Ostomy Creation Research Articles

Use of prophylactic mesh to prevent parastomal hernia formation: a systematic review, meta-analysis and network meta-analysis.

To evaluate the effectiveness of prophylactic mesh placement in reducing the incidence of parastomal hernias following colostomy, ileostomy, and ileal conduit formation. A systematic review identified relevant studies evaluating parastomal hernia incidence with prophylactic mesh use during stoma formation. Pairwise meta-analysis and network meta-analysis using Bayesian modeling were performed. 25 studies, consisting of 16 randomized control trials (RCT), 6 follow up studies, and 3 retrospective cohort studies, were included. Prophylactic mesh led to significantly fewer parastomal hernias beyond 6 months follow-up (OR 0.43, 95% CI 0.33-0.58). Hernias were reduced with mesh for both ileal conduits and colostomies. When analyzing hazard ratios (HRs), only 6 studies were included, and a statistically significant difference was observed among both randomized controlled trials (RCTs) (HR 0.75 [0.53, 0.92], p = 0.01) and non-RCTs (HR 0.57 [0.36, 0.92], p = 0.02). Network meta-analysis found the retromuscular approach with mesh had the lowest hernia rate. Regression was non-significant for variations between study types. This meta-analysis demonstrated prophylactic mesh placement during ostomy creation significantly reduced parastomal hernia risk, more prominently beyond 6 months, consistently across randomized trials and observational studies for urologic and gastrointestinal ostomies. The retromuscular technique was most effective.

Ghost-ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer: results of a randomised controlled multicentre pilot trial (DRKS00013997).

The objective of the current pilot trial was to evaluate whether ghost ileostomy is a safe alternative to the current standard of care in terms of a conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision (LAR/TME) for rectal cancer. This randomized controlled pilot trial included patients undergoing LAR/TME, randomly assigning them to ghost ileostomy or conventional loop ileostomy intraoperatively. Follow-up spanned 6months, evaluating the following endpoints: comprehensive complication index (CCI), postoperative morbidity, transformation of ghost ileostomy, presence of ostomy at 6months, Wexner score, and quality of life (EORTC QLQ-C30 & CR29). Exploratory statistical analysis based on the intention-to-treat principle was conducted. Recruiting 30 patients from May 2018 to September 2022, the trial was prematurely stopped due to slow recruitment. The mean CCI was comparable between groups at any point of time (at 6months: 30.7 vs. 29.7, p = 0.889). There was no mortality and no need for creation of a terminal ostomy. Anastomotic leakage rates were similar in ghost ileostomy and loop ileostomy groups (p > 0.99). The ghost ileostomy was converted into a conventional loop ileostomy in 6 of 15 (40.0%) patients. Neither postoperative function, nor the overall quality of life showed significant differences. Ghost ileostomy appears as a viable and safe option for selectively deciding ileostomy creation in LAR/TME for rectal cancer. However, challenges in patient selection, excluding those at high risk for anastomotic leakage, limit widespread application and call for optimization in future research. German Clinical Trials Register ( https://drks.de/ ): DRKS00013997; date of registration: April 9th 2018.

Pouching System Leakage and Peristomal Skin Complications Following Ostomy Surgery in the Immediate Postoperative Period: A Retrospective Review.

The purpose of this study was to explore the performance of pouching systems with respect to leakage and the development of peristomal skin complications (PSCs) in an acute care setting immediately following ostomy creation. Non-experimental, retrospective cohort study. The sample comprised 214 patients admitted for stoma-creation surgery at one of the 2 University of Pittsburgh Medical Center Presbyterian-Shadyside campuses located in the Northeastern United States (Pittsburgh, PA). Patients were seen in an in-patient care setting. Electronic health records from patients who were in the hospital for ostomy creation surgery were reviewed by wound ostomy continence nurses from each hospital. Demographic and selected clinical data were collected. The main outcome variables used to evaluate pouching system performance were leakage and PSCs. These outcomes were assessed starting at pouch placement in the operating room and at every subsequent pouch change (up to 5) through discharge or 2 weeks following surgery. Use of an elastic tapeless barrier (ETB) significantly reduced the risk of leakage compared to a ceramide-infused tape-border barrier (CIB) for patients (41% reduced risk of leakage, P =.011). Use of the ETB also reduced leakage risk compared to the CIB for patients who experienced leakage 2 or more times during the observation period (31% reduction in leakage risk, P =.043). Five types of PSCs occurred during the study and statistical analysis indicated no significant differences in the number of PSCs was documented between barrier types. The use of an ETB significantly reduced the risk of leakage compared to a CIB.

