To evaluate outcomes of a single-site divided colostomy in neonates with anorectal malformations (ARM). A retrospective review was conducted of neonates with ARM undergoing colostomy creation between 2012 and 2024 at a tertiary referral center. The technique used a divided colostomy with the proximal limb raised ~ 1.5cm above skin level and a narrowed distal mucous fistula within the same opening, allowing coverage with a single stoma bag. The distal bowel was irrigated at surgery. Complications were classified using the Clavien-Madadi (CM) system. Sixty-one patients (79% male) were included, operated at a median age of 1 (1-3) day. Postoperative complications occurred in 12 (20%) patients. Two (3%) had CM IIIb complications (parastomal hernia and misidentification of bowel limbs). Urinary tract infection (CM II) developed in 6 (10%) patients; three with rectourethral fistula (one with vesicoureteral reflux), two with cloaca, and one without a fistula. Additional complications included granulation tissue requiring treatment (1) and wound infections requiring antibiotics (3). Major dressing difficulties were reported in 5 (8%) patients, while 20 (33%) had minor to moderate issues managed conservatively. Single-site divided colostomy is a safe technique with predominantly minor complications, minimal scarring, and no observed fecal overflow.

Ileal conduit urinary diversion is associated with complications involving the uretero-ileal anastomosis, conduit segment, stoma, and abdominal wall. Complex complications may require individualized reconstructive strategies based on the specific anatomic failure mechanism. A video-based descriptive technical analysis was performed using a narrated operative recording of four robot-assisted reconstructive procedures for ileal conduit complications: right uretero-ileal stricture, bilateral uretero-ileal stricture, delayed conduit torsion with parastomal hernia, and crossed ureters after ileal conduit diversion. The unilateral stricture repair used antegrade methylene blue injection, needle confirmation of the ureteral lumen, ureteral incision and spatulation, ileal conduit incision, stenting, and running side-to-side uretero-ileal reimplantation. The bilateral stricture repair required mobilization and removal of the prior conduit, creation of a longer ileal conduit, bowel reconstruction, ICG-assisted ureteral identification, bilateral ureteral spatulation, stenting, and running uretero-ileal reimplantation. The torsion case involved circumferential stomal access, fascial opening, detorsion of a 360-degree conduit twist, and parastomal reinforcement with polypropylene mesh. The crossed-ureter revision used bilateral excision of prior anastomoses to healthy tissue, side-specific dye/saline confirmation, bilateral spatulation, double-barrel ureteral reconstruction, and circumferential anastomosis to the conduit. Complex ileal conduit revision can be organized around problem recognition, ureteral identity confirmation, preparation of healthy tissue, tension-aware reconstruction, and repair selection based on the underlying anatomic defect. This mechanism-based approach provides a structured framework for robot-assisted correction of uretero-ileal strictures, conduit torsion, and ureteral malorientation after ileal conduit diversion.

Parastomal hernia (PSH) is one of the most frequent long-term complications following abdominoperineal resection (APR) for rectal cancer. The optimal colostomy route to minimize PSH remains controversial. This study aimed to compare PSH risk between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) after laparoscopic APR. A retrospective cohort study was conducted including patients who underwent laparoscopic APR for rectal cancer between 2014 and 2017. Patients were categorized according to colostomy route (EPC vs. TPC). The primary endpoint was PSH, and secondary endpoints included other short- and long-term stoma-related complications and perioperative outcomes. Propensity score matching (1:3) was applied to balance baseline characteristics. Risk factors for PSH were further analyzed using logistic regression. A total of 464 patients were included. After matching, 102 patients in the EPC group and 243 in the TPC group were analyzed. Perioperative outcomes and overall stoma-related complication rates were comparable between groups. However, PSH occurred less frequently in the EPC group than in the TPC group (10/102 [9.8%] vs. 79/243 [32.5%], P < 0.001). Multivariate logistic regression demonstrated that EPC was an independent protective factor against PSH (OR 0.190, 95% CI 0.089-0.406, P < 0.001), whereas increasing age and female sex were significant risk factors. Extraperitoneal colostomy was associated with a lower risk of PSH after laparoscopic APR for rectal cancer without increasing perioperative morbidity. These findings support consideration of the extraperitoneal route in experienced centers to improve long-term stoma outcomes, while prospective multicenter studies are needed for further validation.

