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One of the biggest challenges for specialist stoma care nurses (SCNs) caring for anyone living with a stoma is that of being confronted with a problematic stoma. This can be described as an ostomy that continues to cause leakage issues for the patient which, if persistent can quickly impact negatively on their quality of life. A convex stoma appliance, also termed convexity, is a possible solution to a problematic stoma. However, the use of a convex appliance should be considered only after a thorough assessment has been undertaken by a specialist SCN. Professionally, stoma care nursing has advanced greatly in recent years and there has been a realisation that there is a need for clinical guidelines to direct practice and offer a process for the novice SCN to follow. This realisation has been the catalyst behind the development of the new guideline for the assessment and use of convexity by the Association of Stoma Care Nurses UK, which was published this year ( https://ascnuk.com/ ). This article explores the concept of convexity and how the guideline can assist the practice of specialist SCNs, as well as that of ward and community-based nurses who wish to gain more information on using convexity within the specialist sphere of stoma care.

Postoperative Komplikationen nach Anlage eines Enterostomas haben einen beachtlichen Einfluss auf die Lebensqualitat der Patienten. Die akkurate operative Technik steht bei deren Pravention im Vordergrund und setzt fundierte aktuelle chirurgische Kenntnisse sowie ausreichende Erfahrung voraus. Eindeutig nachgewiesen ist die prophylaktische Bedeutung der praoperativen Konsultation sowie perioperative Betreuung durch einen Stomatherapeuten. Je nach Schwergrad der Komplikation sollte zunachst eine ambulante konservative Behandlung eingeleitet werden. Ist die konservative Behandlung nicht mehr ausreichend, kommen eine operative lokale Revision oder die Laparotomie infrage, wobei die Indikation sehr zuruckhaltend gestellt werden sollte. Dieser Artikel gibt eine Ubersicht der aktuellen Evidenz hinsichtlich Pravention und Behandlung postoperativer Stomakomplikationen.

Urogenital involvement in neurofibromatosis is extremely rare and thus is less documented. Herein, we discuss a 11-year-old boy who was referred with a diagnosis of neurofibroma bladder on bilateral flank ureterostomy with mild renal failure. A diagnosis of neurofibroma of the bladder with ureterohydronephrosis had been made and partial excision had been attempted, followed by bilateral ureterostomy because of increasing ureterohydronephrosis. He was 13 years and wanted to be dry as he wanted to go to school. With the plan of attaining dryness with stable upper tracts, he was posted for surgery. Near-total excision followed by a sigmoid conduit was performed. The biopsy was reported as plexiform neurofibroma and is on regular follow-up, dry on a stoma bag with stable renal parameters.

Management of malignant left-sided colonic obstruction remains challenging and requires a stoma in 40–65% of patients. In those with obstructive splenic flexure colon cancer (OSFCC), a debate still exists regarding the most appropriate surgery. The aim of this muticenter study was to report and compare the different surgical procedures in OSFCC patients with a special focus on operative and histological characteristics and survival outcomes including 12-month stoma-free survival. Between 2000 and 2015, 2325 patients were treated for obstructive colon cancer in centers members of the French National Surgical Association (AFC). Among them, 198 underwent surgery for OSFCC and were retrospectively analyzed. Patients with OSFCC and proximal colonic ischemia or perforation were excluded. Four procedures were performed: decompressing stoma (DS, 39%), splenic flexure colectomy (SFC, 39%), subtotal colectomy (STC, 17%,) and left hemicolectomy (LHC, 5%). All patients treated with LHC underwent a Hartmann’s procedure. There was no significant difference between groups for postoperative mortality and morbidity. Hospital stay was significantly longer after DS. The length of the specimen, longitudinal resection margins and number of harvested lymph nodes were significantly higher in the STC group. There was no difference for overall and disease-free survival. Stoma-free survival was significantly lower after LHC (62%) in comparison with the other groups (p

Patients at risk of recurrence after curative surgery for rectal cancer usually receive adjuvant chemotherapy. Postoperative recovery after low anterior resection (LAR) for rectal cancer can be improved by placement of a diverting stoma to reduce anastomotic leakage. However, it remains unclear how a diverting stoma affects administration of adjuvant chemotherapy in these patients. We identified Japanese patients with rectal cancer who underwent LAR in 2014 and received adjuvant chemotherapy within 12 months of surgery in the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Doses of five types of chemotherapy administered (tegafur/uracil, tegafur/gimeracil/oteracil potassium, capecitabine, 5-fluorouracil, and oxaliplatin) were assessed according to the presence or absence of diverting stoma and the timing of stoma closure. There was no significant difference in the cumulative doses of chemotherapy administered in the 12 months after LAR between patients with and without diverting stoma, but more doses were administered in the early postoperative period (0–2 months after LAR) in patients without diverting stoma. Also, more doses of chemotherapy, regardless of type, were administered in the late closure group (7–12 months after LAR) than in the early closure (≤ 6 months) and no closure groups. Presence of a diverting stoma did not influence the dose of adjuvant chemotherapy administered within 12 months after LAR but could have delayed the start of adjuvant chemotherapy. Patients with late closure of a diverting stoma received more doses of adjuvant chemotherapy administered over 12 months.

