Colostomy - what is it?

There are two types of colostomies on the surface of the abdominal wall: flat and protruding colostomies. In a shallow colostomy, the intestine is exposed to the skin wound through the retroperitoneal space and sutured to the parietal peritoneum and aponeurosis, leaving it almost flush with the skin surface. If the colostomy survives, the edges of the intestine are pulled out by 2-3 cm and sutured to the aponeurosis, peritoneum and skin. The colostomy technique is a laparotomy procedure.

Coronal inlay

An incisal inlay is a microprosthesis that is a core structure made of metal, ceramic or zirconium dioxide. It is used when the crown of the tooth and the preserved root are severely damaged. The prosthesis fills the gap and forms a support onto which the artificial crown is placed. Before inserting an inlay, the tooth must always be ground down.

Dental inlays are one of the reliable prosthetic techniques. If the root canal is well sealed and high-quality materials (e.g. gold) are chosen, it can last up to 15-20 years.

Mitino Dental Center offers a consultation with a qualified orthopedic dentist who can perform any type of dental restoration.

When a core renovation is indicated

If a tooth is damaged to 70 % or more, a restoration with filling material using a post is no longer justified - such a restoration can no longer bear the load. There is a risk that the root itself will break. This leads to extraction of the tooth and therefore more complex prosthetic work. So if practically only the root is left, the best solution is an endodontic post. However, the edge of the tooth must protrude above the gum to which the post can be securely attached, otherwise an artificial core is not possible.

Important! Crown inlays can only be used in conjunction with a healthy root.

An inlay is also used when a tooth is prepared as a support for a bridge or splint structure - this increases their reliability.

This method can also be used for pathological tooth wear and anomalies of the anterior teeth in adults that cannot be corrected by orthodontic techniques.

What is that?

A crown and root inlay is used to replace a completely or significantly damaged tooth. It is a high-quality alternative to traditional dentures. If the tooth is severely damaged, a partial crown restoration is necessary, in which an artificial crown is placed on the tooth. Inexperienced specialists use a metal post and filling, which will soon fall out. This situation does not arise with crown inlays.

The post consists of two parts: the crown, which resembles a tooth stump, and the root, a metal post that anchors the post in the root canal. Inserting the pen takes just a few steps and ensures a secure hold on the object.

Read more: Zirconia or metal-ceramic: advantages and disadvantages of zirconium oxide crowns, before and after photos of teeth

After the post is fitted, the pressure exerted on the tooth is evenly distributed over the entire tooth surface. The post is secured with a special dental cement that ensures that the attachment conforms as closely as possible to the rest of the tooth and prevents breakage or further decay. The photo shows an illustration of crown inlays.

Different types of inlays

There are different types of dental inlays. Depending on how they are made, they are either cast (one-piece) or folded. The doctor must only decide which model to use after a thorough examination of the patient's mouth in order to rule out possible contraindications.

Pour

When producing a cast sole, the product is exposed to high temperatures and pressure in a casting process. The structure consists of a core part called the acetabulum and posts used to fuse the post to the root canal. Solid core pins are characterized by their high strength, which gives them a long service life.

Removable

Split stumps are used when the root has 3 or 4 canals. In some cases, the posts are removable because the root canal is not freely accessible. Such inlays are practically indistinguishable from full inlays. The split orthodontic product adapts optimally to the shape of the restored tooth. Because this type of nuclear reconstruction cannot be removed once inserted, it is guaranteed for life.

Indications for the operation

The specific indication for resection depends on the region in which the abnormality is present, the histologic diagnosis, and the extent of damage. The following are considered absolute indications for surgical intervention:

• Oncology. In this case, resection is the only viable option. The cancerous tumor is located in any part of the stomach. If the antral part is affected, a distal resection is indicated; if the cardiac (or subcardiac) part is affected, a proximal resection is indicated. The human stomach has an extensive network of lymphatic vessels. This contributes to the rapid spread of tumor metastases in the wall, peritoneum and lymph nodes. For this reason, a radical approach is preferred in oncology and subtotal resection is most often performed.
• Presence of chronic ulcers. Organic lesions such as peptic ulcer disease (when the disease is caused by abnormalities in the gastrointestinal tract) are an indication for resection. This is because the ulcer process spreads to nearby organs, which can lead to perforation with bleeding. Surgical intervention is also indicated for long-lasting, non-healing processes in elderly patients.
• Diagnosis of decompensated pyloric stenosis. Although there are many plastic surgeries to correct this problem, additional resection is also indicated.

