Stoma Group Research Articles

STAT trial: stoma or intestinal anastomosis for necrotizing enterocolitis: a multicentre randomized controlled trial

PurposeThe STAT trial is a multicenter randomized controlled trial in 12 centers worldwide aiming to determine the most effective operation for neonates with necrotizing enterocolitis (NEC) requiring intestinal resection: stoma formation (ST) or primary anastomosis (PA).MethodsInfants having a primary laparotomy for NEC were randomized intraoperatively to PA or ST if the operating surgeon thought that both were viable treatment options for that patient. The primary outcome (duration of parenteral nutrition [PN]) was evaluated by Cox regression.ResultsEighty patients were recruited from 2010 to 2019. Infants undergoing anastomosis finished PN significantly earlier than patients undergoing stoma (hazard ratio PA vs. ST 2.38, 95% CI 1.36–4.12 p = 0.004). There was no difference in mortality between the two groups (PA 4/35 vs. ST 8/38 p = 0.35) or in the rate of complications requiring further unplanned operations (p = n.s.). Multiple intestinal complications were more frequent in the stoma group compared to the anastomosis group (ST 12/26 vs. PA 5/31, p = 0.02, Fisher’s Exact test).ConclusionAt laparotomy for NEC, when there is no disease distal to resected intestine, primary anastomosis should be performed as it enhances the recovery from NEC, reduces the risk of multiple intestinal complications and does not increase adverse outcomes.

Stoma Self-care: Knowledge and Practices among Ostomates with Intestinal Stoma

The objectives of the study were: (1) to assess the knowledge of ostomates regarding self-care of stoma, (2) to assess the practices of ostomates during self-care of stoma, and (3) to find out the association of knowledge of ostomates regarding self-care of stoma with selected clinical and sociodemographic variables.The study was conducted in stoma clinic of selected tertiary care hospitals, New Delhi, India using cross-sectional and descriptive study design. Two hundred and fifty subjects with intestinal stoma were recruited in the study using total enumerative sampling technique. Data were collected using self-structured questionnaire that was developed utilizing an adapted version of the “home management guidelines for stoma care.” Slightly more than half of the subjects (50.4%) had good knowledge regarding self-stoma care. However, 44.8% of subjects had average knowledge regarding stoma self-care, and only 4.8% had poor knowledge regarding self-stoma care. Duration of stoma, status of stoma (whether temporary or permanent), training received regarding stoma care, and subjects linked with stoma group were statistically significant (p < 0.05) in predicting knowledge regarding stoma self-care. The study emphasizes on educational needs of ostomates and recommends developing strategies to meet these needs.

Impact of fecal diversion in Perineal Necrotizing Soft Tissue Infection on disease survival: A large retrospective study

IntroductionColostomy is usually proposed during the acute phase of Fournier Gangrene, nevertheless its impact on disease outcome remains still debated. We conducted a retrospective study in an academic center to determine the impact of fecal diversion on disease morbidity and specific survival. MethodsAll medical charts of Fournier Gangrene cases in the past 30-years were reviewed. Mortality rate, hospitalization duration, time to complete healing and number of excision surgeries were compared between the stoma and the non-stoma groups. Time between initial diagnosis and stoma creation, type of fecal diversion, as well as specific morbidity were analyzed. ResultsOf 89 patients included, 59 had stoma creation. Stoma group had significant higher catecholamine drugs use. Mortality, time to complete healing and number of excision surgeries did not significantly differ between both groups. Hospitalization duration was significantly higher in the stoma group. Mortality and hospitalization duration were higher when loop transverse colostomy was performed, and when colostomy was done in the first 3-days. Morbidity occurred in 41 % of patients with colostomy, with 25 % life-threatening complications. 31 % of colostomies remained definitive, while median time to intestinal recovery was 159-days. DiscussionConsistently with current literature, disease survival was not improved by colostomy creation although skewed. Colostomy creation was associated with a higher hospitalization duration and a significant morbidity including risk of definitive stoma. To limit over-indicated stoma and improve early results, a damage control strategy using colostomy creation is advised. ConclusionThe benefit of colostomy during the acute phase of Fournier Gangrene was uncertain, with no clear impact on mortality. In fact, colostomy was associated with increased hospitalization duration and specific morbidity. Finally, when fecal diversion is deemed necessary, we advocate for coelioscopic delayed loop left colostomy. Alternative minimally invasive treatment as bowel catheters should also be discussed.

The economic burden of stomas in the UK: a retrospective observational study of health records and hospital encounters

Background: Stomas divert waste from the small intestine (ileostomy), large intestine (colostomy) or ureters (urostomy), and complications are common. Aims: This study evaluated healthcare resource utilisation (HCRU) and costs of stomas from a UK perspective. Methods: This was a retrospective observational study of adults with new stomas (New Stoma Group) or new/existing stomas and >6 months of follow-up (Established Stoma Group) using health records linked with hospital encounters (January 2009–December 2018). Age- and sex-matched controls were identified for each stoma case (1:50) Findings: Both the New (n=8533) and Established (n=9397) stoma groups had significantly higher HCRU (all P<0.0001) and associated costs (all P<0.01), driven by inpatient admissions. New Stoma Group: colostomy versus controls, £3227 versus £99 per person; ileostomy, £2576 versus £78 per person; and urostomy, £2850 versus £110 per person (all P<0.0001). Findings were similar in the Established Stoma Group. Conclusion: Stomas are associated with a substantial economic burden in the UK driven by hospital care. (Supplementary data tables can be obtained from the authors.)

