Stoma Closure Research Articles

A retrospective cohort study of the application of Santulli enterostomy in neonatal necrotizing enterocolitis

The use of Santulli enterostomy (SE) for necrotizing enterocolitis (NEC) has been limited to a small number of studies involving a small number of patients and no control group. Our study aimed to compare the clinical safety and efficacy of Santulli enterostomy with those of single- or double-lumen enterostomy for neonatal NEC through a retrospective cohort study. One hundred ten patients who met the criteria were divided into an SE group (64 patients) and a conventional enterostomy (CE) group (46 patients). The CE group underwent single- or double-lumen enterostomy. There were no significant differences in complication rates or prognoses between the two groups after either procedure. Although the stoma was positioned higher in the SE group, the length of the unused small intestine (USI) was not significantly different. Multivariate analysis revealed that the length of the USI influenced the likelihood of malnutrition after enterostomy (OR = 1.108, P = 0.008). After stoma closure, compared with those in the CE group, the operation time, intestinal recovery time, fasting time, hospitalization time, intraoperative blood loss volume and the incidence of complications requiring surgical reintervention was significantly lower in the SE group. In conclusion, Santulli enterostomy is not only a safe treatment option for NEC but also an effective method for increasing the length of the small intestine after enterostomy, thereby improving the patient’s postoperative nutritional status. In addition, the procedure is associated with good recovery and a reduced incidence of surgical reintervention after stoma closure.

Optimal Timing of Stoma Closure in Premature Infants Affected by Necrotizing Enterocolitis

Optimal Timing of Stoma Closure in Premature Infants Affected by Necrotizing Enterocolitis

Prophylactic Sublay Mesh Placement During Stoma Closure to Prevent Incisional Hernias: a Pilot Study

Prophylactic Sublay Mesh Placement During Stoma Closure to Prevent Incisional Hernias: a Pilot Study

Effectiveness of negative pressure wound therapy (NPWT) in preventing incisional surgical site infection after stoma closure: a single institutional retrospective study.

Recent findings suggest that utilizing negative pressure wound therapy (NPWT) concurrently with stoma closure may decrease the risk of incisional surgical site infection (iSSI). However, the specific impact of NPWT on iSSI after stoma closure remains unclear. This study investigated the impact of NPWT on SSI after stoma closure. Between January, 2010 and December, 2022, 185 patients underwent stoma closure at our hospital. Multivariate analysis was conducted to identify the risk factors for iSSI, using logistic regression analysis. Propensity score matching (PSM) was performed to balance the effect of potential co-factors of stoma closure with and without NPWT, on the incidence of superficial SSIs. Multivariate analysis identified that the absence of NPWT was an independent risk factor for iSSIs (Odds ratio [OR]: 11.1; 95% confidence interval [CI]: 1.88-64.9; P = 0.0078). Following cohort matching, the NPWT-absence and NPWT-presence groups comprised 54 patients each. The incisional SSI rate was significantly lower in the NPWT-presence group than in the NPWT-absence group (0.9%; n = 1 vs. 7.4%; n = 8, respectively; OR: 9.2; 95% CI 1.11-76.4; P = 0.04). The findings of this study demonstrated that stoma closure with NPWT reduced the SSI rates remarkably. Therefore, NPWT should be considered for stoma closure procedures.

Blood Group Misinformation Impacting the Attendant's Decision-Making for a timely Blood Transfusion in their Patient: An Ethical Dilemma.