Relative indications for surgery:

• Presence of protracted peptic ulcer disease when progressive therapy over 2-3 months is unsuccessful.
• Benign tumors (multiple polyps).
• Presence of compensated or subcompensated pyloric stenosis.
• Severe stage of obesity.

Preparation

The surgeon performs the operation according to a predetermined plan. It is preceded by special procedures aimed at a thorough and comprehensive examination of the patient. The diagnostic procedures that must be carried out in the preparatory phase include the following.

• Urinalysis and blood tests, including coagulation tests.
• Determination of blood group.
• Detection of parathyroid hormones.
• Determination of lipid and fat concentration.
• Checking the functionality of the liver, thyroid and lungs.
• Diagnostics with X-ray contrast media.
• Ultrasound examination of internal organs.
• Esophagogastroduodenoscopy with biopsy.
• X-ray of the chest, duodenum and esophagus.
• Electrocardiogram.
• Consultation of the family doctor.

After a thorough analysis of the results, the doctor decides whether the patient is ready for surgery. Before the operation, the patient is given a cleansing enema and irrigation with a probe is performed.

Read also: Tongue and gastritis: How to recognize the disease in time

Removal of part of the stomach or the entire organ is indicated in emergencies when severe bleeding occurs or perforation of the ulcer is diagnosed.

Preoperative examination

The patient must undergo standard examinations to assess her health and readiness for surgery:

• General blood and urine tests;
• Biochemical blood count;
• coagulation picture;
• blood test for RW and HIV;
• X-RAY;
• ECG;
• Consultations with related specialists as required.

It is necessary to exclude contraindications. Acute inflammatory processes must be treated. In remission, surgery is possible. To rule out cervical abnormalities, the following tests are performed:

• dilated colposcopy;
• Microbiological and cytological smears;
• testing for sexually transmitted diseases (STDs);
• Ultrasound examination, usually transvaginal.

Preparation

Before the operation, the patient undergoes the usual and additional medical examinations, receives the necessary advice and is psychologically prepared.

Uterine amputation is performed under general or regional anesthesia. This procedure is usually performed between the 5th and 14th day of the menstrual cycle. To avoid postoperative complications of amputation, we recommend:

• A colon cleansing diet 3 days before the procedure: avoid bread, fresh vegetables, fat and fried foods. An enema is given the day before surgery. With a vaginal approach, the procedure is repeated twice in the evening and in the morning;
• Last intake of food and water 8 hours.

Types of dental caps

According to the structure, there are two types of structures: folded and cast inlays.

Cast crown inlays are one of the most commonly used restoration methods. It is used for single and double rooted teeth. Monolithic structures are cast (if metal alloys are used) or milled (if zirconium dioxide is used).

Removable constructions are used to treat multi-rooted teeth (with 3-4 canals). Doctors try to use all root canals to ensure the stability of the restoration. The crown post consists of several parts - a die and additional removable posts, each of which is inserted into the root canal. Thanks to this design, it can adapt to the complex shape of multi-rooted teeth.

Which materials are used?
… What materials are used in the production of …

Many different materials are currently used in manufacturing. The choice depends on the dentist's indications, the patient's wishes and the restoration area (front or chewing teeth).

• Metal core inlays (cxc) are constructions made from a cobalt-chromium alloy. They are strong and durable, but not very aesthetic and are therefore recommended for treating cavities in chewing teeth.
• Ceramic These restorations are made from a single ceramic block using a pressing technique. They are characterized by high aesthetics and are ideal for use in the smile area. The biggest and only disadvantage of these products is their fragility.
• Zirconia Zirconia endodontic inlays are considered the best option for both maxillary and anterior teeth. They are very durable and aesthetically pleasing, and their white color does not allow the crown to show through.

Why are crown inlays better than fillings and posts?

Fillings and posts are only suitable if the tooth has sufficient healthy tissue. If only the root or thin walls of the tooth remain, it cannot be restored with an inlay, as this type of restoration does not offer any other quality or reliability.

First, the post can break under stress and damage the tooth root. Root trauma is an immediate indication for extraction; no technique can save the tooth if the root system is damaged.

Second, dentures that sit on large fillings and posts are more likely to fall out some time after restoration. If this is the case, the treatment must be repeated, which entails significant new costs.

Important: Some dentists attempt to cement the lost crown and post. This isn't helpful - the restoration won't hold in place, and inflammation can develop underneath the restoration, leading to tooth decay.

In the case of severe caries, only an inlay in the abutment can provide a high-quality and long-lasting prosthetic result.