National Trends in the Creation of Diverting Ileostomy at the Time of Ileal Pouch-Anal Anastomosis in Adults With Ulcerative Colitis.

The impact of diverting ileostomy in adults with ulcerative colitis (UC) undergoing ileal pouch-anal anastomosis (IPAA) is unclear. This study uses a novel approach with population-level data to identify patients with diverting ileostomy at the time of IPAA and determine the impact of diverting ileostomy on postoperative outcomes. Using the International Business Machines (IBM) MarketScan® database, adults (18-64years old) with a diagnosis of UC who underwent IPAA between 2000 and 2019 were examined. Patients were assigned to the diverting ileostomy (DI) cohort or no-DI cohort based on the presence of an ostomy closure code in the 1-year following their IPAA. Rates of ileostomy formation and readmissions were quantified and outcomes between cohorts compared. There were 540 patients in the no-DI and 2494 in the DI cohort. There were regional differences in the rate of ostomy creation, but the overall rate of ostomy creation remained stable across years. Patients with no-DI vs DI had a longer index length of stay (LOS) (7 vs 6days, P = .001). Adverse postoperative outcomes did not differ between cohorts. Diversion did not independently affect the likelihood of a 30-day readmission, and since 2000, readmission rates have declined for all IPAA patients. This is the first study to capture population-level data on the effect of diversion at the time of IPAA for adult UC patients. This study demonstrates that the rate of fecal diversion at the time of IPAA has remained stable over time, but readmission rates have declined.

Factors Limiting Ostomy Reversal After Cytoreductive Surgery for Ovarian Cancer: A Retrospective Study.

To investigate the factors related to non-reversal of ostomy after cytoreductive surgery in ovarian cancer. In many women with ovarian cancer, transitory ostomies are performed to limit the consequences of anastomotic leak. Although intended to be temporary, a proportion of these ostomies might never be reversed. This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a transitory ostomy during primary or secondary cytoreductive surgery at the Bergonie Institute, France, and the University Hospital of Las Palmas, Spain, between January 2012 and December 2022. Rate of ostomy reversal, its timing (weeks) and postoperative complications were assessed. Multivariate logistic regression analysis was performed to identify limiting factors for ostomy reversal. During the study period, we reviewed data on 181 consecutive patients with ovarian cancer with transitory ostomy creation; 89 (49.2%) patients were not candidates for an ostomy reversal surgery because of disease progression (n=65), death (n=16), and patient's refusal of surgery (n=8). A total of 92 patients were candidates for reversal surgery and were therefore included in the final analysis. In total, 57 (62%) patients had their ostomy reversed. The mean time from ostomy creation to ostomy closure was 47.7 (standard deviation=33.1) weeks. Hartmann's procedure (leaving a rectal stump of 5-6 cm) was identified as an independent predictive factor for non-reversal of ostomy (odds ratio=6.42, 95% confidence interval=1.61-25.53; p=0.008). Complications after ostomy reversal occurred in 32 patients (34.8%). Hartmann's procedure is a limiting factor for ostomy reversal in patients with ovarian cancer. We recommend avoiding Hartmann's procedure during cytoreductive surgery, even after colorectal anastomotic leak.

Outcomes after right-sided colon surgery in Crohn's disease versus cancer.