Purpose The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%–40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure. Methods An unpaired case–control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis. Results 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97–17.68). Conclusions The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

In Japan, the actual number of stoma constructions and stoma closures is not known. The aim of this study was to conduct a survey to determine the number of gastrointestinal stoma constructions and closures in Japan.Enrolled participants comprised patients undergoing selected gastrointestinal surgeries who were recorded in the National Clinical Database. This database uses the "Common Items for Gastrointestinal Surgeons." These procedures were formulated by the Japanese Society of Gastroenterological Surgery during 2013-2018.According to the National Clinical Database, a total of 154,323 gastrointestinal stomas were constructed between January 1, 2013 and December 31, 2018. By procedure, there were 78,723 cases of stoma construction, 39,653 of abdominoperineal resection, 2470 total pelvic exenteration procedures, and 33,572 Hartmann's procedures. The ratio of stoma closures to stoma constructions increased annually in patients under 70 y of age but not in older patients. Approximately 35% of total colectomies, 60% of proctocolectomies, and 20% of low anterior resections were accompanied by stoma construction. The number of patients with rectal cancer who underwent colostomy increased gradually during the study period and the number who underwent stoma construction increased among older patients.The number of cases of gastrointestinal stoma construction has increased gradually in Japan, and the proportion of older patients is increasing each year. The purposes and surgical techniques for stoma construction are diverse and are expected to increase in Japan, a super-aged society.

Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed to clarify the risk factors for SOO after IPAA, focusing on the anatomical perspective.This study included 68 UC patients who underwent IPAA with diverting ileostomy. These cases were analyzed based on clinicopathological factors and computed tomography (CT)-based anatomical factors.SOO was identified in 18 patients (26.5%). We compared this SOO group with the non-SOO group. The two groups significantly differed in sex distribution, and patients in the SOO group tended to have a longer postoperative hospital stay. Regarding surgery-related factors, patients who underwent two-stage surgery and experienced high-output syndrome tended to develop SOO. Analysis of anatomical risk factors revealed that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA-bEAS). This tendency remained significant even with adjustment for patient height. In multivariate analyses, adjusted rSMA-bEAS (191.0 mm/m) and male sex were independent risk factors associated with SOO.A long rSMA-bEAS distance suggests that the mesentery is likely to be under tension. In such cases, surgeons should endeavor to avoid tension in the mesentery as much as possible.

Background: Small-bowel ostomies and large-bowel ostomies are two subtypes of intestinal ostomies based on the portion of the intestine that is exposed above the skin. Protecting the anastomosis from infection and keeping the peritoneum clean are critical functions of ileostomy and colostomy. Objective: to evaluate short term outcome of ileostomy and colostomy closures to recognize which procedure is better for diversion based on the outcomes of the stoma reversal. Methods: Two groups of 32 patients having a colostomy or an ileostomy in Zagazig University Hospitals underwent a clinical comparison of the outcomes of stoma closure. 16 patients in Group 1 had an ileostomy for reversal. Those in Group 2 who had a temporary colostomy for reversal included 10 patients with Hartmann procedure and 6 patients with simple loop stoma. During the first month, patients were seen at the outpatient clinic once a week, then once a month for the next five months. Results: As regard intraoperative complications: Amount of blood loss was higher among Hartmann’s group (112 ±18 ml) due to severe adhesions during laparotomy compared to ileostomy group (89 ± 16 ml) and loop colostomy group (98 ± 16 ml). In terms of intraoperative blood loss, there was no statistically significant difference between ileostomy and loop colostomy, although there was a statistically significant difference between ileostomy and the Hartman procedure. In the ileostomy group, postoperative problems such as wound infection, anastomotic leakage, ileus, and intraabdominal collection were less common and more easily controlled. Conclusion: Ileostomy closure is superior to colostomy closure as simple closure with small circumferential incision was easier than colostomy which need exploration in most cases.

When it comes to stoma appliances, there are a variety of available products available. Jennie Burch looks at caring for the older person with a stoma and gives some advice on how to make the right selections for each individual

There is limited evidence to suggest that the more distal a penetrating colonic injury, the poorer its expected outcome, prompting consideration of diversion rather than anastomosis when faced with left colonic injury. The clinical outcomes of penetrating colonic trauma in relation to their anatomical location within the colon were reviewed. A review was performed over eight years (2012—2020) of all patients over 18 years who had sustained penetrating colon injury and presented to our trauma centre in South Africa. Direct comparison was made between right colon vs left colon injuries. A total of 450 patients were included; right colon: 260, left colon: 190. Gunshots predominated in the right colon, and the PATI was higher in this group. There were minimal differences in admission physiology and blood gas parameters between groups, but higher damage control surgery and ICU admission rates for the right colon group. There were similar rates of primary repair, anastomosis, and stoma between groups. Leak rates were no different between the two groups, and although overall complication rates were higher for the right colon, there was no difference with regard to gastro-intestinal and other complications, nor for mortality. While regression analysis did identify PATI to be a risk factor for overall complications and mortality, it failed to do so for anastomotic leak. Our study did not demonstrate any difference in anastomotic leak rates or mortality between right vs left colonic injury. We recommend that all colonic injuries should be treated on their own merit, balanced against the patient’s condition, regardless of anatomical location within the colon.