In the third week of November 2024, a critical incident involving the refusal of a blood transfusion was reported at our hospital. The case involved a 65-year-old Indian patient who had been admitted for a proposed stoma closure surgery. Although the healthcare team deemed an urgent blood transfusion necessary as part of the patient's treatment plan, the transfusion was refused due to misinformation from the patient's attendants regarding the patient's original blood type. Their refusal was also driven by a fear of the potential consequences of an erroneous mismatched blood transfusion. The blood transfusion centre (BTC) laboratory confirmed the patient's blood type as B Rh (D) positive. However, the attendants raised concerns about the accuracy of this blood grouping, citing previous misunderstandings and misinformation that led them to believe the patient was AB Rh (D) positive until that point. Despite receiving multiple assurances and thorough explanations from the attending physician and nursing staff, the attendants remained distrustful of the BTC laboratory results and requested a re-evaluation of the patient's blood type. As a result, a fresh blood sample was collected for repeat typing. After a one-on-one discussion with our transfusion medicine specialist, the attendants were ultimately convinced of the confirmed blood type. Subsequently, three compatible packs of packed red blood cells (PRBC) of B Rh (D) positive were issued to the patient over the next three consecutive days from our blood centre. This situation underscores the importance of effective communication and education regarding the patient's actual blood type. Our report further details the incident, its consequences, the associated ethical dilemmas, and recommendations to prevent similar occurrences in the future.

Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).

Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses. From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications. In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146days (range 9-483days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications. This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up.

Complications of Purse-String Closure Technique Vs Linear Closure in Patients with Stoma

Background: A variety of surgical techniques have been proposed for abdominal wall closure in patients with stoma with the aim of reducing the incidence of surgical site infection. However, the ideal skin closure technique has not yet been determined. Surgical site infection was one of the most common postoperative morbidities of ileostomy and colostomy reversal and although several skin closure procedures have been developed to reduce the rate of surgical site infection and its associated comorbidities, the incidence rates nationally and internationally range between 2% and 41% and it has been reported that it can increase costs, prolong hospitalization time and affect the patient's quality of life. Objetive: To compare the tabaco closure technique vs. linear closure in patients with stoma at the Regional General Hospital 01. Materials and methods: Observational, analytical, retrospective study, information was collected from both outpatient and hospital records of patients with a stoma during the period 2022-2024, the evolution after stoma closure, its main post-surgical complications, type of wall closure technique, comorbidities, days of hospitalization and days of antimicrobial therapy. The data obtained were analyzed together with a methodological advisor in a specially created database and for statistical analysis, SPSS was used to create result graphs, as well as descriptive statistics. Results: According to the inclusion criteria the total sample was 25 participants, the average age was 50.9 years predominating in the age range 51-66 years, according to sex with a higher frequency male 15 (60%), Regarding the type of stoma in greater presentation was the colostomy 13 (52%) and according to the technique used for stoma closure we found tobacco pouch 13 (52%) and linear 12 (48%) it was identified regarding the tobacco pouch technique did not have any complications in 11 (44%), in 2 (8%) presented dehiscence and regarding the linear technique 5 (20%) presented incisional hernia, followed by dehiscence 3 (12%), infection 2 (8%) and 2 (8%) presented no complications. According to statistical analysis SPSS Pearson Chi-Square was reported a value of 13.412 with significance p = 0. 004 for the association of the tobacco pouch technique and linear technique with complications.. Conclusion: The tabaco purse technique had fewer complications compared to the linear technique

Risk Factors for Anastomotic Leakage Following Stoma Closure: A Retrospective Study in Tertiary Hospitals in Yemen.

Introduction Anastomotic leakage (AL) following stoma closure is a significant complication that can lead to increased morbidity and mortality. Identifying risk factors associated with AL is essential for improving surgical outcomes, especially in resource-limited settings like Yemen. Methods We conducted this retrospective study at Al-Thawra Modern General Hospital and the Republican Teaching Hospital Authority in Sana'a, Yemen, between August 2020 and April 2024. The analysis included 50 patients aged 18-65 years who underwent stoma closure. We analyzed patient data, including demographics, comorbidities, surgical technique, and outcomes, to identify risk factors for AL. Results The incidence of AL was six (12%) out of 50 cases. Significant risk factors included smoking, with AL present in four (67%) smokers and two (33%) non-smokers (p = 0.045). Patients with diverticulitis were more likely to require a stomain two (33%) cases, and perforated small bowel with peritonitis in one (17%) case, compared to trauma cases in two (7%) and colorectal cancer cases at one (11%) (p = 0.038). AL was most common in colorectal anastomosis, observed in four (67%) cases, compared to other sites in two (5%) cases (p = 0.001). The surgical technique impacted the incidence of AL, with hand-sewn anastomosis showing a higher rate in four (67%) cases compared to stapled anastomosis in two (33%) cases (p = 0.036). No significant associations were found for age, sex, American Society of Anesthesiologists (ASA) classification, or surgeon experience. Conclusion This study identifies key risk factors for AL following stoma closure in the context of hospitals in Yemen, emphasizing the need for targeted preoperative and intraoperative strategies, such as smoking cessation and careful surgical technique selection, to reduce the risk of AL. Future studies should focus on larger cohorts and the impact of enhanced perioperative care protocols in low-resource settings.

