This symosium was organized in the following way: there were five themes, and each was discussed for 15 minutes by a doctor and a nurse.
1. Preparations before operations
The importance of informing patients was acknowledged, but only a few hospitals in Japan actually do it. Compared with western countries, the reason seem to include dif-ferent attitudes towards religion and a differently structured society. The stoma site marking shoud be done by the patient in collaboration with his doctor, the nurses and his family. This has become an accepted procedure in state hospitals throughout Japan.
2. Abnomino-perineal resection and stoma making
An operation method that avoids later dysfunctions is required. For stoma building an extra peritoneal aproach is desirable, the protruding part ideally being of a height of about 1.5 cm.
3. Care immediately after operation and early complications
The most important thing is the care for the skin, and there has been a remarkable progress. Systematic urinary training is a matter of course in most hospitals, but it has been reported that even without rigorous training the results do not differ. This will have to be investigated further. Early complication occur in less than 10% but re-oper ation may be required for cases of prolapsus, ileus, and stenosis.
4. Dysfunctions and (treatment) countermeasures
Dysfunction occurs when nerves are severed, and then usually repair can not be done. But there are rare cases of recovery if it was a unilateral removal of lymph nodes.
5. Problems concerning stoma clinics Stoma clinics are necessary, but difficult to maintain, because there are not enough patients or the specialists and no credit points are given for the care by the insurance system.