Introduction: In patients with a history of radical cystectomy and with intestinal diversion, urolithiasis in the upper urinary tract is a frequent event. Material and methods: We describe for the first time a case of retrograde endoureterotomy used to treat a calculus proximal to the ureterointestinal junction. Results: This technique is of interest when antegrade access is not possible. In our example, after passing the guidewire percutaneously, and externalize it through the stoma, the left meatus was reached with a resectoscope inserted through the ileal duct. After the use of a balloon to prevent migration of the calculus, a retrograde endoureterotomy was performed with a Collins knife and the stone removed. The patient’s progress was satisfactory. Conclusion: Endoscopic management of calculi in patients with intestinal diversion can be performed with different approaches. We recommend retrograde endoureterotomy as a feasible treatment option for the removal of impacted calculi at the ureterointestinal junction.

Aim: Stoma opening causes patients to experience various problems in terms of physiological, social, psychological, and sexual aspects. All these problems negatively affect the quality of life (QoL) of patients; thus, this study aimed to evaluate the QoL of patients with a stoma. Method: This descriptive cross-sectional study includes 115 patients with a stoma for at least 3 months. Data were collected using the City of Hope Ostomy QoL Questionnaire between March 2015 and June 2016. Approval from the ethics committee and informed consent from participants were obtained. Descriptive statistics, Kruskal-Wallis test, Student t-test, and Mann-Whitney U test were used. Results: Of the 115 participants, the duration of stoma was 17.5±23.2 months. A colostomy is present in 54.8% of patients, ileostomy in 47.8%, and urostomy in 6.1%. The overall QoL score was 5.37±1.32, with subscale scores as follows: physical 4.42±2.78, psychological 5.33±1.45, social 5.37±1.32, and spiritual 6.97±1.70. A statistically significant difference was found between psychological, social subscale, and overall QoL scores of patients with a permanent and temporary stoma (p

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

The most common complication in individuals with ostomies is irritant contact dermatitis from the acidic stoma effluent coming into contact with the peristomal skin. Although protective powders are widely used for the treatment of peristomal skin, there is little scientific evidence to justify their use. The combined use of sodium carboxymethylcellulose cellulose fibers (SCCFs) together with a hydrocolloid dressing for fixation is an effective alternative in the management of these wounds. Here, the authors report a case series of three patients presenting at a stoma therapy clinic with peristomal skin lesions because of severe irritant contact dermatitis. Patients were men aged between 70 and 81 years, had been diagnosed with colon cancer (n = 2) or bladder cancer (n = 1), and had undergone a colostomy (n = 1), ileostomy (n = 1), or Bricker-type ureteroileostomy (n = 1). A semiocclusive care protocol was applied in a moist environment using SCCF and an extrathin hydrocolloid adhesive dressing, and the collection device was secured using adhesive resin and an ostomy belt. The combined use of SCCF and hydrocolloid dressings provided beneficial results to treat the dermatitis, with reduced discomfort after 7 days and lesions healing within 4 weeks.

PURPOSE Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN Scoping literature review. SEARCH STRATEGY Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.

Objectives: To report a case of a stoma reversal in a patient with an acquired, extreme microcolon after a long-standing transversostomy and to give a review of the current literature. Methods: Case report and literature review by performing a PubMed database search, using the keywords Santulli enterostomy, anal atresia, posterior sagittal anorectoplasty and acquired microcolon. Results: An 18-year-old patient with a previous history of anal, rectal and sigmoid atresia, was admitted to our hospital with an acquired microcolon due to a long-standing transversostomy. The patient had a posterior sagittal anorectoplasty at the age of one year, but by reason of an enormous dilatation of the ascending colon and the associated discrepancy of the caliber of the proximal and distal colon, the colostomy was maintained. The patient was lost in follow-up during several years. Now, 16 years later, the patient requested closure of the colostomy. Since barium enemas still showed a dilated colon ascendens and a microcolon descendens, a staged approach was chosen. First, a right hemicolectomy was performed and a Santulli enterostomy was created by constructing an ileocolostomy just proximal of an end ileostomy. Progressively, more transanal bowel movements were seen and barium enemas showed a progressive expansion of the remaining colon and rectum. Test closing of the enterostomy using an inflated bladder catheter did not cause signs of obstruction. During the second stage, 17 months later, at the age of 20 years, the stoma was closed. Now, the patient has two to three solid stools a day, with a complete fecal continence. Discussion: The used technique is well known in pediatric surgery. We successfully implemented it in the treatment of a microcolon in an adult. The advantage is that we can feed the distal colon to achieve expansion, while the enterostomy functions as a venting system, hereby preventing obstructive complaints when the caliber of the colon is still narrow. In conclusion, long-standing colostomas with a concurrent microcolon can be closed but require a step-by-step approach.

