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Purpose: The STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA). Methods: Infants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression. Results: Eighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36–4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher's Exact test). Conclusion: At laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusions Patient or Public Contribution Relevance to Clinical Practice The aim of this study was to understand the dynamic changes in the needs of patients with enterostomy during the 3 months after discharge and its possible influencing factors.A prospective observational design.This study investigated the supportive care needs of patients who underwent colorectal cancer surgery with colostomy in three Chinese hospitals from May 2023 to October 2023 during the 3 months following discharge from the hospital. The growth mix model was used to describe the needs trajectory and analyse the heterogeneity of the trajectory. Univariate analysis was used to find the factors that might affect the heterogeneity of needs trajectory of patients with enterostomy, and then logistic regression analysis was used to determine the influencing factors of the heterogeneity of needs trajectory of patients with enterostomy. The reporting of this study adhered to the STROBE checklist.A total of 232 patients with enterostomy completed follow‐up. There was heterogeneity in the developmental trajectories of supportive care needs of enterostomy patients and the trajectories of the five dimensions of supportive care needs. The heterogeneity factors affecting the trajectory of supportive care needs included the enterostomy patient's psychosocial adjustment score, type of enterostomy, and educational background and the heterogeneity factors affecting the five dimensions trajectory of supportive care needs include psychosocial adjustment score, tumour staging, type of enterostomy, smoking, chemotherapy and enterostomy self‐care knowledge score.The needs of patients with enterostomy within 3 months after discharge were dynamic. Identifying and meeting the unmet needs of patients with enterostomy was crucial to improving the health‐related quality of life of patients with enterostomy.None.The needs of patients with enterostomy were dynamic, with the needs of most patients with enterostomy decreasing within 3 months of discharge, but some patients with enterostomy continued to have high needs at 3 months after discharge, and clinical nurses were expected to pay special attention to these patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Stoma formation affects an individual in various ways, including physical, emotional, social, and cognitive functions. Diverse studies report ways of an individual lives with new stoma formation. However, the comprehensive understanding of the entire process by the patient, which includes knowledge before the surgical procedure, as well as the subsequent acceptance, adaptation, and challenges to living with a stoma is lacking. MATERIALS AND METHODS: In-depth interview session were conducted with 12 colorectal cancer patients who have undergone surgical procedures for intestinal stoma formation. The patterns and themes within the data were identified by thematic analysis, involving data familiarisation and coding followed by themes' generation and refinement of the themes. RESULTS: Four themes and 9 subthemes were identified, which revealed the sufficiency of stoma-related information and understanding prior to surgery as well as positive acceptance of self and family members reflected through their reactions and support. Nonetheless, the challenges were anticipated which highlights the complications of the stoma itself, obstacles surrounding social life, and financial burdens. CONCLUSION: This study provided valuable insights into the experiences of individuals living with a stoma following colorectal cancer surgery. The themes and subthemes highlight the need to address social stigma as well as financial issues to alleviate the burden of stoma-related expenses. Increasing public awareness and improving financial assistance could be a way to enhance the overall quality of life for patients living with stoma. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The "quality-of-life scale" was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital – community – family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies. [ABSTRACT FROM AUTHOR]

Aim Method Results Conclusion The aim of this work was to investigate the incidence of enterocutaneous fistula (ECF), including both small bowel and colonic fistulas, in a defined population of 1.04 million during a 10‐year period and to describe aetiology, treatments, care consumption and outcome.A comprehensive search algorithm including diagnostic and procedural codes, enterostomal therapy nurse notes and in‐hospital care for >60 days yielded 1970 search hits. After reviewing medical records, 187 patients with ECF were identified.The annual incidence of ECF was 2.3 per 100 000, the incidence of ECF with intestinal failure type II was 0.9 per 100 000. Spontaneous closure of the fistula occurred in 16.0% of patients, while closure was seen in 97.3% of patients who underwent reconstructive surgery with recurrences in 6.7% and 8.3%, respectively. Cumulative ECF‐related in‐hospital care until closure or end of follow‐up was 4 (range 0–61) weeks. Eighty‐eight patients (47%) received home‐based healthcare including parenteral feeding and/or fistula wound care. The estimated overall mortality at 1, 3 and 5 years was 33.7%, 42.1% and 47.6% respectively. Mortality was mainly in patients without spontaneous closure or reconstructive surgery, and the risk of ECF‐related death was 30.2%.This study defines the population‐based incidence of ECF and reports a high overall mortality rate. Initial survivors were characterized by either spontaneous closure or eligibility for later reconstructive surgery, but with an eventual mortality rate of approximately 20%. ECF patients are high consumers of care: 55.1% needed ≥4 weeks in hospital and many received home‐based healthcare. [ABSTRACT FROM AUTHOR]

Summary: Background: High‐output intestinal fistulas and small bowel enterostomies are associated with morbidity and mortality. Current standard treatment for output reduction consists of fluid and dietary restrictions and medical therapy. There is conflicting evidence regarding the use of somatostatin analogues for output reduction. Aim: The aim of this study is to investigate whether lanreotide, added to current standard treatment, further reduces intestinal output in patients with high‐output fistulas and enterostomies. Methods: This was an open‐label, multicentre, randomised controlled trial. Adult patients with a high‐output intestinal fistula (>500 mL/24 h) or small bowel enterostomy (>1500 mL/24 h) more than 4 weeks post‐surgery and receiving standard medical treatment (dietary‐ and fluid restriction, PPI, loperamide and codeine) for at least 2 weeks were eligible for inclusion. We randomised patients 1:1 between continuing standard treatment (control), and subcutaneous lanreotide 120 mg every 4 weeks with standard treatment. The primary outcome was the number of responders, with response defined as an output reduction of ≥25%, 8 weeks after randomisation. We also investigated the proportional change in output. Results: We randomised 40 patients; 17 had a fistula and 23 a small bowel enterostomy. There were 9/20 responders in the intervention group and 2/20 in the control group (p = 0.013). The proportional output reduction was −26% (IQR −4 to −38) in the intervention group, compared to an increase of 4% (IQR 20 to −13) in the control group (p = 0.004). Conclusions: In patients with a high‐output fistula or small bowel enterostomy, addition of lanreotide to current standard treatment can provide a clinically relevant output reduction. Trial registration: EudraCT: 2013‐003998‐10. [ABSTRACT FROM AUTHOR]

Background: Enterostomy is important for radical resection of colorectal cancer (CRC). Nevertheless, the notable occurrence of complications linked to enterostomy results in a reduction in patients' quality of life and impedes adjuvant therapy. This study sought to forecast early stoma-related complications (ESRCs) by leveraging easily accessible nutrition-inflammation markers in CRC patients. Methods: This study involved 470 individuals with colorectal cancer who underwent intestinal ostomy at Changhai Hospital Affiliated with Naval Medical University as the internal cohort. Between January 2016 and December 2018, the patients were enrolled and randomly allocated into a primary training group and a secondary validation group, with a ratio of 2:1 being upheld. The research encompassed collecting data on each patient's clinical and pathological status, along with preoperative laboratory results. Independent risk factors were identified through Lasso regression and multivariate analysis, leading to the development of clinical models represented by a nomogram. The model's utility was assessed using decision curve analysis, calibration curve, and ROC curve. The final model was validated using an external validation set of 179 individuals from January 2015 to December 2021. Results: Among the internal cohort, stoma complications were observed in 93 cases. Multivariate regression analysis confirmed that age, stoma site, and elevated markers (Mon, NAR, and GLR) in conjunction with diminished markers (GLB and LMR) independently contributed to an increased risk of ESRCs. The clinical model was established based on these seven factors. The training, internal, and external validation groups exhibited ROC curve areas of 0.839, 0.812, and 0.793, respectively. The calibration curve showed good concordance among the forecasted model with real incidence of ostomy complications. The model displayed outstanding predictive capability and is deemed applicable in clinical settings, as evidenced by Decision Curve Analysis. Conclusion: This study identified nutrition-inflammation markers (GLB, NAR, and GLR) in combination with demographic data as crucial predictors for forecasting ESRCs in colorectal cancer patients. A novel prognostic model was formulated and validated utilizing these markers. [ABSTRACT FROM AUTHOR]

Background: An intestinal stoma is an opening of the intestinal tract onto the abdominal wall constructed surgically or appearing inadvertently. Method: This study entitled "Complications of Intestinal Stoma: A Prospective Hospital Based Observational Study" is a prospective study and was conducted at Govt. Medical College, Srinagar in the Postgraduate Department of General Surgery over a period of eighteen months. Postoperative complications were noted Results: In our study, a total of 56 patients were included in which stomas were made for 28 (50%) benign conditions and 28 (50%) malignant conditions. Out of 28 complications in ileostomy procedures, most common complication was peristomal skin excoriation followed by electrolyte disturbance. Out of 9 complications in colostomy procedures, most common complications seen were stoma retraction and peristomal abscess. Conclusion: Our study found, peristomal skin excoriation and electrolyte imbalance as the most common post-operative complications in intestinal stomas. Emergency procedures increased the risk of complications in intestinal stomas and Stoma related complications resulted in longer hospital stay. [ABSTRACT FROM AUTHOR]

