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This study aimed to investigate the status of sense of coherence (SOC), acceptance of disability (AD) and psychological distress (PD) of patients with permanent colostomy and evaluate the role of AD in mediating the relationship between SOC and PD. Cross-sectional data were collected from 162 patients with permanent colostomy at stoma care outpatient clinic. Structural Equation Model of the SOC, AD, and PD was established to examine the mediating effect. Results indicated that the SOC and AD of patients with permanent colostomy were both at a low level, and PD was common in patients. In addition, a partial mediating effect of AD between SOC and PD was verified. Enhancing the SOC and AD of patients with permanent colostomy could be essential for alleviating their PD.

OBJECTIVE. Parastomal hernia (PSH) is a common complication that can occur after end colostomy and may result in considerable morbidity. To select the best candidates for prophylactic measures, knowledge of preoperative PSH predictors is important. This study aimed to determine the value of clinical parameters, preoperative CT-based body metrics, and size of the abdominal wall defect created during end colostomy and measured at postoperative CT for predicting PSH development.MATERIALS AND METHODS. Sixty-five patients who underwent permanent end colostomy with at least 1 year of follow-up were included. On preoperative CT, waist circumference, abdominal wall and psoas muscle indexes, rectus abdominis muscle diameter and diastasis, intra- and extraabdominal fat mass, and presence of other hernias were assessed. On postoperative CT, size of the abdominal wall defect and the presence of PSH were determined. To identify independent predictors of PSH development, univariate analysis with the Kaplan-Meier method and multivariate Cox regression analysis were performed.RESULTS. PSH developed after surgery in 30 patients (46%). Three independent risk factors were identified: chronic obstructive pulmonary disease (COPD) as a comorbidity (hazard ratio [HR], 6.4; 95% CI, 1.9-22.0; p = 0.003), operation time longer than 395 minutes (HR, 3.9; 95% CI, 1.5-10.0; p = 0.005), and maximum aperture diameter of more than 34 mm (HR, 5.2; 95% CI, 2.1-12.7; p CONCLUSION. COPD, longer operation time, and larger abdominal wall defect at the colostomy site can predict PSH development. Intraoperative creation of an abdominal wall ostomy opening that is more than 34 mm in diameter should be avoided.

This article considers the implications of a descriptive doctoral study on the long-term care needs of colorectal cancer patients with a permanent colostomy. It explores how figurative language shapes how patients and clinicians describe and perceive illness, including the pitfalls of moralistic and military metaphors, as well as how metaphors can be used for effective clinician–patient communication. It considers how the concept of survivorship is defined and experienced by cancer patients, including the disruption of perceived time and the therapeutic value of narratives. It also looks at the importance and extent of patient empowerment for self-care, as well as the necessity and lack of long-term support for cancer patients after discharge following the 5-year NHS follow-up period. Finally, it proposes how ongoing support could be provided, as modelled by the Care for Life Plan.