Urological complications and renal function outcomes following total pelvic clearance: A five-year retrospective cohort study.

Ostomy Complications: A Narrative Review for Emergency Clinicians.

Faecal incontinence is a complex condition with multifactorial aetiology and significant medical, social, psychological and economic implications. Stoma formation is typically considered a last resort, and evidence on outcomes remains limited. This study aimed to evaluate the characteristics, management and outcomes of patients undergoing stoma formation for faecal incontinence. A retrospective study was conducted in a tertiary unit, including patients with stoma formation for faecal incontinence between February 2011 and August 2023. Twenty-one patients were identified, of whom 18 participated. Participants completed a 19-item questionnaire, including a Colostomy Impact Score. Eighteen patients participated (15 female and 3 male) with a mean age of 67 years (median 68). All had severe faecal incontinence affecting quality of life. Seventeen patients had a colostomy (6 loop and 10 end) and one had a loop ileostomy. Ten procedures were laparoscopic, four were trephine and four were open. The mean duration of symptoms prior to stoma formation was 100 months. All had failed conservative treatment; additional treatments included sacral neuromodulation, transanal irrigation and anal sphincter repair. Time from specialist consultation to stoma ranged from 1 to 60 months (mean 17 months, median 7.5 months). Parastomal hernia occurred in 15 patients, seven requiring multiple repairs. Overall, 78% reported improved quality of life and 83% wished for earlier surgery. Median Colostomy Impact Score was 11 and Decision Regret Scale was 13. Stoma formation for refractory faecal incontinence can significantly improve quality of life. However, stoma-related complications remain common and should be addressed during preoperative counselling and long-term follow-up.

The preclinical evaluation of various meshes and surgical techniques for parastomal hernia (PSH) repair is limited due to the lack of a standardized, responsive, and clinically relevant animal model. This study aimed to validate a previously established rat PSH model and evaluate its ability to discriminate the biological and biomechanical properties of diverse meshes. A total of 24 Sprague-Dawley rats were included in this study. A standardized PSH model was induced by a 3 × 2cm abdominal wall defect, partial rectus abdominis resection, and functional end-colostomy. Keyhole repair was performed using biological meshes (porcine small intestinal submucosa [SIS] or porcine acellular dermal matrix [ADM]) or synthetic meshes (polyvinylidene fluoride [PVDF] or polypropylene [PP]). The model was validated using metrics such as survival, weight trends, and 8-week host responses, including recurrence/bulging, intestinal adhesion, erosion, inflammation, and angiogenesis. The model demonstrated excellent surgical feasibility and tolerance. All groups showed 100% survival and stable weight gain. The model sensitively discriminated mesh-specific outcomes. The SIS group exhibited significantly higher recurrence rates than that of the other groups. The ADM group showed minimal inflammation but moderate adhesion formation. Severe adhesions with histologically confirmed erosion into the stoma intestine were observed in the PVDF and PP groups. Significant differences in inflammation and angiogenesis were observed among the four groups. This rat PSH model provided a validated preclinical platform for evaluating PSH repair strategies and exhibited differential responses among the four meshes in biocompatibility and key repair outcomes.