Surgery for Crohn's disease (CD) is considered to have more complications due to the underlying inflammation, immunosuppression, and malnutrition.We sought to study the outcomes of right-sided colonic resection in patients with CD and patients with cancer at a high-volume tertiary center utilizing a standardized perioperative protocol. This is a retrospective study of outcomes for all patients with CD or patients undergoing ileocolic resection or right hemicolectomy with ileocolic anastomosis at a single institution from 2013 to 2022. Patients were excluded if they simultaneously underwent another procedure or ostomy creation. Data were analyzed using Wilcoxon rank-sum and chi-squared tests for univariate analyses, and logistic and linear regressions for multivariate analyses. In total 141 patients with CD and 589 patients with cancer were included. Patients with CD were significantly younger with lower body mass index and less likely to have comorbidities, including diabetes and hypertension. Patients with CD were less likely to have a smoking history or prior abdominal surgery, but more likely to be on steroids. Both groups had similar rates of laparoscopy, intraoperative complications, and blood loss. Despite the preoperative and intraoperative differences, both patients with CD and patients with cancer had similar lengths of stay (LOS), readmission, reoperation, and mortality rates.None of the surgical outcomes differed significantly between the two groups.On multivariate analysis, CD diagnosis was not associated with reoperation, readmission, mortality, or LOS while controlling for other characteristics. With the use of standardized perioperative protocols, surgery for CD at a high-volume center with expertise in CD can be performed with comparable results to other indications like cancer.

Impact of pandemic and socioeconomic influences on decision-making for emergency ostomy procedures: Key factors affecting hospital visit decisions.

Emergency surgeries are linked with increased morbidity and reduced life expectancy, often associated with low socioeconomic status, limited access to healthcare, and delayed hospital admissions. While the influence of socioeconomic status on elective surgery outcomes is well-established, its impact on emergency surgeries, including ostomy creation and closure, is less clear. This study aimed to explore how the pandemic and socioeconomic status affect emergency ostomy procedures, seeking to determine which has a greater effect. It emphasizes the importance of considering socioeconomic factors in patient care pathways for ostomy procedures. A total of 542 patients who underwent emergency ostomy formation between 2016 and 2022 were retrospectively analyzed and divided into pre-pandemic and pandemic periods. The pre-pandemic and pandemic periods were compared between themselves and against each other. Demographic data (age and sex), comorbidities, socioeconomic status, etiology of the primary disease, type of surgery, stoma type, length of hospital stay, ostomy closure time, and postoperative complications were retrospectively analyzed for all patients. In total, 290 (53%) patients underwent surgery during the pandemic period, whereas 252 (47%) underwent surgery during the pre-pandemic period. Emergency surgery was performed for malignancy in 366 (67%) patients. The number of days patients underwent ostomy closure was significantly higher in the low-income group (P = .038, 95% CI: 293,2, 386-945). The risk of failure of stoma closure was 3-fold (95% CI: 1.8-5.2) in patients with metastasis. The risk of mortality was 12.4-fold (95% CI: 6.5-23.7) when there was failure of stoma closure. When compared to pandemic period, the mortality risk was 6.3-fold (95% CI: 3.9-10.2) in pre-pandemic period. Pandemic patients had a shorter hospital stay than before the pandemic (P = .044). A high socioeconomic status was significantly associated with early hospital admission for ostomy closure, and lower probability of mortality. More metastases and perforations were observed during the pandemic period and mortality was increased during pandemic and in patients without ostomy closure. The socioeconomic status lost its effect in cases of emergency ostomy creation and had no impact on length of hospital stay in either the pre-pandemic or pandemic period.

Pediatric stoma in Zambia: Current ethical challenges and advancement of public policy.

Pediatric ostomy creation is becoming increasingly prevalent in Sub-Saharan Africa (SSA). The procedure is associated with both physical and ethical challenges for patients, their families, and medical providers. Counseling parents of children in need of ostomy creation must address each of their trepidations while seeking to promote the ethical tenets of beneficence, non-maleficence, autonomy, quality of life, and justice. As pediatric surgical care in SSA continues to progress, efforts to ameliorate challenges to providing holistic patient-centric care must also progress. This manuscript outlines ethical dilemmas associated with pediatric ostomy care in SSA and lists efforts and initiatives seeking to address them.