Background Parastomal hernias are common with permanent colostomies and prone to complications. The short-term results of trials of parastomal hernia prevention are widely published, but long-term results are scarce. Objective The aim of the study is to detect the long-term effects and safety of preventive intra-abdominal parastomal mesh. Design This is a long-term follow-up of a previous prospective randomized, controlled multicenter trial. Settings This study was conducted at 2 university hospitals and 3 central hospitals in Finland. Patients Patients who had a laparoscopic abdominoperineal resection for rectal cancer between 2010 and 2013 were included in the study and invited for a follow-up visit. Main outcome measures The primary outcomes measured were clinical and radiological parastomal hernias. Results Twenty subjects in the mesh group and 15 in the control group attended the follow-up visit with a median follow-up period of 65 (25th-75th percentiles, 49-91) months. A clinically detectable parastomal hernia was present in 4 of 20 (20.0%) and 5 of 15 (33.3%) subjects in the mesh and control groups (p = 0.45). A radiological parastomal hernia was present in 9 of 19 (45.0%) subjects in the mesh group and 7 of 12 (58.3%) subjects in the control group (p = 0.72). However, when all subjects (n = 70, 1:1) who attended the 12-month follow-up were screened for long-term results according to register data, 9 of 35 (25.9%) subjects in the mesh group and 16 of 35 (45.6%) subjects in control group were diagnosed with a parastomal hernia during the follow-up period (p = 0.10). In addition, only 1 of 35 (2.7%) subjects in the mesh group but 6 of 35 (17.1%) subjects in the control group underwent a parastomal hernia operation during the long-term follow-up (p = 0.030). Limitations The study is limited by the small number of patients. Conclusion Prophylactic intra-abdominal keyhole mesh did not decrease the rate of clinically detectable hernias but reduced the need for the surgical repair of parastomal hernias. Further trials are needed to identify a more efficient method to prevent parastomal hernias. See Video Abstract at http://links.lww.com/DCR/B171. Clinical trial registration https://clinicaltrials.gov. Identifier: NCT02368873. ESTUDIO PROSPECTIVO ALEATORIZADO SOBRE EL USO DE MALLA PROTESICA PARA PREVENIR UNA HERNIA PARAESTOMAL EN UNA COLOSTOMIA PERMANENTE: RESULTADOS DE UN SEGUIMIENTO A LARGO PLAZO: PREVENCION DE HERNIA PARAESTOMAL, NEOPLASIA COLORRECTAL/ANAL: Las hernias paraestomales son comunes con colostomias permanentes y son propensas a complicaciones. Los resultados a corto plazo de los ensayos sobre la prevencion de la hernia parastomal se publican ampliamente, pero los resultados a largo plazo son escasos.El objetivo del estudio es detectar los efectos a largo plazo y la seguridad de la malla parastomal intraabdominal preventiva.Este es un seguimiento a largo plazo de un estudio aleatorizado prospectivo, controlado y multicentrico previo.Este estudio se realizo en dos hospitales universitarios y tres hospitales centrales en Finlandia.Los pacientes que se sometieron a una reseccion abdominoperineal laparoscopica por cancer de recto 2010-2013 fueron incluidos en el estudio e invitados a una visita de seguimiento.Hernias parastomales clinicas y radiologicas.Veinte sujetos en el grupo de malla y 15 en el grupo control asistieron a la visita de seguimiento con una mediana de seguimiento de 65 meses (25-75 ° percentil 49-91). Una hernia paraestomal clinicamente detectable estuvo presente en 4/20 (20.0%) y 5/15 (33.3%) en los grupos de malla y control, respectivamente (p = 0.45). Una hernia parastomal radiologica estuvo presente en 9/19 (45.0%) en el grupo de malla y 7/12 (58.3%) en el grupo de control (p = 0.72). Sin embargo, cuando todos los sujetos (n = 70, 1: 1) que asistieron a los 12 meses de seguimiento fueron evaluados para obtener resultados a largo plazo de acuerdo con los datos del registro, 9/35 (25.9%) sujetos en el grupo de malla y 16/35 (45,6%) sujetos en el grupo control fueron diagnosticados con una hernia paraestomal durante el periodo de seguimiento (p = 0,10). Ademas, solo 1/35 (2.7%) en el grupo de malla pero 6/35 (17.1%) en el grupo control se sometieron a una operacion de hernia paraestomal durante el seguimiento a largo plazo (p = 0.030).El estudio esta limitado por un pequeno numero de pacientes.La malla intra-abdominal profilactica en ojo de cerradura no disminuyo la tasa de hernias clinicamente detectables, pero redujo la necesidad de la reparacion quirurgica de las hernias paraestomales. Se necesitan ensayos adicionales para identificar un metodo mas eficiente para prevenir las hernias parastomales. Vea el resumen del video en http://links.lww.com/DCR/B171. (Traduccion-Dr. Gonzalo Hagerman).NCT02368873.