Indications and contraindications for crown inlays

Dental inlays are indicated in the following cases:

• an inlay under a crown for a prosthetic restoration;
• Fracture of the coronal part of the tooth;
• caries on the crown;
• abnormalities in the position, shape, or size of the tooth;
• enlargement of the crown; abnormalities in the position, shape, or size of the tooth; low crown;
• Fabrication of a bridge with a core structure to support the tooth;
• The need for splinting.

The strength of the attachment, the quality of workmanship and the durability of the product depend on the condition of the tooth root at the time of insertion of the microorthodontic post. The root must not wobble, must not be curved in the upper third, must have a continuous and well-filled root canal and sufficiently thick walls for prostheses. The use of an abutment structure is not recommended in the following cases:

• Damage to the circumflex ligament;
• apical root resection (temporary relative contraindication) and inflammatory processes in which damage to the gingiva or root tissue may occur;
• bad hygiene;
• incomplete obturation of the canal;
• Level 3 mobility.

In each clinical case, the treating orthopedic surgeon, together with the responsible specialists, makes the decision for an abutment structure, weighing up all the advantages and disadvantages of this care. In case of relative (temporary) contraindications, curative or corrective surgical treatment, as well as replacement of incompetent orthopedic structures, can be carried out before prosthetic care.

decubitus

Pressure ulcers develop at pressure points and where lateral (lateral) forces act on the skin, especially in the presence of moisture. Common sites for pressure and cutting injuries include bony prominences, the edge of the prosthetic socket, and the distal portion of the stump.

The first sign of skin damage is erythema, which may be accompanied by pain, swelling, blistering and ulcers. The skin that comes into contact with the prosthetic socket must be carefully protected and monitored to avoid skin damage and skin infections. Pain is the first symptom. Read more .

Although skin breakdown cannot be completely prevented, some measures can help prevent or delay it:

Stump hygiene (morning and evening): Wash the stump twice daily with a mild soap solution and rinse thoroughly (more often for patients who sweat profusely). The prosthetist can provide special antiperspirants for amputees.

Maintaining a stable body weight: This is the best way to ensure your prosthesis fits properly; even small changes in weight can affect the fit.

Eating a healthy diet and drinking water throughout the day: This helps control weight and maintain healthy skin.

If you notice any signs of skin changes, you should contact your dentist immediately to rule out poor fit as a cause and adjust the prosthesis if necessary. If possible, patients should not wear the prosthesis until it is fitted. If the prosthesis is not the cause of the damage or if proper fit does not resolve the problem, a medical evaluation should be performed.

Skin infections

In normal, healthy skin, bacterial and fungal microorganisms are in balance due to the dry, intact epidermis. However, the stump is encased in a sheath, a type of viscoelastic gel or plastic layer that creates a warm, moist environment that promotes bacterial and fungal growth and infection. The wet skin also tends to crack, allowing bacteria to easily enter the body. The result is the spread of the infection.

Symptoms of infection include soreness, redness of the skin, pimples, ulcers or necrotic areas, and purulent discharge. An unpleasant smell can indicate an infection or poor hygiene. A mild bacterial infection can develop into mucus. Phlegma is an acute bacterial infection of the subcutaneous skin, usually caused by streptococci or staphylococci. Symptoms and signs include pain, hot flashes, and rapidly spreading illness. A skin abscess is a localized collection of pus in the skin that can develop anywhere on the skin. Symptoms and signs of this condition include pain and painful formations. Read on, in such cases patients may experience fever and general malaise.

Any signs of infection should be investigated immediately. Patients should be advised to seek medical attention immediately if the following symptoms occur:

Treatment for a bacterial infection usually involves cleaning the wound and administering topical antibiotics. Sometimes surgical treatment of the wound, oral administration of antibiotics, or both is necessary. As a rule, the prosthesis should not be worn until the skin infection has healed. Erythema may indicate a serious medical problem; in this case, medical diagnosis and therapy is required.

symptoms

While primary gastric cancer often goes undetected in the early stages due to a lack of clear symptoms, recurrent cancer occurs against the background of the postoperative syndrome.

After a surgical procedure, the patient's quality of life is significantly impaired. This is because all basic functions of the stomach are impaired: reservoir, secretory, motor-evacuation and endocrine functions. The patient experiences diarrhea, symptoms of reflux gastritis, and may also develop ulcerative lesions of the stomach stump. A strict diet and the administration of digestive enzyme preparations are required to get the dysfunction under control. Because of the constant discomfort, patients 'overlook' the first signs of a relapse and mistakenly consider them to be postresection syndrome.

Worsening of symptoms against the background of a period of relative calm should be a cause for concern. The main complaints include:

• loss of appetite;
• weight loss;
• epigastric discomfort;
• Nausea;
• Vomit;
• Impaired swallowing;
• dehydration.