Objective: While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. Methods: We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2 years. Results: We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3 kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182 min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6 months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Conclusions: Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1 year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage. [ABSTRACT FROM AUTHOR]

Optimal criteria and timing for enterostomy closure (EC) in neonates is largely based on clinical progression and adequate weight, with most institutions using 2.0–2.5 kg as the minimum acceptable weight. It is unclear how the current weight cutoff affects post-operative morbidity. To determine how infant weight at the time of EC influences 30-day complications. Infants weighing ≤4000 g who underwent EC were identified in the 2012–2019 ACS NSQIP-P database. Demographics, comorbidities, and 30-day outcomes were assessed using univariate analysis. Multivariable logistic regression controlling for ASA score, nutritional support, and ventilator support was used to estimate the independent association of weight on risk of 30-day complications. A total of 1692 neonates from the NSQIP-P database during the years 2012–2019 met inclusion criteria. Neonates weighing <2.5 kg were significantly more likely to have a younger gestational age, require ventilator support, and have concurrent comorbidities. Major morbidity, a composite outcome of the individual postoperative complications, was observed in 283 (16.7%) infants. ASA classifications 4 and 5, dependence on nutritional support, and ventilator support were independently associated with increased risk of 30-day complications. With respect to weight, we found no significant difference in major morbidity between infants weighing <2.5 kg and infants weighing ≥2.5 kg. Despite using a robust, national dataset, we could find no evidence that a defined weight cut-off was associated with a reduction in major morbidity, indicating that weight should not be a priority factor when determining eligibility for neonatal EC. III. [ABSTRACT FROM AUTHOR]

Background: Globally, ostomy creation rates are rising. Stomas, while life-saving, pose significant challenges. Nurses are vital in providing care and support to stoma patients. However, ostomy care practice and knowledge among Ethiopian nurses remain understudied. This study aimed to assess these aspects among nurses in Bahir Dar City, Ethiopia, in 2022. Methods: An institutional-based cross-sectional study was conducted in three public hospitals in Bahir Dar City from September 19 to September 30, 2022. A simple random sampling technique was used to select 423 nurses. Binary logistic regression analysis was employed to identify associated factors toward dependent variables by considering p -value <0.05 to be statistically significant. Result: From the total samples, 382(90.3%) responded to the questionnaire. The overall good knowledge and practice level of nurses regarding ostomy care was 55.2% and 52.1%, respectively. Taking ostomy care training {AOR = 2.44; 95% CI (1.29, 4.61)} and high level of a monthly income of study participants {AOR = 2.90; 95% CI (1.72, 4.91)} had a significant association with knowledge of ostomy care. On the other hand, taking courses on ostomy care {AOR = 1.76; 95% CI (1.06, 2.93)}, receiving training on ostomy care {AOR = 4.15; 95% CI (2.12, 8.09)} and good knowledge level on ostomy care {AOR = 2.13; 95% CI (1.32, 3.45)} were significantly associated with expressed practice of ostomy care. Conclusion: The study found that only half of nurses exhibit good knowledge and practice in ostomy care. Training and monthly income significantly influence nurses' knowledge, while practice level is associated with training, course attendance, and knowledge. These findings highlight the importance of targeted training programs and education initiatives to enhance nurses' competence in ostomy care. It is also crucial to address factors like nurses' income levels to ensure equitable access to educational resources and opportunities for professional development, thus enhancing their knowledge. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effect of nurse-led multidisciplinary cooperation in the early screening and protection of fecal water dermatitis in hospitalized patients with enterostomy. Material and methods: An enterostomy management team led by nurses with multidisciplinary cooperation was established to investigate the current situation of fecal water dermatitis in patients with enterostomy in our hospital, and the causes of fecal water dermatitis were analyzed. Based on the evidence-based results, the management plan for the prevention of fecal water dermatitis in patients with enterostomy was implemented. The related indicators before and after the implementation of a nurse-led multidisciplinary cooperation management program were compared. Results: The incidence of fecal water dermatitis in patients with enterostomy decreased from 45.56% to 20.73%, the screening rate of nutritional risk for patients with enterostomy increased from 45.57% to 97.56%, the accuracy of stoma positioning by nurses was increased from 65.82% to 98.78%, the incidence of basement warping in enterostomy was decreased from 29.80% to 1.95%, the incidence of fecal water leakage decreased from 50.76% to 22.53%, the 1-hour leakage rate of stoma basement increased from 4.48% to 97.29%, the awareness rate of patients' related knowledge increased from 43.03% to 80.48%, and the average score of self-care ability of patients (family members) increased from 99.5 to 126.7. Patients' mean quality of life scores increased from 80.73 to 98.57, and patients' mean self-efficacy scores increased from 78.34 to 99.26. The differences in the above indicators were statistically significant (p < 0.01). Conclusions: Nurse-led multidisciplinary cooperation can improve early screening and protection of fecal water dermatitis in hospitalized patients with enterostomy and improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Purpose: Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. Methods: UK paediatric surgery centres were invited to recruit patients aged 6–16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. Results: Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1–17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). Conclusion: Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma. [ABSTRACT FROM AUTHOR]

The article describes in detail the history of the development of surgical proctology, from the time of the appearance of colostomy, the imposition of anastomoses, the stages of the surgery of fatigued patients. Methods and results of rehabilitation of fatigued patients, principles of imposition and closure of single-double colostomy, treatment of post-operative complications. The impact of a surgical treatment method on social adaptation and quality of life of patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the mediating role of readiness for hospital discharge (RHD) and stoma self-efficacy (SSE) in the relationship between quality of discharge teaching (QDT) and health-related quality of life (HRQOL) in colorectal cancer patients with temporary enterostomy, and the gender difference of mediating effect. Background: It is not clear how RHD, QDT, SSE and HRQOL interact in colorectal cancer patients with temporary enterostomy. Methods: This was a prospective follow-up survey. 221 colorectal cancer patients with temporary enterostomy were conveniently recruited from a general hospital in Southeast China. The Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Stoma Self-Efficacy Scale, and Stoma Quality of Life Scale were used to collect data. Pearson's correlation and structural equation models were used to analyze the data. SPSS 26.0 and Amos 28.0 software were used for analysis the collected data. Results: Regarding the relationship of QDT and HRQOL, only QDT-T had a direct effect among colorectal cancer patients with stomas (b = 0.233, P<0.001, percentile 95% CI = [0.145, 0.314]). However, both QDT-T and QDT-R can predict HRQOL indirectly through three paths: (1) the mediating role of SSE (b = 0.050, P = 0.009, percentile 95% CI = [0.013, 0.098]; b = 0.077, P = 0.008, percentile 95% CI = [0.021, 0.164]), (2) the mediating role of RHD (b = 0.044, P = 0.004, percentile 95% CI = [0.014, 0.085]; b = 0.044, P = 0.005, percentile 95% CI = [0.010, 0.102]), and (3) the chain mediating role of SSE and RHD (b = 0.030, P = 0.003, percentile 95% CI = [0.011, 0.059]; b = 0.047, P = 0.003, percentile 95% CI = [0.015, 0.103]). The similar chain mediating effect in male stoma patients was also found (b = 0.041, P = 0.002, percentile 95% CI = [0.016, 0.080]; b = 0.046, P = 0.004, percentile 95% CI = [0.011, 0.114]). Conclusions: Stoma self-efficacy and readiness for hospital discharge played important intermediary roles in the relationship between quality of discharge teaching and health-related quality of life in colorectal cancer patients with stomas. Health care providers can design SSE-enhancing and RHD-enhancing discharge planning for colorectal cancer patients with temporary enterostomies. [ABSTRACT FROM AUTHOR]

T-lymphocytic intestinal leiomyositis is a rare cause of "pediatric intestinal pseudoobstructions." Diagnosis may be difficult and requires full-thickness bowel biopsies during laparotomy or laparoscopy with possible enterostomy. Currently, immunosuppressive therapy is the only available treatment. A delay in diagnosis and therapy may negatively affect the prognosis because of ongoing fibrotic alterations; therefore, early diagnosis and consequent treatment are crucial. This review summarizes the available information on the nosology, diagnostic steps, and treatment modalities. Here, we report the youngest case of enteric leiomyositis reported in the last two decades and analyze its management by reviewing previous cases. [ABSTRACT FROM AUTHOR]

