210 Chapter 10 Table 1. Continued Participant, gender, age (years) Surgical procedure POD of AL diagnosis Time since AL diagnosis (months) Treatment of AL Outcomes (at the time of the interview) P6, M, 65 Robot LAR without diverting stoma 6 days 19 Reoperation with stoma creation, and percutaneous drainage Stoma reversal done, incisional hernia at stoma closure site P7, M, 63 Laparoscopic colon resection (no other details provided)* 7 days 6 Laparoscopic reoperation with stoma creation, and percutaneous drainage Stoma reversal planned P8, M, 51 Robot assisted LAR without diverting stoma 8 days 24 First antibiotics and VAC; after 5 weeks reoperation with ileostomy Stoma reversal and incisional hernia repair done, colonic stricture P9, M, 51 Sigmoid resection without diverting stoma* 8 days 4 Reoperation with stoma creation, and percutaneous drainage Stoma reversal done P10, F, 55 Ultra LAR without diverting stoma One month 33 Percutaneous drainage LARS *Benign resection, no malignancy. F = female; M = male; LAR, Low Anterior Resection; LARS, low anterior resection syndrome; VAC, vacuum-assisted closure; POD, postoperative day. Themes and subthemes Four main themes were identified in the interviews (Figure 1): (1) physical impact, (2) emotional impact, (3) coping mechanisms, and (4) important elements of AL care. These themes were relevant to participants throughout the AL care continuum (from the time of diagnosis to long-term recovery). Illustrative quotes within each theme are presented in Table 2. Physical impact Participants reported a wide range of physical symptoms at initial presentation. Some described feeling ‘lethargic, really tired’ (P7) or ‘weak’ (P1), others endorsed experiencing ‘pelvic’ (P5) or ‘stabbing abdominal pain’ (P2). Some participants had a ‘fever’ (P10), experienced ‘loss of appetite’ (P6) or had a ‘bloating feeling’ (P4), while others noticed their recovery was not evolving as planned based on a change in their bowel habits or decreased mobility due to pain. During the treatment phase, percutaneous (transgluteal) drainage was reported as a painful experience, leading to limitations in mobility and daily activities. Additionally, participants faced challenges with narcotic use, both in achieving adequate pain relief and in managing
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