Psychological implications on stoma patients waiting for reversal in the era of COVID-19 pandemic

Editor,

With regard to the article named ‘COVID‐19 pandemic: a large boulder on the head of stoma patients’ by Marino and colleagues¹. We agree that stoma patients not only face serious issues with the availability of medical stoma devices, but also experience obstacles to obtain the appropriate paperwork needed to acquire devices. However, we would like to highlight an extra issue regarding this subset of patients, which is also important.

Due to the cancellation of elective cases and associated redistribution of health care resources, a significant number of patients waiting for reversal of their stomas are experiencing long delays. Limitations on elective surgical cases leads to postponement of operations to restore gastro-intestinal continuity, such as ileostomy reversal after anterior resection for cancer or Hartmann’s reversal after previous emergency surgery for diverticular disease.

The detrimental effects of stoma creation in quality of life of these patients have been thoroughly investigated in scientific literature. The current recommendations of surgical societies encourage interventions and operations with a lower risk of complications, short recovery time and less likelihood of ICU admission, in order not to occupy ICU beds, which could be proved lifesaving for COVID patients. As a consequence, more stomas will be created during this pandemic and the list of patients waiting for reversal will lengthen. The aforementioned change in clinical practice poses an extra ethical challenge which health care system administrators will need to address. Resources must be utilized wisely in order to maximize the treatment benefits for these patients.