The management of complex abdominal wall hernias remains a surgical challenge, particularly in selecting the most appropriate technique. This study reports our experience with the laparoscopic repair of complex hernias using the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique concept and its evolution as LIRA-like, LIRA with transabdominal preperitoneal extension (LIRA-TAPE), and the LIRA-Sugarbaker technique in case of parastomal hernia. A retrospective analysis of prospectively collected data was conducted from 2019 to 2025. Hernias were classified according to the European Hernia Society classification. Techniques were selected based on hernia location: LIRA for M1-M4 W3 defects, LIRA-like for L1-L4 W1-W3, LIRA-TAPE for M5 W1-W3, and the LIRA-Sugarbaker for parastomal hernias. Postoperative seroma was classified according to the Morales-Conde classification. Nine patients underwent LIRA. Median defect width was 11cm (range 10-15cm) and median operative time was 100min (range 60-173min). Seromas occurred in 3 patients (33.3%) (two type I and one type II-a), all managed conservatively. Recurrences did not occur. In the LIRA-like group (11 patients), median defect width was 8cm (range 1.5-14cm), and median operative time was 60min (range 25-110min). Seromas occurred in 6 patients (54.5%) (one type I, two type II-a and 3 type II-b). One recurrence (9.1%) occurred due to central mesh failure. Seven patients with median defect width measured 10cm (range 7-18cm) underwent LIRA-TAPE. Median operative time was 70min (range 45-110min). One patient (14.3%) developed ileus and one (14.3%) seroma (type III-a), treated conservatively. Recurrences did not occur. Three patients, with median defect width of 9cm (range 7-11cm) underwent LIRA-Sugarbaker technique. Median operative time was 95min (range 85-110min). Across all groups, no intraoperative complications or conversions occurred. In this single-center retrospective study, the LIRA concept for the treatment of complex ventral hernias appears to be a safe and feasible approach, allowing tension-free defect closure with encouraging short-term outcomes.

Standard loop ileostomy protects low colorectal anastomoses but causes substantial stoma-related morbidity including dehydration, high-output syndrome and metabolic complications. The Anastomotic Leak Prevention Ileostomy Tube (ALPITube) is a novel CE-marked percutaneous diversion device designed to provide anastomotic protection while avoiding traditional stoma complications. To evaluate the technical feasibility, safety profile and preliminary outcomes of ALPITube in an idea, development, exploration, assessment and long-term study (IDEAL) framework Stage 2a development study, with contextual comparison to published loop ileostomy benchmarks. Multicentre retrospective cohort study of consecutive patients undergoing elective colorectal surgery with low anastomosis and ALPITube diversion at two European centres - Clinica La Maddalena in Palermo, Italy (n = 28), and Hospital HM Regla in León, Spain (n = 15) - between May 2023 and June 2025. Primary outcome was 30-day complication rate. Secondary outcomes included device-specific adverse events, conversion to standard ileostomy and mortality. Forty-three patients were analysed (mean age 69.7 ± 9.0years; 88.4% with ≥1 comorbidity; 76.7% received neoadjuvant therapy). Device implantation was technically successful in all cases (mean implantation time 38 ± 14min). Early complications occurred in 21 patients (48.8%), and were predominantly low-grade (Clavien-Dindo I-II: 25.6%). In total, five patients (11.6%) required conversion to loop ileostomy due to device maintenance difficulties. No anastomotic leaks or high-output syndrome occurred. No adverse events were associated with device removal. Contextual comparison with literature benchmarks suggested lower rates of high-output stoma (0% versus 16%), exit-site skin complications (18.6% versus 43%), postoperative ileus (4.7% versus 33%) and parastomal hernia (0% versus 8%). ALPITube demonstrates technical feasibility with an acceptable safety profile and signals potential reduction in stoma-specific complications. The 11.6% conversion rate reflects early implementation experience. These IDEAL Stage 2a findings support progression to prospective comparative studies.