Randomised Controlled Pilot Trial on GHOST Ileostomy versus Conventional Loop Ileostomy in Patients Undergoing low Anterior Resection for Rectal Cancer

Abstract Background Anastomotic leakage is the most important complication after colorectal surgery. In patients undergoing low anterior resection with total mesorectal excision (LAR/TME) a loop ileostomy is fashioned to protect the low anastomosis. Ghost ileostomy is a pre-stage ileostomy, which can be converted to a diverting ileostomy, if anastomotic leakage is suspected. If there are no signs of anastomotic leakage an actual ileostomy can be avoided. Aims The objective was to evaluate whether ghost ileostomy is a safe alternative to a conventional loop ileostomy. Methods GHOST was a randomised controlled pilot trial without formal hypothesis. Patients undergoing LAR/TME for rectal cancer were intraoperatively randomised to receive a ghost ileostomy or loop ileostomy. Patients were followed prospectively for 6 months. Comprehensive complication index, transformation of ghost ileostomy into loop ileostomy, presence of an ostomy at 6 months, Wexner score and quality of life were assessed. Results Thirty patients were equally randomised. The CCI was 30.7 (± 17.7) in the ghost ileostomy group compared to 29.7 (± 18.6) in the loop ileostomy group at 6 months (p=0.889). The ghost ileostomy was converted into a loop ileostomy in 6 of 15 (40.0%) patients. At 6 months after low anterior resection, 6 (40.0%) patients in the ghost ileostomy group and 7 (46.7%) patients in the ileostomy group still had an ileostomy. There was no mortality and no need for creation of a terminal ostomy within the trial. Neither postoperative function assessed by the Wexner score, nor the overall quality of life showed significant differences. Conclusion Ghost ileostomy seems to be a viable and safe option to a more selective approach regarding creation of an ileostomy in patients undergoing LAR/TME. However, the difficult patient selection with exclusion of patients at high risk of anastomotic leakage limits its widespread application and should be optimised in future trials.

Apple-Peel intestinal atresia: A systematic review

Background: Apple-peel bowel atresia (APA) is rare and thus lacks proper management guidelines. This systematic review analyzes various interventions found in the literature for this type of atresia and highlights the outcomes of each intervention with their complications. Methods: The relevant literature on PubMed, Scopus, Embase, and Cochrane was reviewed from November 2020 to January 2021. Articles published in English, French, Italian, or Spanish between 1990 and 2020, focusing on APA, were included. Data on demography, clinical profile, management provided, time to achieve full feed, length of hospital stay, complications, etc., reviewed. Results: A total of 2495 articles were found, of which only 48 met the inclusion criteria. Among these, 125 patients were treated, with 15 deaths. The most frequently employed intervention was primary resection, with or without tapering, while ostomy creation was less commonly used. The most frequent complication across all techniques appeared to be cholestasis, followed by stenosis of the anastomosis and sepsis. Additionally, there were a total of 7 cases of short bowel syndrome (SBS). Conclusion: The management of apple-peel atresia seems variable in various centers of different countries. The review failed to assess which interventions could lead to faster full enteral feeding. The distal part of the anastomosis must be considered as an active part in the resumption of bowel function.

Palliative Surgery for Patients with Gastroesophageal Junction or Gastric Cancer: A Report on Clinical Observational Outcomes.

Few studies have focused on palliative surgery in patients with advanced gastroesophageal junction (GEJ) or gastric cancer. We sought to evaluate clinical observational outcomes following palliative surgery in this population. Patients with GEJ or gastric cancer who underwent palliative surgery (1/2010-11/2022) were identified. The primary outcomes were symptom improvement, ability to tolerate an oral diet, discharge to home, 30 "good days" without hospitalization, and receipt of systemic treatment. Postoperative outcomes and survival were secondarily evaluated. Among 93 patients, the median age was 59 (IQR 47-68) years, and the median Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 (range 0-3). The most frequent indication for palliative surgery was primary tumor obstruction [75 (81%) patients]. The most common procedures were feeding tube placement in 60 (65%) and intestinal bypass in 15 (16%) patients. A total of 75 (81%) patients experienced symptom improvement. Of these, 19 (25%) developed recurrent and 49 (65%) developed new symptoms. ECOG-PS was significantly associated with symptom-free time. Among those who underwent a bypass, resection, or ostomy creation for malignant obstruction, 16 (80%) tolerated an oral diet. Postoperatively, 87 (94%) were discharged home, 72 (77%) had 30 good days, and 64 (69%) received systemic treatment. Postoperative complications occurred in 35 (38%) patients, and 7 (8%) died within 30 days. The median survival time was 7.7 (95% CI 6.4-10.40) months. Patients with incurable GEJ or gastric cancer can benefit from palliative surgery. Prognosis and performance status should inform goals-of-care discussions and patient selection for surgical palliation.

