V1 - "Utility of the Rivera’s condom technique for the prevention/management, in patients at high risk of peristomal skin complications for ileostomy"

CME Eligible

Purpose/Background: The management of stoma-related complications, especially high-output ileostomies and peristomal injuries, represents a common challenge in colorectal surgery. Constant skin exposure to intestinal effluent can lead to maceration, infection, retraction, or necrosis of the stoma, which delays recovery and compromises the patient's quality of life.

In 1980, Dr. Miguel Ángel Rivera Pérez (from Mexico) developed the Rivera condom technique. He described a simple technique, low-cost and easily accessible technique designed to temporarily control intestinal effluent in situations of complicated stoma, enteroatmospheric fistula, or "hostile" abdomen in trauma surgery.

There are not studies or reports documenting its usefulness in the management of high-output ileostomies or peristomal injuries in colorectal surgery.

Our cases motivate the debate between the use of conventional techniques versus the Rivera condom technique in stomas with a high risk of complications.

Methods/Interventions: We present two case reports where the Rivera condom technique is used to protect against complications and to avoid complications from difficult controlled ostomies.

Results/Outcomes: Case 1

A 58-year-old female patient with a history of total proctocolectomy and terminal ileostomy (1994) due to familial polyposis disease. She sought surgical medical attention due to a progressively growing exophytic peristomal mass, however without systemic affections. The patient was taken to the operating room where a resection of the peristomal tumor, remodeling of the terminal ileostomy was performed.

At the surgery, the surrounding of the ileostomy orifice had to be sutured to remodel it. For the management and protection of the edges around the stoma, the Rivera Condom technique was used. This was made by cutting a double sterile condom and was adapted and secured circumferentially to the edge of the ileostomy with a continue non-absorbable suture. The distal end was then connected to a collection bag. This system allowed for continuous drainage of intestinal effluent, avoiding contact with the peristomal wound.

Weekly outpatient follow-up with condom change, achieving satisfactorily healed stoma edges with adequate stoma function.

Case 2

A 68-year-old woman with a history of rectal cancer underwent open LAR , J-shaped colonic anastomosis, and a shotgun ileostomy.

Following 2 weeks, a high-output ileostomy with macerated edges and superficial peristomal infection was observed, which caused considerable pain.

We placed the Rivera condom around the ileostomy, secured it to the stoma edge, transferred to a collection bag, and applied a hydrocolloid patch around the wound to protect the skin. She continued this care in the ostomy clinic.

Five-month follow-up showed progressive resolution of complications, recovery of skin edges, and good stomal function without further complications.

Conclusion/Discussion: The experience presented demonstrates that the Rivera Condom technique is a useful, economical, and easy-to-implement tool for the management of high-output ileostomies and peristomal injuries. Its application effectively controlled intestinal effluent, protected the sutured edges, and promoted skin healing in both cases.

Despite the lack of studies supporting its specific use in this context, the results observed suggest that it could be considered a safe and effective temporary alternative, especially in resource-limited settings or in the face of immediate postoperative complications.