Parastomal hernia (PSH) is a common complication after stoma creation and may present emergently with obstruction, incarceration, or ischemia. While minimally invasive surgery (MIS, laparoscopic or robotic) shows benefits in elective PSH repair, data in emergencies are limited. This study compared outcomes following open versus MIS emergent PSH repair. In this retrospective cohort using ACS-NSQIP, patients undergoing emergent open, laparoscopic, or robotic PSH repair were identified. Surgical approach was categorized as open or MIS. A 3:1 propensity score-matched analysis balanced demographic, comorbidity, physiologic, laboratory, and operative variables. Primary outcome was 30-day overall postoperative complications; secondary outcomes included wound, medical, and surgical complications, return to the operating room (OR), length of stay, and readmission. Multivariate logistic regression identified predictors of complications. Of 303 patients (249 open, 54 MIS), 192 were analyzed after matching (144 open, 48 MIS) with balanced baseline characteristics. MIS repair had lower overall complications than open repair (22.9% vs. 39.6%, p = 0.037), while wound, medical, and surgical complications were similar. Return to the OR tended to be higher after MIS (14.6% vs. 6.3%, p = 0.070), mainly for ostomy-related revisions. Length of stay and readmission were comparable. Higher ASA class independently predicted complications. Robotic repair was associated with reduced odds of overall complications (OR 0.35; 95% CI 0.15-0.79; p = 0.012). MIS repair of emergent PSH was associated with fewer overall complications, though ostomy-related reoperations may be more frequent. MIS is a safe option in selected high-risk patients, with approach guided by patient factors and surgeon experience.

Parastomal hernia (PSH) repair following ureteroileostomy (Bricker's technique) presents unique anatomical challenges, as short ileal conduits often preclude safe stoma lateralization. This study describes the open surgical technique and long-term outcomes of a retromuscular repair utilizing transversus abdominis release (TAR) and a keyhole mesh configuration. We conducted a retrospective analysis of a prospective institutional registry including all consecutive patients undergoing elective open PSH repair after ureteroileostomy between 2019 and 2023. All procedures utilized an open retromuscular keyhole mesh placement with a right-sided TAR. Primary outcomes included 30-day complications (Clavien-Dindo classification) and long-term recurrence. Fourteen male patients (mean age 75.4 years; mean BMI 28.0kg/m2) were included. Concomitant midline hernias were present in 42.9% (6/14). The overall 30-day complication rate was 57.1% (8/14), primarily consisting of seromas (5/14) and surgical site infections (3/14). One ureteral injury (7.1%) occurred, requiring nephrostomy (Grade III). At a median follow-up of 42.7 months (IQR: 32.8-48.7), with an 85.7% (12/14) CT surveillance rate, the recurrence rate was 14.3% (2/14). Only one patient required surgical reintervention for recurrence. The retromuscular keyhole technique for parastomal hernia repair following ureteroileostomy is feasible but carries high perioperative morbidity, and comparable long-term recurrence to other studies. Randomized trials are required to provide a higher level of evidence.

Incisional and parastomal hernias are frequent and significant complications following abdominal surgery, leading to reduced quality of life and substantial healthcare costs. This review provides a comprehensive review of the latest international guidelines, including the 2022 EHS/AHS guideline on abdominal wall closure and the 2023 EHS Rapid Guideline on parastomal hernia prevention. Key recommendations include risk stratification of patients, the superiority of the small-bites fascial closure technique for midline closure, and the selective use of prophylactic mesh.

Parastomal hernia (PSH) is one of the most common complications after permanent colostomy, yet there is ongoing debate regarding the effectiveness and indications of preventive measures. To evaluate the effectiveness and safety of funnel-shaped mesh in preventing PSH over a 3-year follow-up period. The Chimney Trial was a randomized, single-blinded, multicenter study conducted at 4 university and central hospitals in Finland and 1 central hospital in Sweden. This study presents the 3-year follow-up results. Of 439 screened patients undergoing laparoscopic or robotic abdominoperineal excision or Hartmann procedure for rectal adenocarcinoma, 143 were randomized (68 to the mesh group and 67 to the control group). At 3 years, 50 patients in the mesh group and 51 in the control group were available for analysis; computed tomography (CT) scans were obtained in 44 and 39 patients, respectively. These data were analyzed from September 2025 to December 2025. Placement of a funnel-shaped parastomal mesh vs no mesh at the time of abdominoperineal excision or Hartmann procedure. CT-confirmed PSH at 3-year follow-up. The Chimney Trial included a total of 101 patients (39 female [39%] and 63 male [61%]). At 3 years, CT-confirmed PSH was observed in 25 of 44 patients (57%) in the mesh group and 32 of 39 patients (82%) in the control group (difference, -25%; 95% CI, -42% to -5%; P = .001). Clinically diagnosed PSH occurred in 5 of 50 patients (10%) vs 20 of 51 patients (39%) in the control group (difference, -29%; 95% CI, -44% to -13%; P < .001). PSHs were significantly larger in the control group compared with the mesh group (median [IQR], 86.8 [53.0-136.5] mL for the mesh group vs 185.9 [118.0-411.2] mL for the control group; P = .003). No significant differences were observed in other secondary outcomes. In this study, funnel-shaped mesh significantly reduced PSH incidence without increasing complications over a 3-year follow-up period. These findings support the use of a funnel-shaped mesh as an effective and safe preventive strategy to reduce the risk of parastomal hernia after permanent colostomy. ClinicalTrials.gov Identifier: NCT03799939.