An intestinal stoma creation is one of the most common surgical procedures. Despite benefits, a stoma can have serious effects on a patient's quality of life. Multiple dimensions of everyday life can be affected such as social life, body image, as well as ability to participate in some religious practices, with some faith groups being disproportionately affected. This study sought to understand the extent to which faith is addressed during these sessions given the integral role it plays for some patients. A survey was developed based on literature review and expert consultation. This was distributed to ostomy certified nursing staff, inflammatory bowel disease gastroenterologists and colorectal surgeons caring for patients requiring a permanent stoma at a high-volume academic institution. Follow-up semistructured interviews were conducted to delve deeper into themes identified in the surveys. The overall survey response rate was 57%. Only 35% reported training on how stomas interface with religious practices. Religious services were either rarely or never present during preoperative counseling discussions. During interviews, it was noted that religious beliefs often impact after care but are not always discussed during preoperative sessions. Interviewees found these conversations to be difficult with minimal support or direction on how to navigate them. Although very important, health-care providers are not including faith-based issues surrounding stomas in perioperative counseling partly due to lack of training or awareness of existing support systems. As our population diversifies, understanding cultural and religious practices that influence care is increasingly important. [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery after surgery (ERAS), a global surgical quality improvement initiative, reduces the length of stay in the hospital. Temporary stoma care for rectal cancer is complex, and patients require prolonged care services to adjust to the stoma. The shorter stay durations in the new model challenge the conventional care pathways and create new patient needs. Purpose: This study was designed to explore the supportive care needs of patients under the new surgical model to provide a reference for the design of ERAS nursing care plans. Methods: A convergent parallel mixed-methods design was used in this study. Patients with temporary stomas for rectal cancer were recruited using a convenience sampling method in gastrointestinal surgery wards and wound & stoma clinics in two public tertiary care hospitals in China. Standardized questionnaireswere administered to 140 patients to collect quantitative data, and semistructured interviews were conducted individually with 13 patients to collect qualitative data. The questionnaire data were analyzed using descriptive statistics, and the interview data were analyzed using thematic analysis. Results: "Health system and information needs" and "care and support needs" were identified in both the qualitative and quantitative analyses as the most significant unmet needs of the participants. In addition, the qualitative analysis identified receiving focused stoma care instructions and easily understandable information as essential to fulfilling health system and information needs. Care and support needs included access to continued postdischarge services and attention from medical professionals. Conclusion/Implications for Practice: The participants in this study experienced a variety of unmet supportive care needs under the ERAS protocol, with gaps particularly notable in two categories: "health system and information needs" and "care and support needs." Increased perioperative care and shorter hospital stays under the ERAS protocol reduce opportunities for patients to receive targeted instruction and shift much of the ostomy education and care workload out of the hospital, requiring greater attention from clinical nurses to ensure quality of care. [ABSTRACT FROM AUTHOR]