Introduction There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However, whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis. Objective To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma. Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure. Results We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups. Conclusion and Recommendation Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis.

Summary The fine morphology of the buccal capsule and intestine (midgut) of the marine free-living nematode Odontophora deconincki was investigated. The cheilostome is armed with six equal claw-like odontia that can evert radially by opening the mouth. Light-refracting accessory buccal structures within the cheilostomatal cuticle alternate with odontia and consist of two elements: anterior armilloids and posterior granular armilliths. The buccal cavity (pharyngostome) is surrounded by a complex of longitudinal and oblique muscles partially attached to the cheilostome cuticle at the sites of the accessory buccal structures and enabling a wide opening of the mouth. With the described stoma condition, the nematode probably scrapes food particles from the substrate surface. In cross-section, the midgut consists of 5-7 cells that appear uniform throughout its length. An extracellular matrix (glycocalyx) over the microvillar brush varies in thickness and stratification depending on presence or absence of food content in the lumen. Abundant spherocrystals (globular inclusions with concentric striations) were present in all gut cells. No indication of endocytosis or digestive vacuoles was observed in the gut cells and extracellular digestion predominates. Most specimens had a gut content formed from a long cylinder of compressed flocculent material with some barely identifiable components and few spherocrystals expelled from the enterocytes. We assume that the nematode diet comprises a wide range of objects, mainly eukariotic epigrowth organisms, which are shorn off and scraped from the surface of sand grains and then ingested.

Anastomosis near the ileocecal valve (ICV) are controversial due to the increased pressure on the suture; in this situation, the valve could be removed at a first stage or at the moment of stoma closure. However, preservation of the ICV has proved important benefits in the long term. The aim of this study is to evaluate its feasibility in neonates with focal intestinal perforation (FIP).Retrospective study (2010-2019) of neonates with FIP who underwent intestinal resection and primary anastomosis. Patients were divided into group A (anastomosis less than 5 cm from ICV) and group B (more than 5 cm).Forty patients were treated. Patients ostomized or with resection of ICV were excluded. Finally, 24 patients (birth weight 1043 ± 594 g (520-3000), age 8.8 ± 7.8 days (2-39)) were included for analysis. Patent ductus arteriosus was present in 75%. There were 6 patients in group A (25%) and 18 in group B (75%). Groups were comparable in terms of gestational age, birth weight, and age at the time of surgery (Ileo-ileal anastomosis closer to the ileocecal junction, in neonates with focal intestinal perforation, is an effective and safe option which also allows the preservation of the ICV avoiding the complications derived from its absence in a group of patients with high morbidity.

Colostomy irrigation (CI) involves instillation of water via the stoma into the colon, where it stimulates peristalsis, causing expulsion of stool and water from the stoma. CI allows colostomates to regain controlled evacuation and faecal continence. The first article considered the impact of CI on colostomates' quality of life, including flatus, odour and peristomal skin health, as well as psychological wellbeing. This second article explores the potential barriers to successfully adopting CI. The uptake of CI in the UK remains relatively low. CI is contraindicated in active disease, and there is debate about whether it is suitable in colostomates with stoma-related complications and of different ages. Barriers to uptake among stoma care nurses include misconceptions about safety, physician consent and cost, as well as issues relating to commencement time and the setting and pace of postoperative education. For colostomates, barriers to adherence include short-term issues that can be resolved with nursing support, as well as the time taken to perform irrigation and changes related to older age. Many of these barriers could be overcome with robust education programmes.

Background: Esophageal atresia is a congenital disorder in which there is no esophagus because the proximal and distal esophagus is not connected. Babies with esophageal atresia can show several symptoms: foamy mouth, cyanosis, coughing and tightness, flatulence, oliguria, or worse, pneumonia symptoms. Accompanying anomalies occur in greater than 50% of neonates with esophageal atresia. Esophageal atresia is identified by ultrasound at 18 weeks of gestation, ultrasound, and Magnetic resonance imaging (MRI) of the fetal neck, or examination of a nasogastric tube in the neck of a newborn. The management of esophageal atresia is challenging. The main choice remains the surgical procedure, which usually involves making a stoma on the proximal esophagus and gastrostomy. However, surgery has risky complications. Case: In this case, it was reported that a 22-day-old baby with tracheoesophageal fistula (TEF) type C with Ventricular Septum Defect and Atrial Septum Defect and Double Outlet Right Ventricle (DORV) underwent esophagostomy surgery with general anesthesia. Conclusion: Anesthesia management with general anesthesia, intubation using intravenous ketamine 3 mg, fentanyl 3µg, atracurium 1.5 mg gives stability for esophagostomy in a patient with a double outlet right ventricle.

