Association between the protrusion of ileostomies and peristomal dermatitis: an observational study.

Objective: This is an observational study to explore possible changes in end-ileostomy stoma protrusion through years of modified surgical methods.

Materials and methods: Patients with permanent end-ileostomy were eligible for inclusion. Patients were recruited from two outpatient clinics in South-East Norway and from the Norwegian society for patients with ostomy (NORILCO). Stoma protrusion was measured in upright and supine positions by study nurse (outpatient cohort) or by the patient (NORILCO cohort). Clinical information was obtained through patients' questionnaire replies. For analyses, a pragmatic 24-hour ileostomy protrusion score was created, where 16/24 of upright measurement constituted protrusion during daytime and 8/24 of supine measurement protrusion at sleep.

Results: 93 participated in the study, 32 from outpatient clinics and 61 from NORILCO. The outpatients cohort had shorter stoma history than the NORILCO cohort. There was a weak positive correlation between stoma protrusion and years since stoma was created (r_s =0.303, p < 0.003), but stoma protrusion appeared not to be related to surgical method. In both groups, there was some reduction in stoma protrusion from upright to supine position, from 2.5 cm upright in both groups to 2.0-2.2 cm supine.

Conclusions: Stoma protrusion was positively associated with years since stoma was created, but not with surgical method (laparotomy or laparoscopy). A functional 24-hour protrusion score may reduce the effect of clustering of measurements due to end-digit preferences and a preoccupied focus on 2 cm as the tipping point for skin problems. Further and larger studies are needed with special attention to reduce selection bias.