Open Versus Minimally Invasive Emergent Colectomy for Diverticulitis.

The role of minimally invasive surgery (MIS) in the acute management of diverticulitis remains controversial. Using a national cohort, we examined the relationship between operative approaches with acute clinical and financial outcomes. Adults undergoing emergent colectomy for diverticulitis were tabulated from the 2015-2020 American College of Surgeons National Surgical Quality Improvement Program. Regression models were developed to analyze the association between open and MIS approaches with major adverse events (MAE), as well as secondary endpoints. A subgroup analysis was conducted to compare outcomes between open and MIS requiring conversion to open (CTO). Of 9194 patients, 1580 (17.3%) underwent MIS colectomy. The proportion of MIS resection increased from 15.1% in 2015 to 19.1% in 2020 (nptrend<.001). Compared to Open, MIS patients were younger, equally likely to be female, had a lower proportion of patients with ASA class ≥3, and a higher BMI. Preoperatively, MIS patients were less frequently diagnosed with sepsis. Following adjustment with open as reference, MIS approach had reduced odds of MAE (AOR .56), ostomy creation (AOR .12), shorter postoperative length of stay (LOS; β -1.63), and a lower likelihood of nonhome discharge (AOR .45, all P < .001). Additionally, CTO was linked to decreased likelihood of MAE (AOR .78, P = .01), ostomy creation (AOR .02, P < .001), comparable LOS (β -.46, P = .41), and reduced odds of nonhome discharge (AOR .58, P < .001), relative to open. Compared to planned open colectomy, MIS resection was associated with improved clinical and financial outcomes, even in cases of CTO. Our findings suggest that whenever possible, MIS should be attempted first in emergent colectomy for diverticulitis. Nevertheless, future prospective studies are likely needed to further elucidate specific patient and clinical factors.

The experiences of Chinese colorectal cancer survivors in marital intimacy after ostomy creation: A qualitative study.

Colorectal cancer (CRC) ranks as the third most prevalent cancer globally. The disease and its treatment significantly impact marital intimacy, particularly among individuals who have undergone ostomy creation. Therefore, it is necessary to explore their experiences. This study aimed to explore the experiences of colorectal cancer survivors in marital intimacy after ostomy creation and clarify the domain and sub-domain of marital intimacy in CRC survivors with ostomy. This study used a qualitative descriptive design, and participants were selected by purposive sampling from two hospitals in Henan province, China. Sixteen patients participated in this research, and the data were collected through an in-depth interview from June 27 to September 27, 2023. Colaizzi's method was used to analyze the data. Five themes emerged from data analysis, including physical intimacy, psychological intimacy, social intimacy, spiritual intimacy, and operational intimacy. By profiling the experiences of CRC survivors in marital intimacy after ostomy creation, the domain and sub-domain of marital intimacy were clarified in this cohort and revealed that ostomy had a severe effect on marital intimacy among colorectal cancer survivors. The results from this study could be used by nurses, midwives, and other healthcare professionals to design specific interventions covering all aspects of marital intimacy. Also, the findings will guide the development of a particular instrument for marital intimacy in CRC survivors with ostomy.

Prophylactic defunctioning stomas improve clinical outcomes of anastomotic leak following rectal cancer resections: An analysis of the US Rectal Cancer Consortium