Large language models (LLMs) can analyse scientific literature and draft medical recommendations, but their role in formal clinical guideline development is unclear. To evaluate whether a publicly available GPT-based LLM can generate coherent, GRADE-based guidelines for parastomal hernia management from a predefined evidence base, and to compare these with the 2017 European Hernia Society (EHS) guidelines. A secondary aim was to explore implications for academic publishing and scientific authorship. The 2017 EHS parastomal hernia guidelines (Antoniou et al.) were used as the reference framework. Within a closed session, the model was instructed to apply AGREE II and GRADE principles to 52 full-text clinical papers mirroring the original EHS reference set, and to formulate recommendations for nine key clinical questions (KQs). For each KQ, the model defined PICO, summarized the evidence, rated certainty, and stated direction and strength of recommendation. AI-derived guidance was then systematically compared with EHS statements. Divergences were classified as interpretative, threshold-based (handling of low-certainty evidence), or evidence-weighting. AI-generated recommendations showed full or near-full alignment with EHS guidance in most domains, including diagnosis, prophylactic mesh for permanent end colostomy, rejection of suture-only repair, preference for non-keyhole laparoscopic repair, and favouring synthetic over biologic meshes. Differences arose primarily where evidence was very low quality: the model issued cautious, conditional recommendations (e.g., watchful waiting in asymptomatic hernias, consideration of laparoscopy in suitable patients, preference for retromuscular synthetic mesh and avoidance of cross-linked collagen onlay), whereas EHS opted for no recommendation. Within a closed evidence base, a GPT-based model can reproduce the logic and structure of expert guideline development with high fidelity. Discrepancies mainly reflect different thresholds for acting on low-certainty evidence, supporting a complementary role for AI as a structured methodological and drafting assistant rather than a replacement for human consensus.

The incidence of stoma-site incisional hernia (SSIH) in rectal cancer patients varies widely in the literature. This study aimed to determine the incidence of SSIH, identify its risk factors, investigate the impact of adjuvant therapy, and subsequently develop a predictive model. This was a single-centre, retrospective study involving consecutive patients who underwent radical resection for rectal carcinoma with temporary diverting loop ileostomy and subsequent stoma reversal at our centre from 2020 to 2024. Patient demographic characteristics, comorbidities, operative data, and follow-up information were collected. Logistic univariate and multivariate analyses were used to identify the risk factors for SSIH, following which we constructed a nomogram for SSIH prediction. 331 patients were enrolled in the study, the incidence of stoma site incisional hernia was 24.8% (82/331). Multivariate analysis identified advanced age (≥ 65years), body mass index (BMI) ≥ 24kg/m2, stoma diameter ≥ 3cm, delayed stoma reversal (≥ 6months), presence of a parastomal hernia, and postoperative surgical site infection (SSI) and a low postoperative-to-preoperative albumin ratio(< 0.85) as independent risk factors. Neither adjuvant chemotherapy, radiotherapy, nor immunotherapy was identified as an independent risk factor for SSIH in the multivariate logistic regression analysis. A nomogram based on perioperative patient factors was constructed to predict the occurrence of stoma site incisional hernia (SSIH) after ileostomy reversal in rectal cancer patients. The nomogram demonstrated strong predictive performance and good calibration, providing clinicians with a valuable tool to identify high-risk patients and implement targeted preventive strategies.