Trabajo fin de grado. Defendido en julio de 2022. El cáncer colorrectal causa la muerte de un gran número de personas; en estas últimas décadas, gracias a la detección precoz, se ha logrado disminuir. Una de las principales soluciones para frenar o ralentizar el crecimiento de neoplasias malignas de colon es la formación de ostomías intestinales. Por el contrario, las colostomías ocasionan grandes efectos colaterales, especialmente relacionados con la calidad de vida que se ve afectada negativamente. El presente proyecto de investigación consistirá en un estudio cuantitativo observacional descriptivo y se pretenderá evaluar la calidad de vida de las pacientes con colostomía permanente que acudan a la Consulta de Estomaterapia del Hospital Universitario de Móstoles (Comunidad de Madrid) Abstract: Colorectal cancer causes the death of a large number of people; in recent decades, thanks to early detection, it has been reduced. One of the main solutions to stop or slow down the growth of malignant neoplasms of the colon is the formation of intestinal ostomies. On the contrary, colostomies cause great collateral effects, especially related to the quality of life, which is negatively affected. The present research project will consist of a descriptive observational quantitative study and will aim to evaluate the quality of life of patients with permanent colostomy who attend the Stomatherapy Clinic of the University Hospital of Móstoles (Community of Madrid) Ordenador con navegador de Internet; Adobe Acrobat Reader 50 p. (Según el contador de la aplicación)

Background : Colorectal cancer patients with permanent colostomy may suffer stigma, negative coping style, and low quality of life at varying degrees, which may be improved by the mindfulness-based stress reduction (MBSR). In recent years, MBSR has been used in the comprehensive treatment of colorectal cancer with permanent colostomy, hoping to bring a positive outcome. However, the practical application effect of MBSR has not been elucidated so far. Therefore, this study conducted a meta-analysis to evaluate the effects of MBSR on stigma, coping style, and quality of life in colorectal cancer patients with permanent colostomy, providing reliable evidence for clinical application. Methods : Randomized controlled trials (RCTs) reporting MBSR on stigma, coping style, and quality of life in patients with permanent stoma of colorectal cancer published before December 2021 will be searched in online databases such as the PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, and Chinese Scientific Journal Database. The quality of the literature will be evaluated using the risk of bias assessment tool in Revman 5.4. Meta-analysis will be performed using Revman 5.4 software. Results : The Social Impact Scale (SIS), Simplified Coping Style Questionnaire (SCSQ), and quality of life scale will be used to evaluate the effects of MBSR on stigma, coping style, and quality of life in colorectal cancer patients with permanent colostomy. Conclusion : This study will provide a reliable evidence-based basis for MBSR to reduce stigma, improve coping style, and improve quality of life for colorectal cancer patients with permanent colostomy. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/CD4PV.

AimTo assess the efficacy of extraperitoneal colostomy(EPC) in the prevention of stoma-related complications.BackgroundTransperitoneal colostomy (TPC) is still a widely used surgical approach. However, TPC has been reported with highly incidence of stoma-related complications, like parastomal hernia, stomal retraction, stomal prolapse.The purpose of EPC is to prevent these complications. But it is still lack of evidence-based basis.Material and methodsMEDLINE, EMBASE, Web of Science, Scopus, MOOSE, Pubmed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. Revman 5.4 was performed in the meta-analysis.ResultsA total of 5 RCTs were eligible in this study. Compared with TPC, EPC group had lower incidence in Parastomal Hernia (RR, 0.14; 95% CI, 0.04–0.52, P=0.003, I2=0%), Stomal Prolapse (RR, 0.27; 95% CI, 0.08–0.95, P=0.04, I2=0%) and a higher rate of defaecation Sensation (RR, 3.51; 95% CI, 2.47–5.0, P＜0.00001, I2=37%). No statistical difference was observed in Stoma Retraction, Colostomy Construction Time, Stoma Ischemia, and Necrosis.ConclusionAn extraperitoneal colostomy is associated with a lower rate of postoperative complication compared to transperitoneal colostomy. Randomized controlled trial meta-analysis showed better results in permanent colostomy after abdominoperineal resection.

The anastomosis leakage is one of the most terrible complications of rectal cancer surgery. The anastomosis leakage rate after low anterior resection may exceed 20 %. The anastomosis leakage increases postoperative mortality, length of hospitalization, requires the formation of a temporary or permanent colostomy, which impairs the quality of life of patients. In recent years, some authors have suggested using a nomogram, a prognostic algorithm in the form of a graphic image showing the probability of a certain outcome individually for each patient. This review presents literature data on the use of nomograms in predicting the occurrence of colorectal anastomosis leakage after rectal cancer surgery.