General well-being also deteriorates. The ability to work decreases significantly and the affected person becomes weak and tired. the skin becomes pale. These symptoms are a good reason for an unscheduled examination.

diagnosis and treatment

Recurrent gastric stump carcinoma is diagnosed by gastroscopy with endoscopic biopsy. An abdominal ultrasound is necessary to look for possible liver metastases. Computed tomography (CT) is necessary to obtain information about the condition of the other organs of the gastrointestinal tract and regional lymph nodes. The patient will also undergo a general blood test and a biochemical examination.

Treatment is surgical and it is necessary to remove the stomach stump and remove the rest of the organ. Due to the previous removal of the regional lymph nodes, the metastasis of the recurrent cancer can be specific. Therefore, the stump is extirpated by extensive lymphodissection and removal of the spleen and mesentery.

In the case of extensive metastases, palliative interventions can be carried out to relieve the patient, e.g. B. a gastrostomy.

The appropriateness of chemotherapy is decided on a case-by-case basis. In some patients, chemotherapy results in short-term tumor regression, but life expectancy remains virtually unchanged. Chemotherapy may also be prescribed if removal of the stomach stump is not possible.

Radiation therapy is rarely prescribed in the event of a recurrence because the tumor cells may be resistant to radiation therapy. In addition, this treatment can have negative effects on other organs of the gastrointestinal tract.

Nutrition and care

After creating a colostomy, it is important to follow a diet to normalize bowel movements. The diet after colostomy surgery should be varied and balanced, containing all the necessary micronutrients and vitamins. The colostomy diet should include a variety of foods, introduced gradually. One food should be added every day and the intestinal reaction observed. Over time, the diet of colostomy patients will include all foods that are part of a normal, sensible diet. Of course, to reduce the risk of problems in colostomy patients, unhealthy foods containing dyes, flavor enhancers and other chemical additives are excluded from the diet.

Meals should be taken regularly for a colostomy patient. Food should be eaten in small portions and there should be several meals. Food should be chewed long and thoroughly. It is important to know how foods affect stool quality. For example, dairy products (kefir, quinoa, milk), oatmeal, rye bread, vegetables and fruits (beetroot, broccoli, spinach, apples, plums, etc.) have a laxative effect. Simple carbohydrates (white bread, pasta), rice porridge, black tea, potatoes, hard-boiled eggs, pears have a stabilizing effect. Increased flatulence occurs after consuming legumes, white cabbage, sugar and carbonated drinks. The frequency of bowel movements can be regulated by varying the different foods.

If diet does not help regulate bowel movements and the patient suffers from constipation or loose stools, medication may be used. If constipation is severe, an enema may be used. However, great care must be taken to ensure that the intestinal mucosa is not damaged.

The colostomy diet after cancer surgery is no different from the diet for other diseases. If you have cancer, various supplements and adjustments to your diet are possible depending on the type of cancer, the type of treatment and the condition of the body. The diet after a colostomy closure should also include all sensible foods gradually, starting with semi-liquid, light foods and gradually adding denser foods. Nutrition after colostomy closure is very important to normalize bowel function and reduce the risk of obstruction. It's important to follow your doctor's instructions, and it's a good idea to consult a dietitian for more specific instructions. Yusupov Hospital has a dietician who has extensive experience in establishing a reasonable diet for patients with intestinal pathology.

Colostomy bag

As a rule, patients with a colostomy benefit from special colostomy bags - colostomy bags. Colostomy bags are designed to collect feces. They are available in different versions, as disposable and reusable bags. The bag has a circular base that is stuck to the skin around the colostomy. Single-use bags are discarded when full. When using reusable colostomy bags, the feces are flushed out and reinserted. Reusable bags cause less trauma to the skin when left on for long periods of time. Some colostomy bags are equipped with special deodorizers that absorb the odor emitted from the stoma opening.

A colostomy dressing with an opening may also be used. It is intended to prevent hernias in the stoma area. The bandage supports the abdominal wall after surgery. The colostomy opening is usually a standard size or can be customized.

Patients can contact Yusupov Hospital at any time for advice on the need for a colostomy and its care. The hospital employs experienced oncologists, surgeons, physiotherapists and dieticians for the treatment and postoperative therapy of patients with intestinal pathologies and oncological diseases.

Through the Jusupowski Hospital you can make an appointment for a specialist, as well as get information about outpatient clinics and the diagnostic center.

• blunt.
• cultural.
• A tricky stump.
• Who is the orthopedist?.
• What is another name for an orthopedist?.
• What an orthopedist treats and what symptoms to report.
• What does an orthopedist examine?.
• prosthetic leg.