Aim: The purpose of this study was to determine the experiences of baccalaureate nursing students with stoma bags and adaptors over 24 hours. Method: The study was semi-experimental. Participants included 80 students from two nursing faculties with 10 students per class. The students were chosen by random sampling. Stoma adaptors were worn as a pouch and removed after 24 hours. A data collection form was used to gather the students’ demographic and descriptive characteristics, previous degree of knowledge and experience about stomas, and experiences and feelings they had during the process. In the data analysis, percentages and the chi-square test were used. Results: Among the students, 86.3% stated they worried continuously that the stoma bag would leak and 30.0% stated they were anxious because of the stoma. Four main themes emerged from the answers: (1) restriction in social activities, (2) restriction in physical activities, (3) worry about a stoma leakage, and (4) effect on body image. All of the students said that they understood better how stoma patients felt and that it was a good experience for them. Conclusion: These experiences and feelings are important for baccalau reate nursing students to have more awareness about living with a stoma.

Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer. Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen. Relevance: Urothelial cancer at all stages can metastasize to other organs. Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis. Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis. There are no clinical guidelines establishing their correct management. Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.

Introduction The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. Aim To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. Material and methods As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. Results The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03–3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. Conclusions CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients.

Colostomy irrigation (CI) involves instillation of water via the stoma into the colon, where it stimulates peristalsis, causing expulsion of stool and water from the stoma. CI allows colostomates to regain controlled evacuation and faecal continence. A review of the literature suggests that CI is safe and can have a positive impact on key factors affecting quality of life, including flatus, odour and peristomal skin health. CI is also convenient in avoiding the need for frequent disposal of used appliances. All of this has also been shown to improve psychological wellbeing. However, use of CI in the UK remains relatively low. This first article considers the impact of CI on colostomates' quality of life, and the second will explore the barriers to uptake.

Patients with acute colorectal obstruction due to malignancy in the right-sided colon are treated with primary resection and anastomosis. However, considering the generally poor status and prognosis, less-invasive, palliative treatment is desirable, particularly for unresectable malignancies. An ileostomy is useful, but the patient must manage the stoma, which worsens the quality of life. We developed a palliative surgical procedure, termed the “Separation surgery of the right-sided colon,” for treating an obstruction due to unresectable right-sided colon cancer. We identified and divided the ileum and the transverse colon and anastomosed the upper ileum to the lower transverse colon. Then, we created a mucous fistula with the loose ends of the lower ileum and the upper transverse colon. We performed this procedure in five patients. Stoma pouches were unnecessary. No comorbidities were observed, including anastomotic leakage. The “Separation surgery of the right-sided colon” was useful as palliative surgery.

Here, we report our experience with a 5-mm trocar site hernia (TSH) near a stoma. This is the first report describing the relationship between TSH and extraperitoneal colostomy. A 72-year-old man underwent laparoscopic abdominoperineal resection with extraperitoneal sigmoid colostomy and partial hepatectomy for rectal cancer accompanied by synchronous liver metastasis (pT3N1aM1a Stage IVA Union for International Cancer Control [UICC] 8th edition). The surgical procedures were completely performed without morbidity. After 1 year, he presented to our hospital with sudden nausea. Computed tomography (CT) revealed small bowel obstruction due to a 5-mm TSH, 1 cm from the stoma. The patient underwent laparoscopic hernia repair. The incidence of a 5-mm TSH is low. However, an abdominal wall vulnerability caused by the extensive exfoliation of the retroperitoneum due to the construction of the colostomy was observed, and the extraperitoneal colostomy influenced the onset of the 5-mm TSH. When the port and hernia sites are located in close proximity to each other, even a 5-mm trocar site may increase the incidence of TSH.

Background Anastomosis-related complications are common after the radical resection of colon cancer. Among such complications, severe stenosis or completely occluded anastomosis (COA) are uncommon in clinical practice, and the separation of the anastomosis is even rarer. For such difficult problems as COA or anastomotic separation, clinicians tend to adopt surgical interventions, and few clinicians try to solve them through endoscopic operations. Case presentation In this article, we present a case of endoscopic treatment of anastomotic closure and separation after radical resection for sigmoid carcinoma. After imaging examination and endoscopic evaluation, we found that the patient had a COA accompanied by a 3–4 cm anastomotic separation. With the aid of fluoroscopy, we attempted to use the titanium clip marker as a guide to perform an endoscopic incision and successfully achieved recanalization. We used a self-expanding covered metal stent to bridge the intestinal canal to resolve the anastomotic separation. Finally, the patient underwent ileostomy takedown, and the postoperative recovery was smooth. The follow-up evaluation results showed that the anastomotic stoma was unobstructed. Conclusions We reported the successful application of endoscopic technique in a rare case of COA and separation after colon cancer surgery, which is worth exploring and verifying through more clinical studies in the future.