Objective: To investigate the correlation between stigma and ostomy adjustment in patients with a permanent colostomy. Methods: A total of 118 patients (male 81/female 37 with an average age 57.4±15.0) from six grade 3 hospitals of the Midlands of China with a permanent colostomy were recruited. Participants responded to a questionnaire to obtain sociodemographic data, Social Impact Scale (SIS) scores to ascertain stigma level and Ostomy Adjustment Inventory (OAI-20) scores to identify the level of psychosocial adjustment. Results: The patients’ average SIS score was (60.7±10.4). The QAI-20 total score was (41.3±10.8). The SIS total score and SIS subscores were negatively related to the total score and subscore of QAI-20 (r=-0.222~-0.537, all P

Self-expanding metallic stents (SEMSs) are frequently used to decompress malignant large bowel obstruction (LBO) and avoid emergent surgery with often permanent colostomy creation. However, limited data are available on the use and outcomes of SEMS in patients with nonmalignant LBO. We present a case series of 4 patients who were found to have nonmalignant LBO for which they underwent emergent colonic stenting as a bridge to elective surgery following interdisciplinary discussion between gastroenterology, colorectal surgery, and radiology. Through each patient vignette, we illustrate the use of SEMSs as a potential alternative to emergent surgery. 2 of 4 patients avoided stoma creation at the time of surgery, and 1 patient avoided surgery altogether; overall, however, the outcomes of this approach were mixed in this series, indicating a need for further investigation to better identify the patient population that would benefit most from initial SEMS placement for decompression of nonmalignant LBO.

Objectives: To describe the experiences of persons with permanent colostomy regarding their quality of life. Methods: The study design used descriptive phenomenology following the approach of Collaizzi. There were 12 participants who qualified using purposive sampling based on the inclusion criteria.The data generated were in-depth interviews. Analysis and interpretation used verbatim descriptions. Results: The research data revealed seven themes, namely: limitation in daily living activities, limitations in marital relations and social relationship with others, negative feelings about having the colostomy, financial difficulties, increasing demands of living with colostomy, changes in the needs of rest, physical and expectation of complications, and hoping to live a normal life after colostomy. Conclusion: This study revealed that persons with permanent colostomy experience difficulties and limitations pertaining to daily living activities, including marital and social relations. Importantly, they experience psychological concerns, e.g. having negative feelings about ways of living their lives, including financial difficulties and adjusting to new ways of living. However, there is always the hope to live a normal life. This study provides an understanding of the quality of life of persons with permanent colostomy, allowing nurses to provide appropriate nursing care. Resumo: Objetivos: Descrever as experiências de pessoas com colostomia permanente quanto à qualidade de vida. Métodos: O desenho do estudo utilizou a fenomenologia descritiva seguindo a abordagem de Collaizzi. Havia 12 participantes que se qualificaram usando amostragem intencional com base nos critérios de inclusão. Os dados gerados foram entrevistas detalhadas. A análise e a interpretação usaram descrições literais. Resultados: Os dados da pesquisa revelaram sete temas, a saber: limitação nas atividades da vida diária, limitações nas relações conjugais e relação social com os outros, sentimentos negativos sobre a colostomia, dificuldades financeiras, crescentes demandas de viver com colostomia, mudanças nas necessidades de repouso, físicas e expectativa de complicações, e esperança de viver uma vida normal após a colostomia. Conclusão: Este estudo revelou que pessoas com colostomia permanente apresentam dificuldades e limitações relativas às atividades da vida diária, incluindo relações conjugais e sociais. É importante destacar que têm preocupações psicológicas, p.ex., sentimentos negativos sobre formas de viver suas vidas, incluindo dificuldades financeiras e adaptação a novas formas de viver. No entanto, há sempre a esperança de viver uma vida normal. Este estudo fornece uma compreensão da qualidade de vida de pessoas com colostomia permanente, possibilitando aos enfermeiros fornecer cuidados de enfermagem apropriados. Keywords: Quality of life, Colorectal cancer, Permanent colostomy, Collaizzi phenomenological approach, Lived experience, Palavras-chave: Qualidade de vida, Câncer colorretal, Colostomia permanente, Abordagem fenomonológica de Collaizzi, Experiência vivida