Background Neonates undergoing emergency abdominal surgery frequently require a stoma; closing this stoma with a second operation is an essential part of recovery. Timing of closure varies. Optimal timing is unclear and would be best resolved through a randomised controlled trial; such a trial is likely to be challenging. Aim To determine if it is feasible to conduct a clinical trial comparing ‘early’ versus ‘late’ stoma closure in neonates. Design Mixed methods comprising three parallel workstreams incorporating: a clinician survey, prospective observational cohort study, parent interviews, focus groups, database analyses and consensus meeting. Setting Specialist neonatal surgical centres across the United Kingdom. Participants and data sources Neonatologists, neonatal surgeons, neonatal dietitians and neonatal nurses who care for neonates with stomas. Neonates with recent stoma, their parents and the clinicians looking after them. Three existing, overlapping clinical databases. Results One hundred and sixty-six professionals from all 27 neonatal surgical centres completed the survey: 6 weeks was the most common target time for stoma closure across clinical scenarios, although there was wide variation. Timing of closure was influenced by nutrition, growth and stoma complications. The prospective cohort study enrolled 56 infants from 8 centres. Infants were mostly preterm with necrotising enterocolitis or intestinal perforation. Clinicians identified extreme preterm gestation and clinical conditions as reasons for not randomising babies into a hypothetical trial comparing early and late stoma closure. Parents and healthcare professionals identified that comparator arms needed more clinical flexibility in relation to timing of stoma closure. Analysis of existing databases revealed wide variation in current timing of stoma closure in neonates and identified approximately 300 eligible infants for a trial per annum in the United Kingdom. Conclusions A trial of ‘early’ compared to ‘late’ stoma closure in neonates is feasible and is important to families and health professionals. The population of eligible babies in the United Kingdom is sufficient for such a trial. Challenges centre around lack of equipoise in certain scenarios, specifically: extremely preterm infants; infants waiting too long for stoma closure in the ‘late’ comparator; and logistical issues in closing a stoma at a trial-allocated time. These challenges are addressable by incorporating flexibility based on gestation at birth, communicating that both trial arms are standard practice and valid treatment options, and providing resources, for example, for operating lists. Future work We recommend the following population, intervention, comparator and outcome as a starting point to inform future trial design. Population: neonates with stomas (excluding those with a fixed treatment pathway). Intervention: stoma closure at 6 weeks and after 32 weeks post conceptual age. Comparator: expectant management with stoma closure undertaken when the clinical team determines is best for the infant. Primary outcomes: weight gain/growth or length of hospital stay. Study registration This study is registered as IRAS Project ID 278331, REC Reference 20/LO/1227. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128617) and is published in full in Health Technology Assessment; Vol. 28, No. 71. See the NIHR Funding and Awards website for further award information. Plain language summary Babies who develop a bowel problem soon after birth may need surgical treatment and a stoma (where the bowel is brought out into a bag on the tummy). Stomas can be life-saving but can also cause problems. They must be ‘closed’ with a second operation once the baby has got better. The timing of this second operation varies between hospitals and we do not know the best time to do it. To find out the best time to close a baby’s stoma, we wanted to conduct a clinical trial. This would mean some babies having their stoma closed ‘early’, and other babies ‘later’ and seeing which group did better. Babies would be put into the ‘early’ or ‘late’ group at random so that we could have a fair comparison. Because doing a trial may be challenging, we first set out to find out if a trial would be feasible in the Timing of Stoma Closure in Neonates study. What we did Found out what currently happens to babies with a stoma through a survey of healthcare staff and looking at data from several national databases. Collected data on 56 babies with stomas in 8 hospitals, including asking their doctors whether they would recruit these babies to a trial and when they would close their stoma. Interviewed parents of children who had had a stoma. Held focus groups with staff at the eight hospitals. Held a meeting for National Health Service staff and parents to discuss the way forwards. What we found Parents and doctors think this question is important and that a clinical trial is a good idea. Deciding on the timing of stoma closure in the trial and what we mean by ‘early’ and ‘late’ is critical to the success of a trial. The timing may need to take into account that some babies born extremely preterm may be difficult to include. A trial that compares how well infants grow and/or length of stay in hospital between babies having early or later stoma closure may well be feasible. What happens next The National Institute for Health and Care Research (research arm of the Department of Health and Social Care) will use this to information to help decide if they would like to fund a trial in the future. Scientific summary Background Neonates undergoing emergency abdominal surgery for problems such as necrotising enterocolitis (NEC), spontaneous intestinal perforation (SIP) or a congenital bowel obstruction frequently require a stoma. While stomas can be life-saving, they pose a number of challenges including fluid and electrolyte imbalance, local wound and skin problems, malnutrition and growth failure. Reversing (closing) these stomas with a second operation is therefore an essential part of an infant’s recovery. The timing of stoma closure is known to vary between hospitals and, indeed, clinicians and the best time remains unclear, with conflicting evidence from published studies of low methodological quality. Rationale Determining the best time to close stomas in neonates is imperative, as it has significant implications for: infant health outcomes (e.g. stoma complications and growth) families (e.g. reduced neonatal unit stay, healthcare burden, time off work) healthcare providers [e.g. neonatal unit bed-days, parenteral nutrition (PN) use, surgery, cost]. In addition, reducing unwarranted variability in surgical care is a key priority for the NHS. The most methodologically robust way to determine optimal timing of stoma closure would be through an adequately powered randomised controlled trial (RCT). A trial of different stoma closure times in neonates is likely to be challenging, due to: the patient group who have heterogenous underlying diseases and comorbidities clinician factors such as willingness to recruit parent factors such as trial acceptability. This study aimed to explore these potential challenges and determine if a trial comparing ‘early’ and ‘late’ stoma closure is feasible. Aims The overarching aim of the Timing of Stoma Closure in Neonates (ToSCiN) study was to answer the question: is it feasible to conduct a RCT comparing ‘early’ versus ‘late’ stoma closure in neonates? Objectives The specific objectives of the ToSCiN study were: to establish current UK practice for stoma closure in neonates to determine whether there is equipoise among clinicians (neonatal surgeons and neonatologists) and allied health professionals (specialist nurses and dietitians) over when it is best to close stomas in neonates to define ‘early’ and ‘late’ stoma closure for a potential trial to define a population of neonates for inclusion in a trial (in whom there is significant uncertainty over timing) and determine how many infants are eligible for inclusion to establish the most appropriate design and outcome measures for a trial to determine the willingness of parents, neonatal surgeons and neonatologists to include neonates in a trial that would randomise to ‘early’ or ‘late’ stoma closure and identify potential barriers to recruitment to assess the suitability of using routinely collected data for gathering clinical information for a trial. Methods The ToSCiN study used a mixed-methods approach (qualitative and quantitative methodology) and comprised three parallel workstreams. Workstream 1: Survey of clinician and allied health professional perspectives on neonatal stoma closure An online survey was sent to clinicians and allied health professionals involved in the care of newborn infants with stomas at neonatal surgical units across the UK. The survey questions and a series of clinical scenarios to explore current practice/preferences, perspectives on ‘early’ versus ‘late’ stoma closure, which groups of infants should be included in a trial comparing these, preferred trial design including outcomes and barriers to achieving the optimal timing of closure. Workstream 2: Parent and clinician perspectives regarding a clinical trial of neonatal stoma closure This workstream took place in eight UK neonatal surgical centres and comprised three elements: (2.1) An observational cohort study of neonates who had a stoma formed Key clinical and demographic information was recorded prospectively. The data set comprised factors that could influence the timing of stoma closure and outcomes which are likely to be important in a future trial. (2.2) Questionnaires for the principal clinicians (surgeon and neonatologist) caring for each infant recruited to the cohort study These were completed at three time points and explored the acceptability of a hypothetical trial to clinicians for each infant. Time points: (1) approximately 1 week after stoma formation to explore randomising the infant to a trial, (2) 6 weeks after stoma formation to explore following an allocation to early closure intervention and (3) 12 weeks after stoma formation to explore following an allocation to late closure comparator. (2.3) A qualitative study incorporating: (1) focus groups with clinicians and (2) interviews with parents of neonates who had a stoma Multidisciplinary healthcare professional focus groups explored equipoise, current practice and views on early versus late closure, willingness to recruit to a trial, acceptability of a trial and prioritised outcome measures. Parents of infants in the cohort study and additional parents recruited via social media were invited for a telephone or video interview. Their views were explored on: having a child with a stoma, acceptability of a trial, timing of recruitment, potential barriers to trial participation, trial participant information materials, approach to consent for a trial and prioritised outcome measures. Workstream 3: Analysis of three existing national databases Analyses were carried out on three existing national data sets [from the National Neonatal Research Database (NNRD), The British Association of Paediatric Surgeons Congenital Anomalies Surveillance System (BAPS-CASS) and Hospital Episode Statistics – Admitted Patient Care (HES-APC)]. The analyses aimed to: (1) establish current UK practice, (2) define a population for trial inclusion and provide the number of eligible infants and (3) establish values for key outcome measures. Consensus meeting This was held using an online video platform at the end of the study period when data collection and preliminary analysis had been completed. Professionals and parents previously involved were invited and further parents were recruited via social media. A summary of results from the three workstreams was presented to attendees. Facilitated small group discussions took place, followed by a summary of small group discussions presented by group facilitators to all attendees, and electronic voting was conducted about trial acceptability and design. Results Workstream 1 Results One hundred and sixty-six professionals completed the survey with at least one respondent from each of the 27 UK centres. Six weeks was the most commonly stated target time for closure across all scenarios, although there was a high degree of variability, with intervals of 12 weeks or more frequently advocated. While 70–76% of respondents preferred closure prior to discharge in preterm infants and a term infant with jejunostomy, only 46% preferred this in term infants with ileostomy. A sizeable proportion (41%) use weight, rather than time, to determine when to close a stoma. Thematic analysis of free text identified nine key themes influencing decision-making, mostly related to nutrition, growth and stoma complications. With regard to potential trial design, 86% of respondents indicated they would include preterm infants with NEC/SIP and 72% term infants with other conditions. Closure at 6 weeks was the most commonly cited timing of early intervention; the preferred later time point was 12 weeks. Growth was most commonly selected as the favoured primary outcome for a trial, followed by time to full feeds, length of stay and duration of PN. Workstream 2 Results Cohort study Fifty-six infants were enrolled from eight UK units. Infants were mostly preterm (44/56), with median birthweight 961 g (range 415–3962 g). The cohort comprised 37 infants with NEC/SIP and 19 with other diagnoses. Most stomas were in the small bowel, formed at a median of 8 days (range 1–80 days). At 1 week following stoma formation, 18/56 infants were mechanically ventilated, 8 were receiving inotropes and 13 had received blood products in the preceding 24 hours. At this point, surgeons stated they would be willing to randomise 31 infants (59%) into a hypothetical trial of 6- versus 12-week closure. The commonest reason for not being willing was the infant being ‘too small or premature’. At 6 weeks post stoma, median weight was 2024 g (range 795–4460 g) and nine remained ventilated. Eighty per cent (42/56) were reported to have gained weight in the past week. Median enteral feed volume was 127 ml/kg/day, stoma output was < 20 ml/kg/day in 86% and stoma-related complications were reported in one-third. Surgeons would be willing to follow theoretical trial allocation for ‘early’ closure in 17/56 (33%). In nine infants, the stoma had already been closed. The main reasons for not being willing to follow trial allocation were current clinical status and size. Among infants whom surgeons said they would not be willing to follow trial allocation, most (16/25) were < 28 weeks’ gestation at birth and were lighter (median weight 1609 vs. 2090 g). Twelve weeks after stoma formation, median weight was 2548 g and 10% (4/52) remained ventilated. Most (23/42; 55%) were still receiving PN (a higher proportion than at 6 weeks) and 12% (5/42) were not receiving any enteral feed. Stoma-related problems were present in one-third and one-quarter had stoma output > 20 ml/kg/day. Surgeons stated they would be unwilling to follow trial allocation of closure at 12 weeks in 24 infants: 12 of these had required earlier stoma closure and 9 (mainly premature infants) were considered unsuitable for stoma closure for a variety of mainly clinical reasons (rather than logistical or family factors). Again, most infants for whom the surgeon was unwilling to follow trial allocation were < 28 weeks' gestation at birth (13/24). Overall stoma closure took place before the end of the data collection period in 82% (46/56 infants, 4 infants died with a stoma in situ and 6 infants still had a stoma). Median time to closure was 9.9 weeks (range 4.4–28.3 weeks), at median 88 days of age and weight of 2631 g. Qualitative study We interviewed 24 parents (17 mothers, 7 fathers) of babies who required a stoma in the last 3 years in the UK (July 2021–February 2022). Fifteen parents were recruited via hospital sites and nine via social media. Thirty-six staff (14 surgeons, 10 consultant neonatologists, 6 neonatal surgical nurses, 2 research nurses, 1 dietitian and 3 ‘other’ roles) from five study sites took part in one of six focus groups (November–December 2021). Most parents and staff considered the proposed ToSCiN trial to be acceptable and wanted the research question to be answered. Staff would be willing to randomise babies, except the most extremely preterm, to the trial and parents would hypothetically consent to their baby taking part if the ‘emotive’ ‘early’ (6 weeks) and ‘late’ (12 weeks) terminology was changed. Some parents and staff, however, had clear trial arm preference and concerns about the alternative trial arm. They felt that decisions about when to close a stoma should be led by the overall health and well-being of the baby. Stoma-related factors, logistical and organisational factors and family factors also influenced views on acceptable timing of stoma closure. These findings highlight potential challenges for recruitment and retention and trial success. Workstream 3 Results While direct comparison was limited by differences in data set populations and coverage, there was a reasonably consistent number of potentially eligible infants with a stoma for NEC/SIP across data sets, with 163 in 1 year in the BAPS-CASS cohort and mean annual volumes of 193 (NNRD) and 192 (HES-APC). HES-APC was used to estimate non-NEC infant numbers, as it had the most comprehensive coverage, with a mean of 118 per year. The total UK population of potentially eligible infants would therefore be approximately 300 per annum. Median stoma durations for babies with NEC/SIP were as follows: BAPS-CASS 63 days; NNRD 60 days and HES-APC 78 days. For infants with stomas for other reasons, closure was usually earlier: NNRD 45 days; HES-APC 74 days; and in the BAPS-CASS meconium ileus cohort, 51 days. HES-APC included babies who were discharged home with a stoma in situ, hence longer median stoma durations. Consensus meeting The consensus meeting was attended by 52 individuals from a range of health professional and non-professional backgrounds, including 7 parents. Voting on key aspects of trial design showed: (1) 83% favoured including all infants with a stoma, (2) 58% favoured comparing closure at 6 weeks after stoma formation with expectant management rather than comparison to a specific late timepoint, and (3) the favoured primary outcomes were weight gain/growth (38%) and length of hospital stay (32%). Conclusions We found that a randomised trial of early compared to late stoma closure in neonates is feasible and is important to families and health professionals. We identified the following components as being critical to a successful future trial: comparison of closure at 6 weeks versus expectant management comparison that accounts for completed gestational age, rather than solely duration of stoma. We identified the potential population and outcomes for such a trial and established that a sufficient population exists in the UK. We also identified that a trial comparing ‘early’ and ‘late’ closure at rigidly defined time points (e.g. closure at 6 compared to 12 weeks) would not be feasible. The principal challenge for trial conduct was found to be the ‘baby-led’ narrative that came through strongly from study participants. Parents and professionals appeared to lack equipoise in certain scenarios. However, this lack of personal equipoise is not exclusive to ToSCiN, and similar themes have been overcome in trials in the past (including complex surgical trials) by optimising communication. Our findings provide valuable insight into how best to do this in a future trial. Other challenges identified include: (1) concerns about inclusion of extremely preterm infants, (2) concerns about infants waiting too long for stoma closure if randomised to the ‘late’ comparator arm and (3) logistical arrangements for closing a stoma at the time dictated by trial allocation. These challenges are eminently addressable, by designing the trial to: (1) incorporate a degree of flexibility (e.g. using ‘expectant management’ as the comparator), (2) make allowances for certain groups (e.g. having a higher corrected gestational age limit for extremely preterm infants) and (3) ensure parents and professionals are aware both trial arms are standard practice and valid treatment options. Key research recommendations We recommend the following population, intervention, comparator and outcome (PICO) as a starting point to inform the design of a future trial: Population: neonates with stomas, excluding those with a stoma as part of a fixed treatment pathway, for example, anorectal malformations and Hirschsprung’s disease. Intervention: stoma closure at 6 weeks post stoma formation and where 32 weeks post-conceptual age has been reached. Comparator: expectant management with stoma closure undertaken when the clinical team determines is best for the infant. Outcomes: weight gain/growth or length of hospital stay should be the primary outcome measure. In order to optimise a trial, we recommend the following practical steps: Involve higher volume neonatal surgical centres for efficient recruitment. Ensure trial staff at each centre are highly trained regarding current standard practice and equipoise. Approach parents 1–2 weeks after stoma formation. Provide resources to centres to permit stoma closure as per the trial protocol, for example, for ring-fenced operating theatre time and possibility of extended hospital stay. Study registration This study is registered as IRAS Project ID 278331, REC Reference 20/LO/1227. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128617) and is published in full in Health Technology Assessment; Vol. 28, No. 71. See the NIHR Funding and Awards website for further award information.