Dermoid cyst is a congenital and benign disease with most occur on the head and neck. It is rarely that occur on the nasal tip and nasal septum at same time and rarely repair of using nasal septum mucosa. The authors treated a child with dermoid cyst in the nasal tip and septum. Only the dermoid cyst at the tip of the nose caused the change of appearance. Dermoid cyst of nasal septum did not cause any clinical symptoms. She underwent excision of the dermoid cyst at the tip of the nose and endoscopic surgery for the dermoid cyst in the nasal septum and used the nasal septum mucosa for repair at the same time. After 6 months of recovery, the appearance of the nasal tip recovered well without obvious scar, the nasal septum area recovered well, and the local stoma was unobstructed without recurrence. The authors found that this kind of nasal septal cyst with no clinical symptoms can achieve good therapeutic effect through endoscopic surgery and repair of using nasal septum mucosa, with less damage, rapid recovery, and good prognosis.

Purpose: Stoma is a surgical intervention that negatively affects the quality of life and adaptation to social life. The problems experienced by patients with stoma negatively affect the quality of life especially in the postoperative first weeks. Many kinds of nursing interventions to ensure adaptation to social life and to increase the quality of life. The aim of this study was to determine the effect of phone counselling service on adaptation to stoma and quality of life among patients with intestinal stoma Materials and Methods: The study was conducted on patients with intestinal stoma followed up in stoma therapy outpatient clinic of a university hospital. A total of 60 patients (30 in the control group and 30 in the test group) were assigned to two groups by making randomization via computer through "simple randomization method". "Informed Consent Form, Questionnaire for Individuals with Intestinal Stoma, Ostomy Adjustment Inventory and Adaptation of Quality Life Scale" were filled in. The scales were re-applied in both groups in the stoma therapy outpatient clinic in the postoperative 6th and 10th weeks. Results: Phone counselling was effective in increasing the adjustment to stoma and quality of life among patients with stoma in the first 10 weeks after the operation. Conclusion: The test group had higher levels of life quality and social adaptation and also had more responsibilities for self-care.

Surgery is the main method to treat obstructive intestinal obstruction. Stoma formation is desirable in emergency colon surgery. The aim of the study was to compare the results of the newly developed and traditional stoma formation techniques according to the number of wound purulent-inflammatory complications in the early postoperative period in patients with acute intestinal obstruction. Materials and Methods. The authors examined 62 patients with acute intestinal obstruction. The patients were divided into two groups according to the method of stoma formation. The comparison group consisted of 30 patients, who underwent traditional colostomy after obstructive resection of the sigmoid colon (rectosigmoid part of the colon). The main group included 32 patients in whom a stoma was formed using a newly developed method (patent No. 2704477). In patients of the main group, the paracolostomy space was isolated from the abdominal cavity, the preperitoneal and subgaleurotic zones of the paracolostomy space were drained. During the postoperative period local anesthetics and antibacterial drugs were administered through the drain tube. Results. Patients of the comparison group demonstrated more purulent-inflammatory complications of the median postoperative and paracolostomy wounds than those of the control group, 20.2 % (p=0.047) and 23.6 % (p=0.024), respectively. Conclusion. The proposed method of stoma formation helps to reduce wound purulent-inflammatory complications and can be used in the surgical treatment of patients with intestinal obstruction. Keywords: colon cancer, acute intestinal obstruction, postoperative complications, new method of stoma formation. Основным методом лечения обтурационной кишечной непроходимости является оперативное вмешательство. В экстренной хирургии толстого кишечника показано формирование колостомы. Цель исследования – сравнение результатов применения разработанной и традиционной методик наложения колостомы по количеству раневых гнойно-воспалительных осложнений в раннем послеоперационном периоде у больных с острой обтурационной кишечной непроходимостью. Материалы и методы. Клинический материал составили 62 пациента с острой обтурационной кишечной непроходимостью, которые в зависимости от способа формирования колостомы были разделены на две группы. Группу сравнения составили 30 больных, у которых после обструктивной резекции сигмовидной кишки (ректосигмоидного отдела ободочной кишки) выполняли традиционное наложение колостомы. В основную группу были включены 32 пациента, у которых колостома наложена разработанным способом (патент № 2704477). Суть способа состоит в изоляции от брюшной полости параколостомического пространства, дренировании предбрюшинной и подапоневротической зоны параколостомического пространства, введении местных анестетиков, антибактериальных препаратов по дренажу в послеоперационном периоде. Результаты. В группе сравнения гнойно-воспалительных осложнений срединной послеоперационной и параколостомической ран было больше, чем в контрольной группе, на 20,2 % (р=0,047) и 23,6 % (р=0,024) соответственно. Выводы. Предложенный способ формирования колостомы способствует снижению раневых гнойно-воспалительных осложнений и может быть использован в хирургическом лечении больных с обтурационной кишечной непроходимостью. Ключевые слова: рак ободочной кишки, острая обтурационная кишечная непроходимость, послеоперационные осложнения, оригинальный способ формирования колостомы.