Wild boar attacks have rarely been reported in the medical literature. This is the case of an 83-year-old male farmer who was assaulted from behind by an injured adult wild boar. He presented with hemorrhagic shock after sustaining injuries to the right profunda femoris artery and right sciatic nerve as well as significant soft-tissue injuries, bilateral iliac wing fractures, an open pneumothorax, and an anorectal injury. The anorectal injury was treated with fecal diversion but was complicated by soft-tissue infection in the surrounding dead space. The patient needed multiple operations, including removal of the distal rectum and creation of a permanent colostomy. In this report, we highlighted the characteristics of anorectal trauma caused by a wild boar attack. We conclude that penetrating anorectal injuries caused by this type of attack can be associated with extensive soft-tissue damage despite externally appearing to be simple puncture wounds. Anorectal combat injuries have demonstrated similar extensive surrounding soft-tissue injuries and propensity for infection; therefore, this case supports adopting a similar treatment strategy, that of serial and radical debridement, to treat certain wild boar injuries.

There has been a recent increase in patient reported outcomes, specifically quality of life (QoL), following recovery from a restorative proctectomy. The constellation of post-operative bowel dysfunction symptoms has been collectively termed the Low Anterior Resection Syndrome (LARS). Research efforts have resulted in an international consensus statement on its definition and now establishes a foundation of future research on LARS incidence, significance and treatment options. Amidst the myriad of prior treatment options, all efforts by surgeons to provide organ (anus) preservation surgery have unfortunately resulted in an increasing number of patients who intensely suffer from LARS. Perhaps historically considered only for failure of symptom management by both surgeons and patients alike, use of a permanent colostomy may be an appropriate surgical outcome outright when patients are fully informed of what post-operative bowel “dysfunction” is likely to be expected. Still, the future of LARS treatments is just beginning to be investigated and increased physician awareness of those new management strategies may offer hope for patients who continually struggle with their QoL following a restorative proctectomy.

Background: Combined multimodal treatment (CMT) is the preferred treatment for anal squamous carcinoma with radical surgery reserved for treatment failure. Some patients require a defunctioning stoma prior to CMT. Successful closure of such a stoma is unlikely. Abdominoperineal excision (APE) may be suitable as primary treatment in these patients.Objectives: To evaluate organ preservation in the treatment of anal squamous cancer and the closure rate of pre-treatment, temporary diverting colostomy, thereby assessing whether APE could be offered as primary treatment in those requiring a pre-treatment colostomy.Methods: A retrospective review of all patients with anal squamous carcinoma was undertaken. Patients who required defunctioning colostomies prior to CMT were analysed for potential resectability of tumour prior to CMT and rate of permanent stoma.Results: One hundred and twenty-five patients were included of which 58 were males. The mean age was 56 years. 107 were treated with curative intent. Six received primary APE and 12 salvage APE. Thirty (22 males) required pretreatment diverting colostomies. Three (10%) stomas were successfully reversed. Forty-eight (38%) of the 125 completed treatment with a permanent colostomy. Six patients who needed a stoma prior to CMT were deemed resectable.Conclusion: Organ preservation was not possible in about a third of patients. Defunctioning stomas prior to CMT were likely to be permanent. We propose that APE could be considered as an alternative in selective cases where the tumour is resectable with low morbidity and a stoma is indicated.Key words: Anal squamous carcinoma, defunctioning stoma, Nigro protocol, abdominoperineal excision

The status of ostomy-specialized nurses' training and the specialized care for patients with permanent colostomy both in China and abroad are analyzed. Based on features and characteristics of the development of ostomy care outside China, problems in China's ostomy care are discussed to promote the sustainable development of this type of care.

Objectives: To analyze clinical and sociodemographic aspects of people with ostomies in the state of Minas Gerais. Methods: A cross- sectional study was conducted in 54 municipalities in 2016. Data were collected from 418 people with ostomies, registered from a structured questionnaire. Descriptive data analysis, the Pearson chi-square test and the Bonferroni correction were performed. Results: The majority of people with ostomies are elderly, male, have low schooling and low wage income. Colorectal malignant neoplasia was the main cause and 14.3% were treated with chemotherapy. Part of the ostomies is of the regular standing permanent colostomy type. The main complication highlighted is dermatitis, and 45.5% are not able to develop self-care. The type of ostomy was significantly associated with stomatal permanence, marital status and income (p

Surgical resection represents the mainstay treatment of rectal cancer. However, for patients with very low rectal cancer, this usually entails removing the anal sphincter and committing the patient to a permanent colostomy. Dr. Gerald Marks was the first to describe in 1984 the transanal abdominal transanal (TATA) proctectomy, a sphincter-preserving surgery, designed to avoid a permanent colostomy. Despite the advent of neoadjuvant chemoradiotherapy and the refinement of techniques, the rates of abdominoperineal resection (APR) remain high. We are discussing herein the indications and the surgical technique of TATA as well as its functional outcomes compared to APR.

