Peristomal Lipoplasty

Peristomal Lipoplasty

We developed a unique solution for a complex situation.  We had a patient who had undergone multiple surgeries including an ostomy and developed short-bowel syndrome with malabsorption.  Her abdomen was scarred from previous surgeries.  Her stoma was retracted and placed in an abdominal fold with a deep crease though the center.  The opening of the stoma was tilted downward and the patient experienced copious amounts of watery liquid effluent.  Due to the position of the stoma, effluent would pour out and pool towards her midline incision following the course of that deep crease causing the appliance to leak.  We changed her ostomy appliance multiple times daily, sometimes multiple times at one visit.  She became a very resource intensive patient with both supplies and staff time.

We were inspired by Jennifer Lopez’s collagen injections to her lips.  We approached the surgeon and suggested a collagen injection to fill in the gully that ran from the stoma to the midline incision. He referred us to a plastic surgeon.  The plastic surgeon decided to attempt the procedure to improve the patient’s quality of life.  Permission was obtained from the patient to harvest adipose tissue from the unaffected side of her abdomen and inject it under local anesthesia to fill in the fold.  The plastic surgeon felt autologous adipose tissue would be more effective than collagen.  Collagen has more instability and has to be repeated.  The lipoplasty was completed successfully.

The patient continued to experience large volumes of output; unmanageable by a high output pouch.  Working with the hospital maintenance department and raiding supplies from the respiratory department, we developed a high effluent management system.  Using zip ties and respiratory equipment, we were finally able to manage the volume of output and the patient was able to be discharged home.