Aim: Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma‐related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. Method: Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3‐year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. Results: A total of 455 patients were included (median follow‐up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24–5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35–0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92–5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01–8.69), p < 0.001] were risk factors for late SRCs. Conclusion: Stoma‐related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting. [ABSTRACT FROM AUTHOR]

Introduction: Preterm neonates often receive a variety of duration of antibiotic exposure during admission. The aim of the study was to evaluate whether neonatal antibiotic exposure is relevant with longitudinal growth problems in preterm-birth children. Methods: This prospective study enrolled 481 infants who were born <32 weeks of gestation, discharged, and longitudinally followed from corrected age (CA) 6–60 months. After excluding 153 infants with blood culture-confirmed bacteremia, necrotizing enterocolitis, severe cerebral palsy, intestinal ostomy, and congenital anomaly, 328 infants were included for analysis. Covariates included perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure accumulated by term equivalent age. The primary outcome was the anthropometric trajectories in z-score of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6–60 months. Results: Antibiotic exposure duration was significantly negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. Multivariate generalized estimating equation analyses showed antibiotic exposure duration had significantly faltering z-score increment from CA 6 to 60 months in zBW and zBH (adjusted mean [95% CI]; ΔzBW: −0.021 [−0.041 to −0.001], p = 0.042; ΔzBH: −0.019 [−0.035 to −0.002], p = 0.027) after adjustment. Children with neonatal antibiotic exposure duration >15 days were significantly lower in the mean anthropometric zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with neonatal antibiotic exposure ≤15 days (all p < 0.01). Conclusions: Growth increments were negatively associated with antibiotic exposure duration in preterm neonates implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted. Plain Language Summary: Preterm infants often receive a variety of antibiotic exposure duration during admission. This study was to evaluate whether neonatal antibiotic exposure is associated with longitudinal growth problems in preterm-birth children. This study followed a cohort of 328 very preterm infants born <32 weeks of gestation, who were discharged from a tertiary hospital without documented neonatal bacterial infection from 2004 to 2016 and received longitudinal follow-up for growth outcomes at their corrected age (CA) 6, 12, 24, and 60 months. We collected perinatal demographics, neonatal morbidities, extrauterine growth restriction, and antibiotic exposure duration by term equivalent age, to associate with trajectories in z-scores of bodyweight (zBW), body height (zBH), and body mass index (zBMI) from CA 6–60 months. We found antibiotic exposure duration was negatively associated with zBW and zBH at CA 6, 12, and 60 months, and zBMI at CA 60 months. After adjustments, antibiotic exposure duration was associated with decreased growth velocity in zBW and zBH from CA 6–60 months. Children with longer antibiotic exposure >15 days had significantly lower zBW, zBH, and zBMI at CA 6, 12, 24, and 60 months compared with children with antibiotic exposure ≤15 days (all p < 0.01), suggesting that longer antibiotic exposure duration was associated with inferior weight and height gains. This study concludes that long-term growth increments may negatively associate with neonatal antibiotic exposure duration in children born very premature, implicating that antibiotic stewardship and growth follow-up for preterm neonates are thus warranted. [ABSTRACT FROM AUTHOR]

Neonates with intestinal perforation often require laparotomy and intestinal stoma creation, with the stoma placed in either the laparotomy incision or a separate site. We aimed to investigate if stoma location is associated with risk of postoperative wound complications. A multi-institutional retrospective review was performed for neonates ≤3 mo who underwent emergent laparotomy and intestinal stoma creation for intestinal perforation between January 1, 2009 and April 1, 2021. Patients were stratified by stoma location (laparotomy incision versus separate site). Outcomes included wound infection/dehiscence, stoma irritation, retraction, stricture, and prolapse. Multivariable regression identified factors associated with postoperative wound complications, controlling for gestational age, age and weight at surgery, and diagnosis. Overall, 79 neonates of median gestational age 28.8 wk (interquartile range [IQR]: 26.0-34.2 wk), median age 5 d (IQR: 2-11 d) and median weight 1.4 kg (IQR: 0.9-2.42 kg) had perforated bowel from necrotizing enterocolitis (40.5%), focal intestinal perforation (31.6%), or other etiologies (27.8%). Stomas were placed in the laparotomy incision for 41 (51.9%) patients and separate sites in 38 (48.1%) patients. Wound infection/dehiscence occurred in 7 (17.1%) neonates with laparotomy stomas and 5 (13.2%) neonates with separate site stomas (P = 0.63). There were no significant differences in peristomal irritation, stoma retraction, or stoma stricture between the two groups. On multivariable regression, separate site stomas were associated with increased likelihood of prolapse (odds ratio 6.54; 95% confidence interval: 1.14-37.5). Stoma incorporation within the laparotomy incision is not associated with wound complications. Separate site stomas may be associated with prolapse. Patient factors should be considered when planning stoma location in neonates undergoing surgery for intestinal perforation. [ABSTRACT FROM AUTHOR]

Background and Aims: Enterocutaneous fistula is a severe complication of an open abdomen, which poses devastating challenges for critical care nurses. The study aimed to explore and describe the challenges faced by critical care nurses caring for patients with enterocutaneous fistulas in a tertiary public hospital in Gauteng, South Africa. Methods: A qualitative, exploratory, descriptive, and contextual design was conducted to understand the challenges experienced by the critical care nurses caring for patients with enterocutaneous fistulas. The standards for reporting qualitative research checklists are utilized. The study conducted four semistructured focus group interviews with six members in each group. Results: Critical care nurses revealed two overarching themes: the challenges regarding difficult nursing care and the lack of resources to provide quality patient care. Care of patients with ECF highlighted that nurses were not coping with the care of such patients. Conclusion: Collaboration of a multidisciplinary team involving dieticians, surgeons, and enterostomal therapy nurses could improve the management of ECF without surgical intervention, increase the knowledge and skills of nurses, alleviate their challenges, and yield safe patient outcomes. Standardized and updated protocols will ensure the best practices toward quality patient care that facilitate healing, closure, and reducing mortality and morbidity rates. The key principles for caring for patients with open abdomen, presenting with enterocutaneous fistulas, are based on correcting fluids and electrolytes, nutritional optimization and support, control of abdominal sepsis, wound care management, pain control, and emotional support to critical care nurses and ward nurses. Key points: Describes the challenges experienced by critical care nurses in caring for patients with enterocutaneous fistulas.The importance of a multidisciplinary approach in caring for patients with enterocutaneous fistulas.The fundamental principles of management of patients with ECF are correcting fluid and electrolytes, malnutrition, infection source control, and wound care. [ABSTRACT FROM AUTHOR]

Introduction: The adaptation of people with ostomies may be associated with and affected by sociodemographic and clinical factors. The present study aimed to investigate the association between the sociodemographic and clinical characteristics and the adaptation of people with an intestinal stoma. Method: An analytical study, carried out through an interview with 200 patients with ostomy for five months. For that, it was applied to scale for the level of adaptation of ostomy patients to measure the physiological domains, self-concept, role function and interdependence and a questionnaire was used in which sociodemographic and clinical information. Descriptive and multivariate analyses were performed to test the study hypothesis. Results: The study pointed out statistically significant associations with male sex, age group below 60, low education level, Stoma time less than one year, below one minimum wage, temporary permanence criteria and presence of complications relation to low scores of adaptation. Conclusions: The association of sociodemographic and clinical factors with the measured adaptive modes provides important information for the planning of nursing care and other care providers, since it directs actions to the aspects that give greater adaptive difficulty to people with stomas and which are the focus of care nursing to this clientele. [ABSTRACT FROM AUTHOR]