Prophylactic placement of a mesh has been suggested to prevent parastomal hernia, but evidence to support this approach is scarce.The aim of this study was to evaluate whether laparoscopic placement of a prophylactic, dual-component, intraperitoneal onlay mesh around a colostomy is safe and prevents parastomal hernia formation after laparoscopic abdominoperineal resection.This is a prospective, multicenter, randomized controlled clinical trial.This study was conducted at 2 university and 3 central Finnish hospitals.From 2010 to 2013, 83 patients undergoing laparoscopic abdominoperineal resection for rectal cancer were recruited. After withdrawals and exclusions, the outcome of 70 patients, 35 patients in each study group, could be examined.In the intervention group, an end colostomy was created with placement of a intraperitoneal, dual-component onlay mesh and compared with a group with a traditional stoma.The main outcome measures were the incidence of clinically and radiologically detected parastomal hernias and their extent 12 months after surgery. Stoma-related morbidity and the need for surgical repair of parastomal hernia were secondary outcome measures.Parastomal hernia was observed by clinical inspection in 5 intervention patients (14.3%) and in 12 control patients (32.3%; p = 0.049). Surgical repair of parastomal hernia was performed in 1 control patient (3.2%) and in none of the patients in the intervention group. CT detected parastomal hernia in 18 intervention patients (51.4%) and in 17 control patients (53.1%; p = 1.00). The extent of hernias was similar according to European Hernia Society classification (p = 0.41). Colostomy-related morbidity (32.3% vs 14.3%; p = 0.140) did not differ between the study groups.The study was limited by its small size and short follow-up time.Prophylactic laparoscopic placement of intraperitoneal onlay mesh does not significantly reduce the overall risk of radiologically detected parastomal hernia after laparoscopic abdominoperineal resection. However, prophylactic mesh repair was associated with significantly lower risk of clinically detected parastomal hernia.

Hartmann's procedure, colonic resection with an end colostomy and rectal closure, is used in a variety of surgical emergencies. It is a common surgical procedure that is often practiced in patients with colonic obstruction and colonic perforation, resolving the acute clinical situation in the majority of cases. Reversal of Hartmann's procedure with restoration of bowel continuity occurs in a significantly low percentage of patients. There are several reasons contributing to the fact that many patients remain with a permanent colostomy following Hartmann's procedure. These include factors related to the patients' clinical status but also to the significant difficulty and morbidity related to the surgical reversal of Hartmann's procedure. The aim of this study was to review the factors related to the fairly low percentage of patients undergoing Hartmann's reversal as well as surgical techniques that could help surgeons restore intestinal continuity following Hartmann's procedure and deal with the postoperative outcomes.

Background Parastomal hernia is a very common complication after stoma formation. Current surgical techniques for repairing parastomal hernia have unsatisfactory results. We aim to assess our preliminary experience with prophylactic mesh placement at the time of stoma formation. Methods Data were prospectively recorded. A specifically designed mesh made of polyvinyl fluoride with central conduit (Dynamesh IPST®) was fixed using an intra-peritoneal onlay technique. Safety was evaluated by means of surgical data and frequency of mesh-related complications, efficacy by the rate of parastomal hernias. Results Thirty-four patients were included in the study. Three of them died before a year of follow up (not related to the stoma), so they were excluded. The other 31 patients (11 women and 20 men) were prospectively followed up after different pathologies resulting in a permanent colostomy. Twelve months after surgery CT-Scan imaging revealed two (6.4%) parastomal hernias, one of them already clinically suspected. During the follow up, 29% of the patients (n = 9) developed another type of hernia (incisional, inguinal or both). In five patients (16.1%) a light stomal retraction of the otherwise slightly prominent ostomy was observed. Median clinical follow-up was 17.5 months (range 12–34). Conclusion Prophylactic parastomal mesh placement might be a safe and effective procedure with a potential to reduce the risk of parastomal hernia. Routine use of this technique should be further analysed.