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19

The impact of having a stoma on an individual's quality of life (QoL) can be significantly worsened by leakage and consequent peristomal skin complications. Therefore, ostomates require individualised, person-centred and evidence-based care. Stoma care nurses can facilitate this using stoma-specific validated assessment tools, including the Body Profile Assessment Tool, Stoma Quality of Life Tool, Ostomy Skin Tool and Ostomy Leakage Impact Tool. These provide precise, repeatable quantitative data, which avoids reliance on vague language and allows for baseline comparisons to measure progression. This case study describes a female ileostomate who faced a number of stoma-related complications, including body image and confidence. Initial trial-and-error attempts to find an effective combination of products were fragmentary and failed to provide an effective long-term solution. During the COVID-19 pandemic, the patient underwent a remote telephone consultation, aided by digital photography. The stoma care nurse used validated assessment tools to determine the patient's needs. Based on this, she was recommended a new pouching routine suited to her inward body profile, and her progress was measured using the assessment tools. These showed sustained and considerable improvements in peristomal skin health, mental wellbeing and overall QoL. The patient's prescription costs were also dramatically reduced.

Purpose This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults. Methods Scoping review and generation of evidence and consensus-based clinical guidelines. Search strategy The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication. Findings/conclusions This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

Objective: This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy. Patients and methods: We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath. Results: This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications. Conclusion: Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise. Level of evidence Level 4.

Aims: Stoma formation surgery can affect people socially, psychologically and physically. This literature review aims to explore the factors that affect an adult ostomate's sexuality after stoma formation. Methods: The literature search was conducted on three electronic databases: CINAHL, PsychINFO and Medline complete. The search was limited to peer-reviewed studies published in the past 7 years. The reference lists of the identified literature were also searched. Findings: Stoma formation was found to greatly impact sexuality in adults. The main themes identified were: hygiene; satisfaction and desire; self-perception; companionship and sexual relationships; and physical considerations. It was found that people were dissatisfied with the information provided by health professionals about sexuality. Conclusions: Stoma formation was commonly found to negatively affect adults' sexuality. To improve the quality of life of ostomates, these issues need to be thoroughly addressed in healthcare settings.

Background Ileostomy was widely used during colorectal cancer (CRC) surgery and peristomal dermatitis was one of the most common stoma-relative complications. Stoma education class may reduce the rate of peristomal dermatitis. Methods We enrolled patients who were diagnosed with rectal cancer and underwent surgery with ileostomy between January 2018 to December 2018 at a single tertiary hospital. The general demographic information of patients along with the participation in stoma education class and the occurrence of peristomal dermatitis were analyzed. Results A total of 491 patients were included in the study, and 162 patients (32.99%) participated in the stoma education class. Eighty-five patients (17.31%) suffered peristomal dermatitis within one month after ileostomy. The rate of peristomal dermatitis in the stoma education group was significantly lower than that in the control group (11.11% vs. 20.36%, P=0.011). Regardless of the education level, the risk of peristomal dermatitis in the education group was reduced (P

To describe a novel end-to-end “true” reinforced stapling colorectal anastomosis and to assess surgical outcomes in a large case series of advanced cancer patients undergoing this procedure. Anastomotic leakage (AL) remains the main concern following surgery for colorectal cancer. Between September 2006 and May 2018, in the context of the Catalonian Program of Peritoneal Carcinomatosis, 1193 consecutive patients with advanced abdominal and/or pelvic tumors were included in a prospective single-center study. They underwent cytoreductive radical surgery (CRS) in most cases combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Among other surgical procedures, 374 patients underwent rectal resection and colorectal/ileorectal anastomosis, whether alone or associated to other digestive anastomosis. Key aspects of colorectal anastomosis technique were: (1) complete dissection and mobilization of the distal third of the rectum, (2) placement of a stitch that included both ends of the linear stapling of the rectal stump that was knotted on the anvil of the circular stapler, (3) “cleaning” the fatty tissue of the intestinal ends, (4) adjustment of the height of staples to the thickness of the intestinal wall, and (5) a second layer of interrupted nonperforating sutures placed circumferentially to reinforce the stapled anastomoses. A diverting stoma was not performed. According to clinical criteria, of the 1193 patients included, 296 cases underwent CRS (group 1) and 897 cases CRS + HIPEC (group 2). In group 1, 332 surgical procedures were performed, with 248 digestive anastomoses, of which 98 (39.5%) were colorectal anastomoses, associated to other digestive anastomosis in 37 cases. In group 2, 972 surgical procedures were performed, with 707 digestive anastomoses, of which 263 were colorectal (37.2%), 116 were associated with other digestive anastomosis. Ileocolic anastomosis was the most frequently associated digestive anastomosis. 71 major urinary reconstructions, 283 radical hysterectomies and no diverting stoma were performed. Globally, there was only three colo-ileorectal AL (3/374 = 0.8%). The overall 90-day mortality rate was 0.25%. A technical modification to create a “true” end-to-end and completely circular reinforced anastomosis effectively prevents anastomotic leakage in patients with advanced tumors undergoing radical resection of the rectum, with no need of diverting stoma.