Background: Patients with an intestinal ostomy may experience significant sexual dysfunction that may have adverse impacts on quality of life. Appropriate sexual health counseling can be beneficial for these patients. Aim: This study was conducted to determine the effect of sexual counseling on the sexual function and sexual quality of life of women with a permanent intestinal ostomy. Methods: For this experimental study, 60 female patients with a permanent intestinal ostomy were selected through convenience sampling and then randomly assigned to either the intervention or control groups. Patients in the intervention group received four 90-minute individual counseling sessions based on the PLISSIT (permission [P], limited information [LI], specific suggestions [SS], and intensive therapy [IT] model over a period of 4 weeks). The control group underwent routine training. Data were collected by use of a demographic information questionnaire, the Female Sexual Function Index, and the Sexual Quality of Life Female questionnaire. Both groups completed the questionnaires before and after the intervention. Outcomes: Study outcomes were the resulting data for the Female Sexual Function Index and the Sexual Quality of Life Female questionnaire. Results: The results revealed a significant increase in the mean score of sexual function in the intervention group after counseling (P = .001). No significant difference was observed in the mean score of sexual quality of life between the 2 groups before the intervention (P > .05). In contrast, a significant increase was noted in the intervention group's sexual quality of life after the intervention (P = .001). Clinical Implications: The results indicate a need to sexual counseling interventions directed toward sexual function and sexual quality of life in women with permanent intestinal ostomy. Strengths and Limitations: Study strengths include utilization of the PLISSIT model for sexual counseling as an invaluable roadmap for healthcare professionals, systematically addressing patient needs within a tailored framework, and prescribing appropriate strategies over 4 distinct phases. Limitations include the use of convenience sampling and no follow-up duration. Conclusions: This study demonstrated the efficacy of counseling in enhancing sexual well-being of women with permanent intestinal ostomy. [ABSTRACT FROM AUTHOR]

Background: It is still unclear to what extent fast-track (FT) surgery is applicable in paediatric surgery. The aim of the study was to compare the outcome between FT and conventional perioperative care protocols in paediatric intestinal stoma closure to assess the safety for future application. Materials and Methods: This study was a prospective randomised study. Twenty-six paediatric patients who underwent intestinal stoma closure from December 2019 to March 2021 were divided into two groups: group A, conventional methods and Group B FT protocol. The FT protocol included minimal pre-operative fasting, no pre-operative bowel preparation, no routine intraoperative use of nasogastric tube, drain tube, urinary catheter, early post-operative enteral feeding, early mobilisation, non-opioid analgesics and prophylactic use of anti-emetic. Total length of post-operative hospital stays and complications between these two groups were compared. Results: No significant differences were found between the two groups regarding anastomotic leak (nil in both groups), wound infection (7.7% in Group A vs. 0% in Group B; P = 1.0) and wound dehiscence (7.7% in Group A vs. 0% in Group B; P = 1.0). No significant differences were found in post-operative length of stay (median 5, interquartile range [IQR] 4-9 in Group A and median 6, IQR 4-7 in Group B, P = 0.549) and time to appearance of bowel function (passage of stool) (median 2 days in both groups; P = 0.978). Conclusions: FT surgery was comparable to the conventional method in terms of complication and thus can reduce unnecessary interventions. [ABSTRACT FROM AUTHOR]

Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective cohort study was performed to compare the outcomes of primary peritoneal drainage (PD) vs. laparotomy (LAP) in patients with intestinal perforation due to necrotising enterocolitis (NEC) or spontaneous intestinal perforation. Additionally, it aims to identify demographic and clinical characteristics of eligible infants. Material and methods: We identified infants hospitalised in the Neonatal Intensive Care Unit of the University Children's Hospital of Kraków between November 2014 and April 2022 and diagnosed with intestinal perforation due to NEC or spontaneous intestinal perforation. These infants underwent surgical intervention with either PD or LAP . The primary outcomes were death, short bowel syndrome (SBS), and combined outcome of death and/or short bowel syndrome. Odds ratios (OR) were calculated for these outcomes. Statistical significance was determined by a p-value < 0.05, with a 95% confidence interval (CI) other than 1.0. Results: The primary outcome of death occurred in 8 (21%) of patients who had PD and in one (5.8%) of patient who had LAP as the initial surgery (OR = 0.23, 95% CI: 0.02-2). Short bowel syndrome occurred in 14 (36.8%) and 6 (35%) babies who had drainage and LAP, respectively (OR = 0.93, 95% CI: 0.28-3.0). Composite outcome of death and/or SBS occurred in 19 (50%) and 7 (41%) babies who had drainage and LAP as the initial surgery, respectively (OR = 0.70, 95% CI: 0.22-2.2). Conclusions: Our findings indicate that the choice of initial surgical procedure does not significantly impact the combined outcome of death and/or short bowel syndrome. Further studies are necessary to assess the impact of initial surgery on survival, intestinal function, and long-term neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusions Relevance to Clinical Practice Patient or Public Contribution This study aimed to explore the psychosocial adjustment of enterostomy patients on a national scale.Based on a national cross‐sectional survey.From December 2021 and February 2023, a total of 22,040 enterostomy patients were assessed using the ostomy adjustment inventory‐20. Initial analysis involved employing the chi‐square test or Kruskal‐Wallis H test to identify factors influencing the psychosocial adjustment of these patients. Subsequently, multinomial logistic regression was used to determine the factors affecting the classification of psychosocial adjustment levels of enterostomy patients. The reporting of this study adhered to the STROBE checklist.Eventually 21,124 patients with enterostomy were included in this study, out of which 7788 (36.9%) patients with low level of psychosocial adjustment, 11,803 (55.8%) patients with medium level of psychosocial adjustment and 1533 (7.3%) patients with high level of psychosocial adjustment. The factors influencing the classification of psychosocial adjustment levels of enterostomy patients were gender, educational background, carer, enterostomy self‐care knowledge score and medical payment method.The overall psychosocial adjustment level of enterostomy patients is not optimistic, and the factors that may affect the classification of their psychosocial adjustment level are analysed. Individualised intervention should be given according to different psychosocial adjustment levels of enterostomy patients.The number of enterostomy patients with a high level of psychosocial adjustment is small in relation to the total number of enterostomy patients, and caregivers can provide health education to enterostomy patients by analysing the factors affecting the level of psychosocial adjustment of enterostomy patients.None. [ABSTRACT FROM AUTHOR]

Introduction: The efficacy of antibiotics for diverticulitis without abscess or peritonitis (uncomplicated diverticulitis) is controversial. We aimed to investigate the effectiveness of antibiotics for uncomplicated diverticulitis. Methods: We collected admission data for patients with acute uncomplicated diverticulitis using a nationwide database. We divided eligible admissions into two groups according to antibiotic initiation within 2 days after admission (antibiotic group vs. nonantibiotic group). We conducted propensity score matching and compared the rates of surgery (intestinal resection and stoma creation), in-hospital death, and medical costs between the groups. We also performed multivariate analysis to identify the clinical factors that affect surgery. Results: We enrolled 131,936 admissions; among these, we obtained 6,061 pairs after propensity score matching. Rates of both intestinal resection and stoma creation in the antibiotic group were lower than those in the nonantibiotic group (0.61 vs. 3.09%, p < 0.0001, and 0.08 vs. 0.26%, p = 0.027, respectively). Median costs in the antibiotic group were higher than those in the nonantibiotic group (315,820 JPY vs. 300,175 JPY, p < 0.0001, respectively). Multivariate analysis showed that non-initiation of antibiotics within 2 days after admission was a clinical factor that increased the risk of intestinal resection (odds ratio [OR] = 5.19, 95% confidence interval [CI]: 4.38–6.16, p < 0.0001) and stoma creation (OR = 2.68, 95% CI: 1.53–4.70, p = 0.0006). Conclusion: Our results indicated that antibiotics for uncomplicated diverticulitis expected to have moderate to severe disease activity may reduce the risk of intestinal resection and stoma creation. Further investigations are warranted. [ABSTRACT FROM AUTHOR]

ObjectiveBased on machine learning method, four types of early postoperative frailty risk prediction model of enterostomy patients were constructed to compare the performance of each model and provide the basis for preventing early postoperative frailty of elderly patients with enterostomy.MethodsThe prospective convenience sampling method was conducted and 362 early postoperative enterostomy patients were selected in three hospitals from July 2020 to November 2023 in Shanghai, four different prediction models of Support Vector Machine (SVM), Bayes, XG Boost, and Logistic regression were used and compared the test effects of the four models (MCC, F1, AUC, and Brier index) to judge the classification performance of the four models in the data of this study.ResultsA total of 21 variables were included in this study, and the predictors mainly covered demographic information, stoma-related information, quality of life, anxiety and depression, and frailty. The validated models on the test set are XGBoost, Logistic regression, SVM prediction model, and Bayes on the MCC and F1 scores; on the AUC, XGBoost, Logistic regression, Bayes, and SVM prediction model; on the Brier scores, Bayes, Logistic regression, and XGBoost.ConclusionXGBoost based on machine learning method is better than SVM prediction model, Logistic regression model and Bayes in sensitivity and accuracy. Quality of life in the early postoperative period can help guide clinical patients to identify patients at high risk of frailty and reduce the incidence of early postoperative frailty in elderly patients with enterostomy.