Rectal ultralow, intersphincteric anterior resection (RIE) can be used in selected cases with the intention of improving the quality of life of patients avoiding permanent colostomy. RIE is indicated for tumors that are located from 1-2 cm above the anorectal ring to the top of the internal anal sphincter without involvement of the pelvic floor, puborrectalis muscle or external anal sphincter. RIE aims to get a free distal margin tumour not less than 1cm. Correct preoperative staging and anatomical tumour location and relation with adjacent structures and organs is fundamental. Intestinal transit reconstruction can be performed manually with a coloanal anastomosis according with Parks and with a lateral ileostomy or, alternatively, by a two-stage coloanal anastomosis technique as Turnbull-Cutait avoiding the stoma protection. Postoperative morbidity and mortality and the rate of local recurrence and overall disease-free survival at 5 years after RIE are comparable to those observed in standard ultra low anterior resection. Postoperative functional alterations of the RIE can affect the quality of life of patients regardless of reconstructive technique. Published studies do not provide sufficient data to establish the most efficient reconstruction method in terms of functional outcomes.

Purpose Patients with rectal cancer have issues in adjusting to their permanent colostomy after surgery, and support is required to help them resume normal life. However, few studies have explored the experience and factors that affect a patient’s decision-making and maladjustment prior to colostomy surgery. The aim of this study was to explore the experience of rectal cancer patients who have to undergo colostomy surgery. Method A descriptive, qualitative design was used. We studied a purposive sample of 18 patients who had received a diagnosis of primary rectal cancer and were expecting permanent colostomy surgery. The thematic analysis approach was used to analyze the data collected using semi-structured, open-ended questions. Results The overriding theme that emerged was ‘stoma dilemma: a hard decision-making process’. From this main theme, three themes were derived: the resistance stage, the hesitation stage, and the acquiescence stage. Conclusion It is hard for preoperative rectal patients to choose to undergo stoma surgery or a sphincter-saving operation. From the initial stage of definitive diagnosis to the final consent to stoma surgery, most patients experience the resistance and hesitation stages before reaching the acquiescence stage. Arriving at a decision is a process that nurses can facilitate by eliminating unnecessary misunderstanding surrounding colostomy surgery and by fully respecting patients’ right to choose at the various stages.

This study investigates couples’ adjustment to rectal cancer and a colostomy using the ‘Classification System of Couple Adjustment to Cancer’, a framework delineating fluctuations in couples’ sense of ‘I’ and ‘We’ in response to cancer. Nine couples affected by rectal cancer and adjusting to life with a colostomy were interviewed. A theoretical thematic analysis of the transcripts was conducted; nearly all ‘I–We’ shifts of the Classification System of Couple Adjustment to Cancer were observed – often in unique ways in response to rectal cancer–specific challenges – and one new shift was described. The results provide a novel and experientially grounded means of conceptualizing complex dyadic coping processes.

Purpose The aim of this study was to evaluate health-related quality of life in patients with a colostomy immediately before and during the first year after surgery. Subjects and setting Patients (aged ≥20 years) who were diagnosed with rectal cancer and scheduled to undergo curative surgery with a permanent colostomy were recruited for this study. Data were collected at 2 university hospitals in Tokyo. Methods Participants were asked to complete a self-administered questionnaire regarding health-related quality of life before surgery and a mailed or hand delivered questionnaire to evaluate quality of life at 2, 6, and 12 months after surgery using the Short Form-36 version 2. For patients who responded at all 4 time points, the scores at each time point were compared using paired t tests to examine longitudinal changes in quality of life after surgery. Results Mean quality-of-life scores in most domains before surgery and during the first year after surgery were lower than the normal control in the norm-based scoring method. Scores at 2 months after surgery were lower than those before surgery. At 12 months after surgery, however, quality-of-life scores improved almost to the level observed before surgery, with the exception of the score in the social functioning domain. Statistical differences in scores between the time points of the survey were observed in the role-physical, bodily pain, and mental health domains. Conclusions These results suggest that patients with permanent colostomy after curative resection for rectal cancer need additional medical support and care before surgery and during the first year after surgery.