PurposeAnastomotic leak (AL) is a complication of low anterior resection (LAR) that results in substantial morbidity. There is immense interest in evaluating immediate postoperative and long-term oncologic outcomes in patients who undergo diverting loop ileostomies (DLI). The purpose of this study is to understand the relationship between fecal diversion, AL, and oncologic outcomes.MethodsThis is a retrospective multicenter cohort study using patient data obtained from the US Rectal Cancer Consortium database compiled from six academic institutions. The study population included patients with rectal adenocarcinoma undergoing LAR. The primary outcome was the incidence of AL among patients who did or did not receive DLI during LAR. Secondary outcomes included risk factors for AL, receipt of adjuvant therapy, 3-year overall survival, and 3-year recurrence.ResultsOf 815 patients, 38 (4.7%) suffered AL after LAR. Patients with AL were more likely to be male, have unintentional preoperative weight loss, and are less likely to undergo DLI. On multivariable analysis, DLI remained protective against AL (p < 0.001). Diverted patients were less likely to undergo future surgical procedures including additional ostomy creation, completion proctectomy, or pelvic washout for AL. Subgroup analysis of 456 patients with locally advanced disease showed that DLI was correlated with increased receipt of adjuvant therapy for patients with and without AL on univariate analysis (SHR:1.59; [95% CI 1.19–2.14]; p = 0.002), but significance was not met in multivariate models.ConclusionLack of DLI and preoperative weight loss was associated with anastomotic leak. Fecal diversion may improve the timely initiation of adjuvant oncologic therapy. The long-term outcomes following routine diverting stomas warrant further study.

The clinical and economic burden of illness in the first two years after ostomy creation: a nationwide Danish cohort study

ABSTRACT Background Living with an ostomy is often associated with costly complications. This study examined the burden of illness the first two years after ostomy creation. Methods Data from Danish national registries included all adult Danes with an ostomy created between 2002 and 2014. Results Four cohorts consisted, respectively, of 11,385 subjects with a colostomy and 4,574 with an ileostomy, of which 1,663 subjects had inflammatory bowel disease (IBD) and 1,270 colorectal cancer as cause of their ileostomy. The healthcare cost was significantly higher for cases versus matched controls for all cohorts. In the first year, the total healthcare cost per person-year was €27,962 versus €4,200 for subjects with colostomy, €29,392 versus €3,308 for subjects with ileostomy, €15,947 versus €2,216 when IBD was the underlying cause, and €32,438 versus €4,196 when it was colorectal cancer. Healthcare costs decreased in the second year but remained significantly higher than controls. Hospitalization and outpatient services were primary cost drivers, with ostomy-related complications comprising 8–16% of hospitalization expenses. Conclusion Compared to controls, subjects with an ostomy bear a significant health and financial burden attributable to ostomy-related complications, in addition to the underlying disease, emphasizing the importance of better ostomy care to enhance well-being and reduce economic strain.

Bowel preparation for elective colectomy in Crohn's disease: results from a global cohort study using the NSQIP database.

The role of bowel preparation before colectomy in Crohn's disease patients remains controversial. This retrospective analysis of a prospective cohort study aimed to investigate the clinical outcomes associated with mechanical and antibiotic colon preparation in patients diagnosed with Crohn's disease undergoing elective colectomy. Data were collected from the American College of Surgeons National Surgical Quality Improvement Program participant user files from 2016 to 2021. A total of 6244 patients with Crohn's disease who underwent elective colectomy were included. The patients were categorized into two groups: those who received combined colon preparation (mechanical and antibiotic) and those who did not receive any form of bowel preparation. The primary outcomes assessed were the rate of anastomotic leak and the occurrence of deep organ infection. Secondary outcomes included all-cause short-term mortality, clinical-related morbidity, ostomy creation, unplanned reoperation, operative time, hospital length of stay and ileus. Combined colon preparation was associated with significantly reduced risks of anastomotic leak (relative risk 0.73, 95% CI 0.56-0.95, P = 0.021) and deep organ infection (relative risk 0.68, 95% CI 0.56-0.83, P < 0.001). Additionally, patients who underwent colon preparation had lower rates of ostomy creation, shorter hospital stays and a decreased incidence of ileus. However, there was no significant difference in all-cause short-term mortality or the need for unplanned reoperation between the two groups. This study shows that mechanical and antibiotic colon preparation may have clinical benefits for patients with Crohn's disease undergoing elective colectomy.

Knowledge and Practice of Intestinal Ostomy Care Among Nurses in Bahir Dar City, Ethiopia: A Cross-Sectional Study.

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

Outcomes for pediatric acute lymphoblastic leukemia patients with intestinal perforation.