Parastomal Hernia: Rethinking Prevention and Repair in Contemporary Colorectal Surgery.

Retromuscular (sublay) synthetic mesh reinforcement versus no mesh at end-colostomy creation to prevent parastomal hernia: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials featuring subgroup analysis by CT-mandated versus clinical detection.

Parastomal hernia repair remains a complex surgical challenge due to high recurrence rates and significant technical demands. The modified Sugarbaker technique, particularly Pauli's retromuscular adaptation, has demonstrated promising outcomes. Concurrently, the PeTEP approach enables extensive preperitoneal dissection while preserving the integrity of the abdominal wall. We present the first reported case of atotally endoscopic preperitoneal repair combining both techniques (Pe-Pauli) for the simultaneous treatment of parastomal and midline hernias. A 73-year-oldwoman with a prior Hartmann procedure and failed reconstruction presented with symptomatic parastomal and midline incisional hernias. Through a cranial endoscopic approach, trocars were placed for PeTEP, along with an additional lateral access for parastomal repair. To preserve peritonealintegrity, the Red Cross Step technique was employed, facilitating safe dissection through the transversalis fascia and the musculoaponeurotic edge of the transversus abdominis muscle. The hernia contents were reduced, the defects were closed with barbed sutures, and a 20 × 30 cm Synecor® mesh was positioned in the preperitoneal space. A second polypropylene mesh was placed to reinforce the midline. The procedure lasted 325 minutes, with an uneventful recovery and no recurrence at 6-monthfollow-up. The Pe-Pauli approach allows for anatomical extra peritoneal reconstruction of complex hernias in a single-stage procedure. Although technically demanding, it may improve outcomes in selected patients. Further studies are required to validate its long-term safety and efficacy.

Long-term parietal complications following surgery for inflammatory colitis: An underestimated issue.

Minimally invasive colorectal surgery (MIS) offers reduced pain, faster bowel recovery, and shorter hospitalization compared with open surgery. In patients requiring a stoma, the stoma site can be used for specimen extraction, reducing the number of incisions. However, stoma-related complications, particularly parastomal hernia, may be increased. We synthesized evidence comparing stoma-site specimen extraction (SSE) with alternative extraction sites in MIS. A systematic review and meta-analyses were conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and gray literature were performed (1990-2025). Eligible studies included adults undergoing elective laparoscopic or robotic colorectal surgery with SSE compared against midline or other extraction sites. Outcomes included stoma-related and nonstoma complications, perioperative parameters, and oncologic safety. Random-effect models were applied. Risk of bias was assessed using a modified Newcastle-Ottawa Scale. The study was prospectively registered with PROSPERO (CRD420251137576). Eighteen studies comprising 5699 patients (SSE: 1363; midline: 539; other incisions: 3797) were included. Overall, stoma-related complication rates were comparable between groups (SSE versus midline: OR: 1.04, 95% confidence interval [CI]: 0.37-2.89; SSE versus others: OR: 1.13, 95% CI: 0.75-1.68). The risk of parastomal hernia did not differ significantly between SSE and comparators (SSE versus midline: OR: 2.67, 95% CI: 0.53-13.54; SSE versus others: OR: 1.36, 95% CI: 0.69-2.67). Non-stoma-related complications (OR: 0.96, 95% CI: 0.66-1.38) and readmission rates were also similar. Perioperative outcomes favored SSE, with shorter operative time (mean difference -22.6 minutes versus others) and earlier return of flatus. SSE is a safe and effective technique in MIS, offering perioperative benefits without increasing overall complication rates. Although parastomal hernia incidence was not significantly higher, vigilance is required, particularly in patients with permanent stomas. With appropriate case selection and meticulous closure, SSE represents a technique of MIS that reduces abdominal wall trauma while maintaining surgical safety.