Effect of mucous fistula refeeding in neonates with small bowel enterostomy at a low resource center- a prospective interventional study in a Bangladeshi pediatric surgical unit

Aims: Neonates with small bowel enterostomy face substantial challenges in maintaining fluid balance, optimal nutrition and growth, especially in low- and middle-income countries (LMIC) where parenteral nutrition is not extensively available. Moreover, the discrepancy between proximal and unused distal loop often makes the anastomosis challenging and risky during closure. This study was aimed to describe a simple method of mucous fistula refeeding (MFR) in a resource constrained environment and to see the impact of MFR on growth and nutrition and distal intestine diameter. Methods: A simplified MFR technique requiring minimal resources was employed, which was taught to and carried out by the caregivers. Distal loopogram was performed before commencement of MFR and before stoma closure. The weight gain and width difference of the distal loop at splenic flexure was measured. Statistical analysis was done in SPSS 26.0 and p <0.05 considered to be significant. Results: We implemented MFR on ten consecutive neonates. The indications for enterostomy formation were meconium ileus (6), three among them were complicated, ileal atresia (3), and intestinal perforation (1). Mean rate of weight gain was 18 gm/day and mean gut width increment was 0.1 mm/day (p < 0.05). One patient (10%) had anastomotic leakage following stoma closure. Conclusion: Mucous fistula refeeding is a safe method that can reduce nutritional complications and enhance growth, and reduce bowel lumen discrepancy, making the anastomosis safer during stoma closure.

A COMPARATIVE STUDY ON THE OUTCOME OF ILEOSTOMY VERSUS COLOSTOMY FOR TEMPORARY DIVERSION OF RECTAL ANASTOMOSIS

Temporary diversion with a stoma is often required in patients undergoing rectal resection for rectal cancer to minimize anastomotic complications. Loop ileostomy and loop colostomy are the two common options for fecal diversion. Despite their widespread use, the comparative outcomes regarding morbidity and complications of these procedures, especially in the context of temporary diversion, remain debatable. Objective: To compare the outcomes of loop ileostomy and loop colostomy for temporary rectal diversion in cancer patients undergoing rectal resection. Methods: A prospective study was conducted in the General Surgery Department of Nishtar Hospital, Multan from June 2024 to November 2024. A total of 150 rectal cancer patients undergoing anterior resection were included in the study. Patients were divided into two groups; Group A included 75 patients undergoing loop ileostomy and Group B included 75 patients undergoing loop colostomy. The primary outcome was to perform a comparison between morbidity outcomes after stoma formation and closure between both procedures. Patients were followed up after every 2-4 weeks in OPD after stomal construction and reversal. Results: After stomal construction, the incidence of complications between both groups was similar. Overall morbidity occurred in 23 patients (30.6%) in group A and 21 patients (28%) in group B. The parastomal hernia was the most common complication in the study population in 31 patients (20.6%), the difference in both groups was insignificant (20% vs 21.3%) (p=0.78). After the stomal reversal, 4 (8%) in group A and 1 (1.9%) in group B had anastomotic leaks, however, the difference was insignificant (p=0.19). 50 (66.7%) patients in the ileostomy group and 51 (68%) patients in the colostomy group underwent stoma reversal. Complications after reversal were similar with the most common complication being wound infection (14 vs 7.9%) (p=0.53%). Conclusion: The outcomes of loop ileostomy and loop colostomy for temporary diversion of rectal anastomosis in patients with rectal cancer were comparable. Larger, randomized studies are needed to verify our findings.