Bladder stones are a common complication after augmentation cystoplasty and urinary diversion. However, the treatment of recurrent cystolithiasis in neuropathic children remains a real challenge for urologists and open procedures may be associated with significant morbidity. Currently, mini-invasive management options are available in the therapeutic armamentarium. Herein, we reported a case of Mitrofanoff cystolitholapaxy using a mini PCNL-kit, in a 14-year-old patient with the history of neurogenic bladder due to myelomeningocele managed by bladder augmentation. This technique has been previously described but we have added a unique modification using Nelaton catheter for carefully dilating the Mitrofanoff stoma before inserting an Amplatz sheeth and we report tips and tricks to guarantee a stone free status with one single procedure. Using high energy Holmium laser, this approach is safe and effective even with large stone burden., Highlights • The treatment of cystolithiasis in neuropathic patients with a bladder-neck closure represents a surgical challenge. • Open cystolithotomy is a good option to treat large stone burdens or multiple calculi. • For recurrent stones, endoscopic treatment via a catheterizable channel is an effective option, especially for patients with a closed bladder neck and low-burden stone. • Dilating the channel is the key step. Using serially Nelaton catheter (10-16Fr) is a good trick to preserve the integrity of the Mitrofanoff stoma.

Perineal trauma in children are rare, but they can be life-threatening and surgically challenging conditions in the absence of a standardized therapeutic approach. Colostomy remains important and plays an essential role in minimizing the frequency of perineal wound infections but has known complications. Here, we describe a case of a 7-year-old boy who was a victim of a road traffic accident polytrauma and sustained severe perineal injury. The patient was managed primarily without stoma creation and achieved complete wound healing and continence. This case highlights that selection of primary repair without colostomy must be meticulous and individualized.

Introduction: The installation of a digestive stoma involves changes affecting all aspects of the patients’ lives. The objective of this study was to determine the impact of a digestive stoma on the quality of life of patients operated on at the Yaounde Central Hospital (YCH). Patients and Methodology: We conducted a prospective descriptive study over a period of 12 months from June 2018 to May 2019 in all patients with a digestive stoma for at least 3 months operated on at the YCH. The follow-up was done within 12 months. Quality of life was assessed using the stoma QOL (quality of life) and self-image using the BIS (Body Image Scale). Results: We collected a total of 34 patients, of whom 22 were male, giving an M/F sex ratio of 1.8. The average age of the patients was 42.8 years. The indications were tumoral in 44.11% of cases (n = 15) and non-tumoral in 55.88% of cases (n = 19). The colon was the most frequently ablated organ (n = 26) with 76.5% of colostomies. The complication rate was 67.6%. Stomal oedema was the most common early complication with 38.2% of cases. All patients used colostomy bags. The average time to return to sexual activity was 8 months for men and 9 months for women. 85.3% of the patients had an average impairment of quality of life according to the Stoma Quality of Life Scale. According to the Body Image Scale, 73.5% of the patients had a moderate dissatisfaction with their self-image. Conclusion: The realization of a digestive stoma imposes a long-term follow-up especially on the psychological level in order to allow the empowerment of the patients who all have a modification of their quality of life and their self-image.

Tube obstruction is one of the common complications of tracheostomy. The most frequent cause of tube obstruction is the plugging of tracheostomy tube with mucous plug, clots, or crust. We report a case of low tracheostomy obstructed by a mass of subcutaneous tissue proliferating into the tracheal lumen. When the patient was posted for radical surgery, trachea was cannulated using a regular endotracheal tube (ETT) inserted into the stoma under fiber optic bronchoscope guidance, and general anesthesia was administered. Anatomically distorted tracheostomy tracts may be maintained with customized tracheostomy tubes if available to prevent complications. Any difficulty in inserting tracheostomy tube can be temporarily managed with the ETT inserted into the stoma.

Construction of a diverting stoma can significantly reduce the onset of severe anastomotic leakage in patients with rectal cancer. High-output stoma is one of the most important potential surgical complications after anal function-preserving surgery with ileostomy. Culture-independent techniques have revealed the interaction of the complex intestinal bacterial ecology with various diseases. Our objective was to evaluate the differences in patient characteristics and gut microbiota distribution features in patients with high-output stomas. The cases of 24 consecutive patients who underwent curative resection for rectal cancer at our hospital between November 2016 and June 2018 were reviewed, and the patients were categorized into high-output and low-output groups. Their microbiota were analyzed using next-generation sequencing of ileostomy stool samples collected on postoperative day 7. There was a significant difference in the percentage of Bacteroidetes between the high-output and low-output groups (14.8% vs 0.5%; p=0.01). The percentage of Clostridium butyricum was increased in the low-output group (p=0.01). After the exclusion of those treated with the probiotic Miya-BM, whose principal component is C. butyricum, analyses revealed no significant differences between the high-output and low-output groups. This pilot study provides the first evidence correlating gut microbiota with the pathogenesis of high- output stoma compared with low-output stoma.