Introduction: Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs. Methods: A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020. Results: Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies. Conclusion: While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. Methods: A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small‐bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. Results: During the 3.5‐year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30‐day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small‐bowel to colon 3.0% and for small‐bowel to small‐bowel 0.6%. Conclusion: A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak. [ABSTRACT FROM AUTHOR]

To systematically evaluate the effects of quality nursing interventions on surgical site wound infections (SSWI), length of stay in the hospital and postoperative complications in patients with colorectal stomas. A search was conducted on Embase, PubMed, Cochrane Library, Web of Science, Wanfang and China National Knowledge Infrastructure databases to retrieve publicly available data from the construction of the database until September 2023 in randomised controlled trials (RCTs) evaluating the effects of applying quality nursing in patients with colorectal cancer (CRC) stoma surgery. Two authors independently performed literature screening, data extraction and quality assessment. Stata 17.0 was applied for our meta‐analysis. Fifteen RCTs with 1186 patients, with 593 patients in each of the quality nursing and control groups, were included. Meta‐analysis revealed that compared with the control group, the incidence of SSWI (odds ratio [OR] = 0.34, 95% confidence intervals [CI]: 0.21–0.54, p < 0.001) and postoperative complications (OR = 0.2, 95% CI: 0.16–0.30, p < 0.001) in the quality nursing group were significantly reduced, and the length of stay in the hospital was significantly shorter (standardised mean difference = −1.12, 95% CI: −1.42 to −0.82, p < 0.001). The application of quality nursing interventions after CRC stoma surgery is effective in reducing the incidence of SSWI and postoperative complications and can also shorten hospital stays. [ABSTRACT FROM AUTHOR]

Background: The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown. Methods: Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations. Results: In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation. Conclusions: The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection. [ABSTRACT FROM AUTHOR]

Background: Data characterizing individuals with a stoma in Portugal is limited. Establishing epidemiological estimates can enhance understanding of this population and facilitate the adaptation of healthcare models. Objectives: To estimate the prevalence and incidence of individuals in Portugal who have undergone intestinal or urinary ostomy in 2021. Methodology: Observational, longitudinal, and retrospective study using a stoma appliance dispensing database. Results: In 2021, an estimated 22,045 individuals had at least one stoma, with 19,793 [95%CI:19,599;19,994] having an intestinal/urinary stoma. Most of these individuals were men (61.4%) with a mean age of 70.5 years and resided in the inland region of Portugal. Colostomy was the most prevalent type of intestinal/urinary stoma (48.8%). The estimated incidence of new cases was 6,622, of which 5,834 [95%CI:5,680;5,984] were intestinal/urinary stomas. Conclusion: These results characterize the profile of individuals with intestinal and urinary stomas in Portugal. They may be useful in adjusting prevention and health monitoring programs for this population and allocating specialized resources. [ABSTRACT FROM AUTHOR]

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: An intestinal stoma is a surgically created opening in the anterior abdominal wall. An ileostomy involves the exteriorisation of the ileum on the abdominal skin while colostomy involves connection of the colon to the skin of abdominal wall. Indications for stomas are intestinal obstruction due to benign or malignant disease, perforation with peritonitis, ulcerative colitis or crohn's disease, mesenteric ischemia, colonic growth, colorectal malignancies, anorectal malformations and high anal fistula. This study is aimed to study the different types of stomas, their indications, complications and measures to minimise the complications. Methods: Hospital based prospective longitudinal study conducted on 50 individuals admitted to SVRRGG Hospital, Tirupati, who underwent intestinal stoma creation from April, 2021 to March 2022. Results: The most common indications for stoma construction was Peritonitis(40%). The most common type of stoma constructed was ileostomy(62%) followed by colostomy (34%). 18 patients developed complications and the most common complication observed was Hernia/Parastomal hernia 12%, Local sepsis 8%, Necrosis 8%excoriations (4%), followed by stomal retraction (4%). Average Hospital stay was 16 - 20 days. Conclusion: The study showed stoma construction high in an old age group, mostly done as an emergency procedure compared to an elective procedure. The most common stoma constructed was loop ileostomy. There is a high incidence of peristomal complications related to that. The complications are better managed with proper preoperative planning with effective stoma care in the postoperative period. [ABSTRACT FROM AUTHOR]

Ileostomies are typically created at the time of intestinal and multivisceral transplantation to assist in graft monitoring with endoscopy and biopsies. Often, these ostomies are reversed with a takedown procedure once there is stable graft function, but data are limited on associated complications of the takedown procedure for patients with intestinal transplants. To assess complications associated with takedowns in this patient population, we performed a retrospective analysis of patients who had an intestinal transplant with elective ostomy takedown after transplant. No prisoners were used in the study and this manuscript is in compliance with the Helsinki Congress and the Declaration of Istanbul. A total of 16 patients, 10 isolated patients with intestinal transplants and 6 patients with multivisceral transplants, were included in the study, and takedown occurred at a mean of (236.8 ± 117.1) days after transplant. Of the 16 patients, 5 patients (31%) had uncomplicated courses after takedown with no infection, no rejection, and no hospital readmission within 3 months of takedown. The rest of the patients (69%) developed either infection or rejection within 3 months of takedown, and 1 patient died of infection after ileostomy takedown. This case series highlights the high risk of complications after ileostomy takedown for patients with intestinal transplants and contributes to the growing debate regarding the role of ileostomy creation and reversal in patients with intestinal transplants. [ABSTRACT FROM AUTHOR]

To assess the effect of telemedicine on stoma‐related complications in adults with enterostomy, we conducted a meta‐analysis to evaluate the effects of the telemedicine group compared to the usual group. Literature searches were performed in PubMed, Embase, Web of Science, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang and VIP databases from their inception up to October 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Data collected were subjected to meta‐analysis using Review Manager 5.3 software. The final analysis included a total of 22 articles, encompassing 2237 patients (telemedicine group: 1125 patients, usual group: 1112 patients). The meta‐analysis results demonstrated that, compared to the usual group, the telemedicine group significantly reduced the overall occurrence of stoma‐related complications, with an odds ratio (OR) of 0.22 (95% CI = 0.15–0.32, p < 0.00001). Furthermore, it resulted in a decrease in stoma complications (OR = 0.27, 95% CI = 0.15–0.47, p < 0.00001) and peristomal complications (OR = 0.25, 95% CI = 0.19–0.34, p < 0.00001). Therefore, the existing evidence suggests that the application of telemedicine can reduce the incidence of stoma and peristomal complications, making it a valuable clinical recommendation. [ABSTRACT FROM AUTHOR]

Background: To determine variables associated with outcomes in infants with intestinal failure (IF) and ostomy following reanastomosis (RA). Methods: A single‐center, descriptive cohort study of 120 infants with IF and a stoma from January 2011 to December 2020 with subsequent RA during initial hospitalization. The primary outcome was achievement of enteral autonomy (EA) following RA. Other outcomes were duration of hospital stay, and mortality. Penalized logistic regression and linear regression were used for data analysis. Results: The median gestational age was 26 weeks, and the median birth weight was 890 g. Three infants died. The median duration between ostomy creation and RA was 80 days (interquartile range; 62.5, 100.5). For each additional day of discontinuity, the odds of EA decreased by 2% (odds ratio [OR] = 0.980; 95% confidence interval [CI]: 0.962, 0.999; P = 0.038), and death increased by 4.2% (OR = 1.042; 95% CI: 1.010, 1.075; P = 0.009). For each additional mL/kg/day of enteral feeds at RA, the odds of EA increased by 7.5% (OR = 1.075; 95% CI: 1.027, 1.126, P = 0.002) and duration of hospital stay decreased by 0.35 days (slope coefficient = −0.351; 95% CI: −0.540, −0.163; P < 0.001). Conclusion: Shorter duration of intestinal discontinuity and enteral nutrition before RA could positively influence EA and duration of stay in infants with IF and ostomy following RA. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intestinal stomas are commonly constructed in an emergency as well as elective setting for a variety of indications. Historically associated with a high morbidity, evolution of skills on the part of the surgeon has lead to better understanding of the indications, technique of construction and management of a stoma. This study aims to evaluate the above-mentioned parameters and hence improve the outcome of patients undergoing a stoma. AIM AND OBJECTIVE: 1. To study the various indications of intestinal stomas. 2. To study the techniques of intestinal stomas. 3. To study the complications of intestinal stomas and their management. 4. To study the overall compliance of patients in whom a stoma was constructed. PATIENTS AND METHODS: 50 patients admitted in M K C G Medical college and Hospital Berhampur and later operated and managed with a stoma were closely followed up from the date of admission to the date of discharge and the various parameters were studied. RESULTS: A total of 50 patients were included in the study who underwent stoma formation at this hospital from November 2022 to October 2023. A total of 17 patients, for whom the stoma was constructed, had hollow viscous perforation. Although the site of the perforation varied, the intraoperative findings warranted a stoma in these patients. Loop ileostomy was the most commonly performed surgery (n=16) amongst patients who presented with hollow viscous perforation as the perforation was most commonly located in the ileum or the base of appendix. Only one patient (n=1) underwent a transverse loop colostomy for a perforation in the sigmoid colon. Malignant bowel obstruction was the second most common cause (n=8). Patients with malignant bowel obstruction needed a stoma either for decompression or diversion (n=4 each). All patients with decompression were done a transverse loop colostomy whereas patients requiring diversion were done a loop ileostomy, end ileostomy or an end colostomy according to the level and severity of obstruction. Benign cause of intestinal obstruction was the third most common etiological factor associated with construction of a stoma. However, it is worth noting that benign diseases accounted for 78% (n=39) of all causes of stoma placement. CONCLUSION: Construction and management of stoma was associated with a few complications. Most patients however tolerated the procedure well and the overall compliance was satisfactory. Loop ileostomy was the commonly constructed stoma and the one associated with most complications. Transverse 6 loop colostomy was associated with no complications and was extremely well tolerated. [ABSTRACT FROM AUTHOR]