Comparative analysis of purse-string method versus conventional methods for stoma closure

Comparative analysis of purse-string method versus conventional methods for stoma closure

A comparative study between early and conventional intestinal stoma closure in a tertiary care institute

Background: Little is known about ideal time for stoma closure. Therefore, the aim of this study is to compare early versus conventional stoma closure following bowel surgery in terms of quality of life (QoL), length of hospital stay (LoH), and postoperative complications. Methods: This randomized controlled trial was conducted at a medical college affiliated teaching hospital from May 2023 to June 2024. The 116 patients undergoing bowel surgery with temporary stoma creation were randomized into early closure (3 weeks post-surgery) and conventional closure (8-12 weeks post-surgery) groups. Primary outcome was anastomotic leak rate. Secondary outcomes included other postoperative complications, LoH, and QoL assessed using the EORTC QLQ-C30 questionnaire. Results: There was no significant difference in anastomotic leak rates between early (6.9%) and conventional (12.1%) closure groups. Overall complication rates were similar (56.9% early vs 50% conventional). LoH did not differ significantly between groups. QoL scores were significantly higher in the early closure group, with 100% of patients achieving considerable improvement (EORTC score 26-36) compared to 79.3% in the conventional group (p<0.05). Conclusions: Early stoma closure is safe and feasible in appropriately selected patients, with no increased risk of anastomotic leak or other complications. It significantly improves QoL compared to conventional closure timing, without prolonging hospital stay. These findings suggest that early stoma closure may be a beneficial option for suitable patients following bowel surgery.

Primary anastomosis versus stoma following urgent sigmoidectomy for sigmoid volvulus: 58-year experience in a tertiary referral center.

Primary anastomosis and stoma are the main options in the restoration of intestinal continuity following urgent sigmoidectomy in sigmoid volvulus (SV). Our purpose was to evaluate the outcomes of both techniques in a 1,083-patient SV series. Total 1,083 cases with SV treated in Ataturk University Research Hospital in 58-year period between June 1966 and July 2024 were included in this study. We reviewed the records of 612 patients (56.5%) retrospectively, while the remaining 471 cases (43.5%) were evaluated prospectively. We investigated some preoperative, operative, and postoperative characteristics in non-matched analyses. Among total 379 patients treated with urgent colectomy, primary anastomosis was used in 173 cases (45.6%), while stoma was required in 206 patients (54.4%). The mean age was significantly lower in primary anastomosis group (P<0.005), while male/female ratios were statistically similar (P>0.05). Mean ASA score (P<0.001) and rates of shock (P<0.001), bowel gangrene (P<0.001), bowel perforation (P<0.01), and risky bowel (P<0.005) were also significantly lower in the primary anastomosis group. When stoma closure was considered, operation time was significantly shorter (P<0.001), additionally, morbidity and mortality rates were significantly lower in the primary anastomosis group (P<0.001, in each). The distributions of reoperation rates were statistically similar in both groups (P>0.05). Conversely, hospitalization time was significantly shorter and cost was significantly lower in the primary anastomosis group (P<0.001, in each). Primary anastomosis has some advantages in comparison to stoma in the restoration of intestinal continuity following urgent sigmoidectomy in SV. However, stoma is generally preferred in patients with bad health status, old age, and risky bowel. New prospective randomized clinical studies or matched analyses may help to clarify the optimal choice.

Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation.

This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation. The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement. In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1month of stoma closure and waiting a minimum of 3months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations. This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI.

A Retrospective Study of Cricotracheostomy: Indications, Techniques, and Clinical Outcomes.