Intestinal perforation during acute lymphoblastic leukemia (ALL) treatment in children is rare, but represents a severe complication with possible long-term consequences. In this study, we aim to provide an overview of the epidemiology and clinical characteristics of these patients; analyze surgical pathology findings for possible causes; and determine its impact on patients' therapy, nutritional status, and outcome. Historical chart review from January 2000 to October 2020 of children with ALL and intestinal perforation during therapy diagnosed at a single institution. Data collected included patient demographics, anthropometric measurements, ALL characteristics, diagnosis and surgery of intestinal perforation, pathology, adjustments to treatment plan, and outcome. Of 1840 ALL patients, 13 (0.7%) presented with intestinal perforation during treatment. Perforation occurred during induction phase in 91% of cases. Most patients underwent laparotomy with ostomy creation, and no patient died from the intervention or developed malnutrition. Pathology mainly revealed inflammation at the perforation site. Two samples showed leukemic infiltration and presence of microorganisms. Patients were able to resume ALL therapy in all cases. A total of eight patients (73%) were in first remission at last follow-up, with a median follow-up time of 42months (interquartile range=42). Early surgical intervention is a successful treatment approach for intestinal perforation in ALL patients. There is a clear predilection for induction phase in the occurrence of intestinal perforation in ALL patients. No specific cause was identified. Patients can receive bridging chemotherapy during surgical recovery and proceed with their treatment without apparent impact on outcome.

Different Analgesia Techniques for Postoperative Pain in Children Undergoing Abdominal Surgery for Intractable Constipation: A Retrospective Cohort Study in a Single Tertiary Children's Hospital.

Functional constipation in the pediatric population is a prevalent issue that is usually well managed. However, in rare cases, conservative treatment fails, and surgical intervention is necessary. This retrospective cohort study aimed to describe and compare different perioperative analgesic techniques in children undergoing major abdominal surgery for intractable constipation. Conducted between 2011 and 2021, this study enrolled patients under 18 years old who underwent initial major abdominal surgery for intractable constipation (i.e., creation of ostomy or subtotal colectomy). Patients were categorized according to the perioperative analgesic technique (i.e., systemic, neuraxial, or truncal block). Of 65 patients, 46 (70.8%) were female, and the median age was 13.5 [8.8-16.1] years during initial major abdominal surgery. Systemic analgesia was used in 43 (66.2%), neuraxial in 17 (26.2%), and truncal blocks in 5 (7.7%) of the surgeries. Patients with neuraxial analgesia reported less postoperative pain (median [interquartile range] numeric rating scale (NRS) 2.0 [0-4.0]), compared to systemic analgesia (5.0 [2.0-7.0], p < 0.001) and to truncal blocks (5.0 [3.0-6.5], p < 0.001). In this preliminary investigation, neuraxial analgesia appears to be the most effective approach to reducing acute postoperative pain in pediatric patients undergoing major abdominal surgery for intractable functional constipation. However, well-designed studies are warranted.

Influencing factors associated with peristomal skin complications after colorectal ostomy surgery: a systematic review and meta-analysis.

Peristomal skin complications (PSCs) are the most common complication among patients with ostomies after ostomy creation. This systematic review and meta-analysis aimed to evaluate the factors influencing the occurrence of peristomal skin complications. A systematic review was conducted across multiple databases by using a combination of subject terms and free words for online search. The databases were searched from their inception to October 31, 2023. All studies that met inclusion criteria were examined to identify risk factors for PSCs. Two researchers independently conducted literature screening and information extraction, evaluated the literature quality using the Newcastle-Ottawa Scale, and performed descriptive analysis of the results. Ten studies were included in this review. A total of 3753 patients with ostomies participated in the studies, and 981 patients suffered from PSCs, with PSC incidence ranging from 15.5% to 47.7%. Type of ostomy, diabetes, self-care knowledge, and chemotherapy were significant factors associated with PSCs. This review highlighted 4 factors that influence the occurrence of peristomal skin complications. The quality of included literature is generally low, with significant heterogeneity in study design and choice of outcome indicators. Therefore, further research involving high-quality studies with larger sample sizes is needed for deeper investigation.