This technical report discusses a surgical method called "peristomal cerclage" used to repair stoma prolapse, a common complication after stoma construction. The method involves placing a vessel tape around the colostomy to fix the prolapse. The report includes a case study of a patient who underwent this procedure and had successful long-term results. The authors highlight the importance of reporting on the outcomes of this method as it becomes more widely used. They also mention that the procedure may not be suitable for all cases due to the risk of necrosis and perforation. [Extracted from the article]

Colorectal cancer is typically treated through surgery, and self‐care skills play a crucial role in disease adaptation and quality of life improvement. Therefore, this study aimed to investigate the effectiveness of a multimedia patient education intervention on enhancing the self‐care and quality of life among patients with a postoperative stoma as well as on establishing an easy‐to‐use ostomy self‐care skills assessment. The sample comprised 108 patients with new ostomies who were randomly assigned to two groups. Data were collected from June 2018 to March 2019. The conventional education service program group received individual education in the hospital environment, consisting of four 3‐h sessions delivered over 4 consecutive days. The multimedia group viewed a multimedia educational program using a laptop. Data were collected at baseline and 3 months after the intervention using a demographic questionnaire, an ostomy self‐care ability scale and the Stoma Quality of Life Scale. Before the intervention, there were no significant differences in self‐care ability and quality of life scores between the two groups (p = 0.764 and p = 0.466, respectively). However, 3 months after the intervention, the group that received the multimedia software intervention showed significantly higher self‐care ability and quality of life scores compared to the group that received conventional education services (p < 0.001). When a set threshold is reached, self‐care ability and a good quality of life can be met. The threshold value of the ostomy self‐care skill scale was determined to be 20 points, resulting in a sensitivity of 77.8% and a specificity of 75.5%. The results indicate that the multimedia education program enhanced home self‐care ability and quality of life among patients with enterostomy. [ABSTRACT FROM AUTHOR]

A meta‐analysis was conducted to comprehensively assess the effect of continuous nursing on wound infection and quality of life in patients with cancer‐related stomas, providing an evidence‐based rationale for the care of these patients. A computerised search of PubMed, Web of Science, Ovid, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data for randomised controlled trials (RCTs) on the effect of continuous nursing on wound infection and quality of life in patients with cancer‐related stoma was conducted from the time the database was created to March 2023. The retrieved literature was screened, data were extracted, and the quality of the literature was evaluated according to the inclusion and exclusion criteria. Meta‐analysis was performed using RevMan 5.4 software. Seventeen RCTs involving 1437 patients were included. Of the 1437 patients, 728 were in the continuous nursing group and 709 were in the control group. The results showed that continuous nursing significantly reduced the rate of wound infection in patients with cancer‐related stomas (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.16–0.53, p < 0.001) and improved their quality of life (standardised mean difference: 1.90. 95% CI: 1.32–2.47, p < 0.001). Available evidence suggests that continuous nursing for patients with cancer‐related stomas can significantly reduce wound infections and improve their quality of life. [ABSTRACT FROM AUTHOR]

Aims: This study compared those living with and without an intestinal stoma in relation to physical and psychological health, stress and coping, quality of life and resilience. Also, identifying factors that could be used to promote better self‐care in stoma patients in the future. Design: A cross‐sectional and comparative study design was employed. Methods: Participants were recruited via email and social media (Facebook and Twitter) between August 2018 and March 2019, to complete an online survey. The data were analysed using analysis of variance to examine group difference and a series of hierarchical linear regression analyses determining predictors of psychological well‐being. Results: Of 278 participants aged 18–68 years who completed the survey, 129 (46%) had a stoma and reported significantly poorer physical health. Approximately one‐fifth experienced problems with stoma management. Psychological well‐being was mediated by the duration of living with a stoma (under 3 years) and frequency of leaks (weekly and monthly). [ABSTRACT FROM AUTHOR]

Abstract Background Very early-onset inflammatory bowel disease (VEOIBD) with interleukin-10 (IL10R) signaling deficiency usually requires enterostomy in patients who are refractory to traditional treatment. This study aimed to evaluate long-term outcomes after enterostomy for VEOIBD patients with IL10R signaling deficiency. Methods The medical records of all patients undergoing enterostomy for signaling deficiency were retrospectively assessed during 2012.1–2022.7 in a tertiary teaching hospital, Children’s Hospital of Fudan University, Shanghai, China. Data on disease history, diagnosis and details of enterostomy and stoma closure and follow-up were collected. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors associated with the long-term outcome of delayed stoma closure. Results A total of 46 patients underwent an enterostomy, 19 who required emergency enterostomy and 27 with selective enterostomy. After ten years of follow-up, 35 patients underwent hematopoietic stem cell transplantation (HSCT), and 25 patients were alive after HSCT. The median timeframe between HSCT and stoma closure was 19.6 [15.9,26.2] months. Nineteen patients underwent stoma closure and had an average age of 3.9 ± 1.5 years; 6 patients were waiting for stoma closure. Based on a univariate logistic model, risk factors significantly associated with late stoma closure were age at enterostomy and age at HSCT. However, multivariate logistic regression showed no statistically significant factor associated with late stoma closure. There was no significant difference between the stoma closure group and delay closure group in the z scores of weight for age at follow up. Conclusions This study determined the long-term outcomes after enterostomy for VEOIBD with interleukin-10 signaling deficiency. The appropriate time point of enterostomy and HSCT may improve quality of life in the long term.

Trichobezoar is a rare diagnosis among pediatric patients highlighting underlying psychiatric illness. Gastric bezoar with a long tail extending into small bowel may present with varied presentation including small bowel obstruction. Isolated small bowel trichobezoar is rare making diagnosis difficult highlighted in the index case. [ABSTRACT FROM AUTHOR]

Background: Very early-onset inflammatory bowel disease (VEOIBD) with interleukin-10 (IL10R) signaling deficiency usually requires enterostomy in patients who are refractory to traditional treatment. This study aimed to evaluate long-term outcomes after enterostomy for VEOIBD patients with IL10R signaling deficiency. Methods: The medical records of all patients undergoing enterostomy for signaling deficiency were retrospectively assessed during 2012.1–2022.7 in a tertiary teaching hospital, Children's Hospital of Fudan University, Shanghai, China. Data on disease history, diagnosis and details of enterostomy and stoma closure and follow-up were collected. Univariate and multivariate logistic regression analyses were used to evaluate the risk factors associated with the long-term outcome of delayed stoma closure. Results: A total of 46 patients underwent an enterostomy, 19 who required emergency enterostomy and 27 with selective enterostomy. After ten years of follow-up, 35 patients underwent hematopoietic stem cell transplantation (HSCT), and 25 patients were alive after HSCT. The median timeframe between HSCT and stoma closure was 19.6 [15.9,26.2] months. Nineteen patients underwent stoma closure and had an average age of 3.9 ± 1.5 years; 6 patients were waiting for stoma closure. Based on a univariate logistic model, risk factors significantly associated with late stoma closure were age at enterostomy and age at HSCT. However, multivariate logistic regression showed no statistically significant factor associated with late stoma closure. There was no significant difference between the stoma closure group and delay closure group in the z scores of weight for age at follow up. Conclusions: This study determined the long-term outcomes after enterostomy for VEOIBD with interleukin-10 signaling deficiency. The appropriate time point of enterostomy and HSCT may improve quality of life in the long term. [ABSTRACT FROM AUTHOR]

Background: Preoperative management of Hirschsprung's disease (HD) is currently being conducted with the goal of performing single-stage radical surgery without ileostomy. Methods: We retrospectively reviewed HD cases between 2013 and 2022, as well as their outcomes related to preoperative management. Results: Thirty-nine patients with HD were included in this study, including short-segment HD (30 cases), long-segment HD (4 cases), and total colonic aganglionosis (5 cases). Among these 39 patients, 95% (37 of 39 patients) underwent single-stage radical surgery after management with glycerin enema use (n = 13), irrigation with tube insertion each time irrigation was performed (n = 13), and irrigation using a tube placed in the bowel (n = 11). Conclusions: Preoperative management of patients with HD allowed for single-stage surgery of long-segment HD and total colonic aganglionosis. Cases that could be managed without performing an emergency enterostomy during the neonatal period were managed with irrigation until radical surgery was performed. [ABSTRACT FROM AUTHOR]