Cricotracheostomy (CT) is a surgical procedure for airway access that can be performed using 2 techniques: excising the cricoid cartilage (CTrach), or by creating an inverted U-shaped flap from the first tracheal ring (CTrachT). The aims of this study are to clinically evaluate factors such as patient background, complications, and stoma closure status in patients who underwent CT, and to compare the clinical outcomes between CTrach and CTrachT. Retrospective, cross-sectional study. Single-institution academic center. Records of patients who underwent CT at the University of Tokyo Hospital between 2014 and March 2024 were reviewed, detailing their demographics and clinical characteristics. We investigated differences in clinical backgrounds, complication risks for each surgical procedure, and factors contributing to stoma closure and complications after CT. The median age for patients undergoing CT was 70 years, predominantly male (76%), and most were malnourished. Common indications included low-lying larynx and obesity. Stoma closure was achieved in 16% of patients. Early complications were surgical site infection (9%) and subcutaneous emphysema (2%), with granuloma formation in 20%. The CTrach group had a significantly higher median age (P = .03), but other factors showed no significant differences. CTrachT was more often performed by board-certified specialists (P = .04). Stoma closure rates and complications were not significantly influenced by any single factor. CT presents a viable option with minimal postoperative complications for patients wherein conventional tracheotomy may be more challenging, such as in low-lying larynx, obesity, advanced age, and poor nutritional status.

Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates

PurposeDespite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries MethodsWe retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure ResultsDuring the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0 %, 4.4 %, and 4.4 %, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group ConclusionBased on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures. Level of evidenceLevel

Comparison of short-term outcomes and defecatory function following robotic and conventional laparoscopic surgery for stapled-ileal pouch-anal anastomosis: a retrospective cohort study.

This study assessed the potential advantages of robotic-assisted Stapled ileal pouch-anal anastomosis (Ro Stapled-IPAA) in ulcerative colitis (UC) compared to conventional laparoscopic surgery (Lap), with a focus on short-term outcomes and postoperative defecatory function, an aspect not previously explored. Out of a total of 132 patients who underwent proctocolectomy or residual rectal resection, consecutive patients undergoing minimally invasive Stapled-IPAA for UC at our hospital from May 2014 to May 2024 were included. The Ro approach was chosen for individuals with severe colitis extending into the anal canal, deeper rectal cancers (beyond T1), and cases requiring residual rectal resection, taking advantage of its benefits. Perioperative outcomes, including anastomosis height, operative time, intraoperative blood loss, complication rate, postoperative hospital stay, and defecatory function using Wexner scores and anorectal manometry before proctocolectomy and 6 months after stoma closure, were compared between the Ro and Lap groups. Thirty-three patients (Lap, n =21; Ro, n =12) were included. The Ro group demonstrated a significantly lower anastomosis height (0.5 vs. 3.0 cm, P <0.001), reduced intraoperative blood loss (35 vs. 118ml, P =0.032), shorter postoperative hospital stay (8 vs. 10.5 days), and no cases of anastomotic leakage (0 vs. 14.3%), as compared to the Lap group. Pouch failure occurred in 14% of Lap group; none were observed in the Ro group. Wexner scores favored the Ro group at 12 months after stoma closure (0 vs. 8 points), and there was better maximum voluntary squeeze pressure (302mmHg vs. 175mmHg, P =0.03), indicating preserved contraction of the external sphincter muscle despite the lower anastomosis. Ro Stapled-IPAA for patients with UC led to better short-term outcomes and preservation of defecatory function with lower anastomosis than Lap, suggesting the clinical advantages of the robotic approach in this field.

