Hernia Surgery Summit is focused on reconstruction of abdominal wall defects, which remains one of the most challenging dilemmas facing surgeons. Even though ventral hernia repair remains one of the most common procedures performed, there is little consensus as to the best surgical technique, prosthetic material of choice, or strategies to repair complex defects.

Learning objectives include:

Minimally Invasive Hernia Repairs
Robotic Hernia Repairs
Complex open abdominal wall reconstruction techniques
- Open (traditional) component separation
- Laparoscopic and periumbilical sparing component separation
- Posterior component separation and transversus abdominis release (TAR)
- Laparoscopic and Robotic Totally Extraperitoneal Retromuscular Repairs
Para-stomal and other difficult hernia repairs
Reconstructions in setting infection, contamination, enterocutaneous fistulas, loss of abdominal domain
Umbilical and inguinal hernia repairs
Comprehensive review of groin repairs and groin pain management
Plastic surgery considerations for difficult soft tissue scenarios

The 2020 conference will be March 5-7 at the The Cliff Lodge in Snowbird, Utah. Visit the Hernia Surgery Summit website to see the full conference agenda.

Advanced Fistula Concepts at the Abdominal Wall Reconstruction Conference

The Advanced Concepts session at the upcoming Abdominal Wall Reconstruction Conference includes soft tissue and hernia repair topics and a pair of exciting enteric fistula presentations. Mary Anne Obst, WOCN and Complex Abdomen Specialist at Regions Hospital, will present "EC Fistulas, Stomas, & Complex Wounds: A Nursing Perspective". Mary Anne will be followed by Eric Pauli, MD from Penn State Health Milton S. Hershey Medical Center who will present "Surgical Management of the EC Fistula Patient".

The Advanced Concepts session will conclude with a panel discussion including best practices in fistula management.

The 2020 Abdominal Wall Reconstruction conference will be June 4-6 at the Mandarin Oriental in Washington D.C. Visit the AWR website to see the full conference agenda.

Fistula Management Team at SAWC Spring 2020

It takes a village to care for fistula patients.

Experience a multidisciplinary team approach to fistula management at SAWC Spring.

Mary Anne Obst and Kristen Lindvall from the Complex Abdominal Reconstruction (CARS) team at Regions Hospital will present Team Management of Enteroatmospheric Fistulas. They will share the CARS methodology for fistula patient care during the 6 to 18 month wait time before definitive surgical treatment. They will cover wound care, nutritional support, psychosocial counsel, medical management, and surgical planning.

Belted Pouching with Fistula Solution Devices

A high-output enterocutaneous fistula or ostomy may produce two to seven liters of effluent per day which can be devastating to the skin and can cause pain, infection and emotional isolation.

Using a belted ostomy pouch with Fistula Solution devices can be a good effluent management option, particularly when:

The perifistula topography of a patients body, creases, or scars make adhesive pouching difficult, or
Ostomy pouches will not adhere to excoriated and weeping peristomal skin.

In these cases intestinal effluent can cause further irritation and wound formation of perifistula skin. To seal and protect the skin from effluent, Fistula Solution devices can be compressed around the patient’s enteric fistula or ostomy with a belted pouching system.

The following "how-to" steps illustrate the use of the Fistula Funnel in these challenging situations.

1. Tailor the Fistula Funnel by cutting along the exterior scribe line to form a skirt. The skirt will help form a good seal around the fistula or ostomy and protect the surrounding skin from effluent.

2. Check the fit of the tailored Fistula Funnel to ensure it will seal when compressed to the surface of the body.

The visible portion of the compression area is indicated by the yellow shape.

3. Center fistula or stoma in opening and compress the device. The fistula or stoma should be visible through the device opening after placement on the patient.

4. Apply a belted ostomy pouch appliance to compress the device to seal and protect skin and capture intestinal effluent.

This technique can be used to protect the skin from effluent and enable healing when other methods may not work and can dramatically improve quality of life for the patient.

