Andersen RM1,2, Thomsen T1,3, Danielsen AK2, Gögenur I3,4, Alkjær T5, Nordentoft T2, Possfelt-Møller E6, Vinther A7
1Rigshospitalet, Abdominal Centre, Copenhagen, Denmark, 2Herlev and Gentofte Hospital, Department of Gastroenterology, Herlev, Denmark, 3University of Copenhagen, Department of Clinical Medicine, Copenhagen, Denmark, 4Zealand University Hospital, Department of Surgery, Køge, Denmark, 5University of Copenhagen, Department of Biomedical Sciences, Copenhagen, Denmark, 6Rigshospitalet, Department of Surgical Gastroenterology, Copenhagen, Denmark, 7Herlev and Gentofte Hospital, Department of Physiotherapy and Occupational Therapy, Herlev, Denmark
Background: Abdominal surgery with creation of a stoma is a major procedure that affects the patient in weeks and months afterwards. Surgery may impact the function of the transversus abdominis muscle (TrA) negatively. Gentle exercises and techniques to activate TrA are sometimes used in postoperative exercise rehabilitation of the abdominal muscles. The proportion of patients who are able to activate TrA after surgery with a stoma is unknown. Change in TrA-thickness, measured with ultrasound imaging, is an indicator of muscle activity.
Purpose: To investigate change in TrA-thickness between rest and abdominal drawing in maneuver (ADIM) as an indicator of the ability to activate TrA following stoma surgery; to investigate potential differences in TrA muscle thickness and function between stoma side (SS) and opposite side (OS).
Methods: As part of a descriptive study, we examined participants with ultrasound imaging within 12 weeks of having an ileostomy or colostomy procedure. Ultrasound measurements of TrA were performed with a 9MHz linear transducer at the level of the umbilicus and with the anterior muscle-fascia junction at the medial edge of the screen. Participants were instructed in ADIM beforehand, and bilateral measurements were done three times each at rest and during ADIM. We used the mean of the three measurements and calculated the contraction ratio (CR = thickness during ADIM divided by thickness at rest) as a measure of relative change in muscle thickness. For CRs of 1.20 or above there were clear visual change in muscle thickness based on inspection of ultrasound images, and this value was used as a cut-off for muscle activity. Participants were recruited from Rigshospitalet, Denmark, and from Herlev and Gentofte Hospital, Denmark.
Results: From of a study population of 37, we analyzed a sample of 33 participants with ultrasound data. Median age was 68 [Interquartile range (IQR): 57; 75] and participants were examined at a median of 32 (range: 2-82) days after stoma surgery. The majority (n=26) had cancer. Thirteen had open surgery while 20 had laparoscopy. Median thickness at rest was 3.1 mm [IQR: 2.7; 4.4] for SS and 3.3 mm [IQR: 2.7; 5.1] for OS. During ADIM, median thickness was 4.9 mm [3.7; 6.5] for SS and 4.8 mm [IQR: 3.9; 6.8] for OS. The median CR was 1.35 [IQR: 1.20; 1.53] for SS and 1.43 [IQR: 1.26; 1.58] for OS. On SS, 69% had a CR of 1.20 or above, and for OS it was 79%. CR did not change with time after surgery for either side.
Conclusion(s): Resting thickness, active thickness, and CR were similar on SS compared to OS in people with a newly formed stoma. Based on CR, 69% of the participants could activate TrA voluntarily with ADIM. There were no signs of higher CRs with increasing time for recovery.
Implications: An exercise (ADIM) targeting TrA-activation was feasible for 7 in 10 with a new stoma. We do not know if there are clinical benefits from TrA-activating exercise. Real-time ultrasound imaging may be helpful in identifying those unable to activate TrA, and it may serve as biofeedback and guidance.
Keywords: stoma, ultrasound imaging, transversus abdominis
Funding acknowledgements: The Research Foundation of the Capital Region of Denmark; Rigshospitalet; Herlev and Gentofte Hospital; and Toyota-Fonden, Denmark.
Purpose: To investigate change in TrA-thickness between rest and abdominal drawing in maneuver (ADIM) as an indicator of the ability to activate TrA following stoma surgery; to investigate potential differences in TrA muscle thickness and function between stoma side (SS) and opposite side (OS).
Methods: As part of a descriptive study, we examined participants with ultrasound imaging within 12 weeks of having an ileostomy or colostomy procedure. Ultrasound measurements of TrA were performed with a 9MHz linear transducer at the level of the umbilicus and with the anterior muscle-fascia junction at the medial edge of the screen. Participants were instructed in ADIM beforehand, and bilateral measurements were done three times each at rest and during ADIM. We used the mean of the three measurements and calculated the contraction ratio (CR = thickness during ADIM divided by thickness at rest) as a measure of relative change in muscle thickness. For CRs of 1.20 or above there were clear visual change in muscle thickness based on inspection of ultrasound images, and this value was used as a cut-off for muscle activity. Participants were recruited from Rigshospitalet, Denmark, and from Herlev and Gentofte Hospital, Denmark.
Results: From of a study population of 37, we analyzed a sample of 33 participants with ultrasound data. Median age was 68 [Interquartile range (IQR): 57; 75] and participants were examined at a median of 32 (range: 2-82) days after stoma surgery. The majority (n=26) had cancer. Thirteen had open surgery while 20 had laparoscopy. Median thickness at rest was 3.1 mm [IQR: 2.7; 4.4] for SS and 3.3 mm [IQR: 2.7; 5.1] for OS. During ADIM, median thickness was 4.9 mm [3.7; 6.5] for SS and 4.8 mm [IQR: 3.9; 6.8] for OS. The median CR was 1.35 [IQR: 1.20; 1.53] for SS and 1.43 [IQR: 1.26; 1.58] for OS. On SS, 69% had a CR of 1.20 or above, and for OS it was 79%. CR did not change with time after surgery for either side.
Conclusion(s): Resting thickness, active thickness, and CR were similar on SS compared to OS in people with a newly formed stoma. Based on CR, 69% of the participants could activate TrA voluntarily with ADIM. There were no signs of higher CRs with increasing time for recovery.
Implications: An exercise (ADIM) targeting TrA-activation was feasible for 7 in 10 with a new stoma. We do not know if there are clinical benefits from TrA-activating exercise. Real-time ultrasound imaging may be helpful in identifying those unable to activate TrA, and it may serve as biofeedback and guidance.
Keywords: stoma, ultrasound imaging, transversus abdominis
Funding acknowledgements: The Research Foundation of the Capital Region of Denmark; Rigshospitalet; Herlev and Gentofte Hospital; and Toyota-Fonden, Denmark.
Topic: Musculoskeletal; Disability & rehabilitation
Ethics approval required: Yes
Institution: Capital Region of Denmark
Ethics committee: The Regional Committee (VEK)
Ethics number: H-16032156
All authors, affiliations and abstracts have been published as submitted.
