Cath Lab Digest

Ostomy surgery (sic) was considered by many to be an unmitigated disaster, a measure of last resort to be undertaken only in patients in extremis because of the inability to control the unpredictable fluid excreta.
  ---Professor Brian Brooke¹

M ost of us who have been in the field of enterostomal therapy for some time are familiar with an etching that appears in a 1750 surgical textbook.² A middle-aged woman is peering down at her abdomen — the rags she had wrapped around her midsection removed to expose her stoma. Amazingly, this woman (who had the first colostomy of record) lived for many years with nothing more than rags or tree moss to absorb and manage her output.

As late as 1900, no manufactured appliances were available, and patients had no other recourse but to invent their own collection devices — inner tubes, tuna fish cans, and bread bags. Concoctions of vanilla and peppermint extracts, aspirin tablets, mouthwash, perfume, parsley, and bicarbonate of soda utterly failed to control odor. Omnipresent peristomal skin problems were treated ineffectually with cornstarch, talcum powder, and aluminum paste.³ Most ostomy patients were relegated to their homes as social outcasts, afraid to venture out into society because of odor, a lack of security, and the fear of embarrassment. Due to the resulting decrease in the quality of life for the patient, ostomy surgery remained the “secret surgery” of last resort for many years.

It was not until the early- to mid-1950s that a cycle of innovation of ostomy pouching systems appeared in the medical device marketplace, literally transforming the life of the ostomy patient. Bulky, heavy rubber products yielded to aesthetically pleasing odor-proof plastics and other modern materials that quickly found their way to ostomy manufacturers’ research benches. At about the same time, peristomal skin care made a quantum leap forward with the introduction of karaya. The “skin barrier” was born.

Over the next few years, skin barriers became the impetus for startling advances, not only in ostomy care but also for incontinence and wound care. However, it was not long before karaya’s limitations became evident. Watery or copious output washed karaya away. It was thermally unstable, had poor adhesion, and many patients developed allergic dermatitis or complained of burning when it was used on broken skin.

In 1965, in conjunction with recommendations by noted colorectal surgeons of the day, a material used to treat oral ulcers (Orahesive® Paste and Orahesive® Powder, developed by J.L. Chen of E. R. Squibb and Sons, Princeton, NJ) was launched in the UK for peristomal skin care. Eight years later, Stomahesive® wafers were introduced by E.R. Squibb and gained rapid acceptance by clinicians and patients due to a decrease in allergic reactions, increased thermal stability, low moisture absorption, increased wear time, and fewer skin problems. These wafers were sandwiched between the skin and a commercially available pouching system to prevent peristomal skin breakdown.

A decade later, ostomy management took another leap forward when ConvaTec, a Bristol-Myers Squibb Company, introduced a two-piece pouching system with a low-profile body-side Stomahesive® wafer incorporating a snap-lock flange. This system afforded the patient the freedom, security, and ability to remove the pouch, empty or rinse it, and reapply it without removing the body-side wafer from the skin. With this freedom and autonomy, people with a stoma gained a sense of security and were able to live more normal lives. Since that time, many versions of the flanged coupling system on two-piece pouching systems have been developed by a variety of manufacturers.