Oral administration of Lactobacillus casei DG® after ileostomy closure in restorative proctocolectomy: a randomized placebo-controlled trial (microbiota and immune microenvironment in pouchitis -MEP1)

ABSTRACT Pouchitis is an idiopathic inflammatory disease that may occur in ileal pouches, and it can lead to ileal pouch failure. This was a single-center, randomized, double-blinded, placebo-controlled trial that assessed the effect of Lactobacillus casei (L. casei) DG®, a probiotic strain, on the ileal pouch mucosa to determine the crosstalk between microbiota and mucosal immune system. Fifty-two patients undergoing restorative proctocolectomy were recruited and randomly assigned to receive a daily oral supplementation of L. casei DG® (n = 26) or placebo (n = 26) for 8 weeks from the ileostomy closure (T0) to a pouch endoscopy after 8 weeks (T1) and 1 year (T2). Ileal pouch mucosa samples were collected at T0, T1, and T2. At T1, the L. casei DG®-supplemented group showed a significant reduction of inflammatory cytokines levels compared to T0 baseline levels in the pouch mucosa, whereas in the placebo group cytokines levels resulted stable. In conclusion, probiotic manipulation of mucosal microbiota by L. casei DG®-supplementation after stoma closure in patients who underwent restorative proctocolectomy has a beneficial impact on the ileal pouch microenvironment. Registration number: NCT03136419 (http://www.clinicaltrials.gov).

Predictive factors of major low anterior resection syndrome after surgery for rectal tumors.

To describe the epidemiological and clinical data of impaired functional outcome secondary to anterior resection of the rectum and to identify the predictive factors of major low anterior resection syndrome (LARS) Methods: This retrospective study considered patients operated on for rectal tumors in surgical department in our hospital, between January 1st,2009 and December 31st, 2021. The primary outcome measure was the development of a major LARS immediately or after stoma closure. In order to identify independent predictors of major LARS, patients were divided into two groups: the "Major LARS" group and the "No Major LARS" group, and then we carried out a descriptive study, followed by an analytical study with logistic regression. We enrolled 42 patients operated for rectal tumor and had an anterior resection. Half of our patients developed LARS of which 14 developed major LARS. The median time to onset of LARS symptoms was 9 [2 -24] months. At the end of this study, 2 factors were retained: age (OR=2.48; CI95% [1.2- 5.10], p=0.012) and pT3T4 stage (OR=5.95; CI95% [1.07- 33.33], p=0.041) as independent predictive factors of a major LARS. Neoadjuvant therapy was also a risk factor for major LARS in our study with a statistically significant difference (p=0.025) between the two groups "Major LARS" and "No major LARS". LARS should be appropriately considered in the management of rectal cancer. Based on our results and data from the literature, age and mesorectal invasion were found to be independent predictors of major LARS.

Investigating colostomy-related morbidity in children following stoma formation and closure in a tertiary hospital, Abha, Saudi Arabia: a retrospective cohort study 2024

BackgroundOverall, stoma-related morbidity affects a reported 20–38% of pediatric patients. However, determining the true incidence of major stoma-related morbidity is challenging due to limited cohort sizes in existing studies. Thus, the aim of this study was to investigate colostomy related morbidity among children both after stoma formation and stoma closure.MethodologyThis is a retrospective cohort hospital-based study, conducted in an Abha maternity and children hospital, between August 1, 2018, and August 1, 2023, among 126 pediatric patients (aged 0–12 years) who underwent colostomy formation and subsequent closure during the study period. Data were collected from medical records. Data was analyzed using Statistical Package for Social Sciences (SPSS) v.26.ResultsThis study included a total of 126 children who underwent colostomy. (N = 37, 29.4%) of cases included in this study were emergency cases, while (N = 89, 70.6%) were elective. A variety of antibiotics were used for surgical prophylaxis, metronidazole (77%) and cefuroxime (62.7%) were the most prevalent. Oral feeding was started after 5–6 days in more than one third of cases (39.7%). Wound infection (N = 15, 11.9%) was the most reported post-operative complication, followed with bowel obstruction (N = 6, 4.8%). Emergency cases had a longer duration of hospital stay than elective cases; this difference was statistically significant (P = .04).ConclusionsMajority of patients reported no stoma related complications, while among those who reported complications, wound infection was the most reported complication, followed by bowel obstruction.