High-output Fistula and Ostomy Effluent Containment

Managing effluent from a high-output fistula or ostomy can be a challenge. Even large, high-output pouches can prove insufficient when a patient puts out 5 to 10 (or more) liters of effluent daily.

Pictured is a technique for managing high volumes of effluent. A container is connected to the pouch using large bore corrugated tubing. Then, as prescribed by the provider, intermittent wall suction is applied to the container to draw effluent out of the pouch.

1. Connect and seal a suction tube near the top of a 3000 ml or other large container. Do not extend the tube more than 3 inches / 6 cm inside the container. Connect the free end of the tube to wall suction.

2. Connect and seal corrugated tubing to the top of the container. Ensure tubing is long enough to reach from the floor to the patient's pouch.

3. Fasten the top to the container and place the container on the floor near the patient.

Note that the container inlets for corrugated tubing and wall suction are spaced apart. This is so the effluent that is drawn into the container will drop to the bottom of the container and not be drawn into wall suction.

4. Connect and seal the free end of the corrugated tubing to the pouch drain.

As indicated by the healthcare provider, apply intermittent wall suction to draw excess effluent out of the pouch and through the corrugated tubing into the container.

This technique tip can help eliminate pouch clogs and effluent overfilling that can result in pouch adhesion failure and spills

The fill level of the large container should be monitored and the container can be emptied as needed. When a patient needs to move the suction tube can be disconnected from the wall so the patient can take the container with them.

Sanford Wound & Ostomy Care Conference: Advance Wound Care

Sanford Health's biennial Wound & Ostomy Care Conference is December 6, 2019 in Fargo, North Dakota. The purpose of the symposium is to increase the knowledge and competence of health care professionals related to evidence-based wound prevention and treatment, and ostomy management. The target audience includes nurses, advanced practice providers, physicians, and other interested health care professionals.

Mary Anne Obst, Complex Abdomen Specialist at Regions Hospital in St. Paul, Minnesota will present on ostomy containment and fistula and wound management while preserving peri-wound skin. She will also present a team approach to managing complex abdominal wounds and fistulas.

Click here for more information.

Virtual Grand Round – Entero-cutaneous and entero-atmospheric fistulas: Have we had a paradigm shift in management?

The American Association for the Surgery of Trauma is hosting the virtual grand round: Entero-cutaneous and entero-atmospheric fistulas: Have we had a paradigm shift in management? The live broadcast is November 20, 2019 at 5:00 PM Eastern.

Dr. Richard Miller, Chief, Division of Trauma and Surgical Critical Care at Vanderbilt Medical Center will be presenting.

Click here for more information.

SAWC Fall 2019: Ask a Surgeon about Fistula and Ostomy Management

Ever wish you could ask a surgeon a question about a fistula or ostomy? Here is your chance! For example, why is this stoma flat? Can you help with this sidewall fistula? Why do we need to wait so long to repair a fistula?

Send your questions or cases for Dr. David Dries’ perspective on solutions. Selected questions and cases will be reviewed during the “Ask a Surgeon” portion of Session 13 - Fistula and Ostomy Management for the Wound Provider at the SAWC Fall conference on October 12th.

Help Fistula Patients Reduce Their Surgery Risk with the CeDAR App

Download the free CeDAR app to facilitate conversations with patients about their fistula repair surgery risk profile. The app is available in the App Store or Google Play.

Users simply answer eight questions about themselves, including height and weight. A percentage chance of developing specific postoperative complications requiring treatment is calculated, along with the corresponding cost of this treatment. These results can then be used to discuss a patient’s risk for wound problems after surgery and what changes they can make to improve the odds for a good result.

Wound problems after surgery are the major reason for increased cost of surgery, including the added cost of other procedures, hospital stays and clinic visits. Because of their wounds, these patients often are not able to work and lose time and money because of specialty wound care, travel, clinic visits and/or hospital stays. The app predicts the risks and financial impact of wound-related problems using a mathematical equation derived from real patient data. Helping patients understand their risks can facilitate a deeper conversation about behavioral changes that will reduce the risk of wound problems.