Quantitative evaluation of pediatric umbilical loop stomas: 2 decades of experience from a single institution

PurposeSince pediatric stomas are often temporary, their creation, management, and closure should be simple, with minimal complications and excellent cosmetic results. We began employing umbilical stomas in 2000. This study aimed to characterize the ingenuity and utility of umbilical stomas and provide a quantitative evaluation of their cosmetic outcomes.MethodsWe examined cases of stoma construction and closure surgery performed in our department from January 2000 to December 2022. The umbilical and non-umbilical stoma groups included 54 and 42 cases, respectively, and the findings for both groups were compared and analyzed.ResultsThe two groups showed no significant differences in the incidence of complications. The Manchester Scar Scale score for the umbilical stoma group (8.42 ± 1.85) was significantly better than that for the non-umbilical stoma group (16.31 ± 2.96; P < 0.01). Likewise, in Patient and Observer Scar Assessment Scale assessments, the umbilical stoma group showed significantly better scores in both the observer scale (9.48 ± 2.50 vs. 21.78 ± 7.26; P < 0.01) and the patient scale (10.5 ± 1.39 vs. 22.40 ± 7.35; P < 0.01).ConclusionsUmbilical stomas are easy to manage and yield an inconspicuous closure incision with excellent cosmetic outcomes. Although patient selection is important, pediatric umbilical stomas are a valuable option that can be actively employed.

85 The SSSLOT study: Surgery, Stent (SEMS), Stoma for Left Obstructive colonic Tumours

Abstract Aim There is no clear consensus on the optimal management of obstructed left colonic malignancy. Although SEMS as a bridge to elective surgery is considered an alternative to primary surgery, comparisons of defunctioning stoma versus stent versus surgery has yet to be explored. This is a pilot study on the management of acute left malignant colonic obstruction (LMCO) in our trust. Methods This is a retrospective review of the management and outcomes of LMCO in our trust from 2019-2021. Results 19 patients were identified (72 y.o., M:F 10:9). T3:4 (8:11). 3 were rectal, 11 sigmoid, 4 were descending, and 1 transverse colon cancer. 7 had SEMS, 7 defunctioning stoma, and 5 emergency resection. All 7 cases of SEMS were clinically and technically successful. Mean time from SEMS to definitive surgery was 49.5 days with one case not leading to surgery. There was one 30-day complication reported which was not SEMS related; 3 year mortality (3YM) was 4/7. In the defunctioning stoma group, 2 did not proceed to surgery; 6 patients experienced complications; 3YM was 3/7. For the straight to surgery group, 5/14 of patients who had bridging-to-surgery procedure had neoadjuvant treatment; 4 complications were reported; 3YM was 1/6. Conclusion Although the results are limited by small numbers, a bridge-to-surgery technique is used approximately 3 times more frequently than emergency surgery, and neoadjuvant treatment is rarely employed. There would appear to be a lower 3YM with emergency surgery compared to the other interventions. Multicenter data collection will assess these preliminary findings.

Analysis of the efficacy of a single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy

BackgroundRadical cystectomy and urinary diversion are the standard surgical treatments for patients with muscle-invasive or high-risk, or recurrent non-muscle-invasive bladder cancer. Although this approach significantly prolongs patient survival, it can lead to postoperative complications. This study aims to compare the efficacy and complications of bilateral cutaneous ureterostomy with a single subumbilical stoma to those of cutaneous ureterostomy with two stomas and an ileal conduit as a means of urinary diversion after radical cystectomy. The findings of this study will provide valuable information for healthcare providers in selecting the appropriate urinary diversion method for their patients.MethodsThe clinical data for 108 patients who received bilateral cutaneous ureterostomy with a single subumbilical stoma (ureterostomy with a single stoma group), cutaneous ureterostomy with two stomas (ureterostomy with two stomas group), or an ileal conduit (ileal conduit group) after radical cystectomy were retrospectively analysed. The operative time, pathological stage, survival status, perioperative complication rate, rate of successful first extubation, rehospitalization rate at 6 months after surgery,ostomy-related medical costs,and postoperative quality of life were compared between the three groups of patients.ResultsA significant difference in the operative time was found between the three groups (P = 0.001). No significant differences in pathological stage, survival status, perioperative complication rate, rehospitalization rate at 6 months after surgery, or bladder cancer index (BCI) score were identified among the three groups. The difference in the successful first extubation rate between the three groups of patients was significant (P = 0.001). Significant differences in ostomy-related medical costs were observed among the three groups of patients (P = 0.006).ConclusionA single subumbilical stoma for bilateral cutaneous ureterostomy after radical cystectomy may result in shorter surgery time, increased success rates for initial catheter removal, and lower medical expenses. However, to confirm these findings, further prospective randomized clinical trials are necessary.

Minor microbial alterations after faecal diversion do not affect the healing process of anus-near pressure injuries in patients with spinal cord injury-results of a matched case-control study.

Retrospective matched case-control study including patients with spinal cord injury who presented with an anus-near pressure injury. Two groups were formed based on the presence of a diverting stoma. To evaluate the primary microbial colonisation and secondary infection of anus-near pressure injuries depending on the presence of a pre-existing diverting stoma and to investigate the effect on the wound healing. University hospital with a spinal cord injury unit. A total of 120 patients who had undergone surgery of an anus-near decubitus stage 3 or 4 were included in a matched-pair cohort study. Matching was realised according to age, gender, body mass index and general condition. The most common species in both groups was Staphylococcus spp.(45.0%). The only significantly different primary colonisation affected Escherichia coli, that was found in the stoma patients less often (18.3 and 43.3%, p < 0.01). A secondary microbial colonisation occurred in 15.8% and was equally distributed, except for Enterococcus spp. that was present in the stoma group only (6.7%, p < 0.05). The time to complete cure took longer in the stoma group (78.5 versus 57.0 days, p < 0.05) and was associated with a larger ulcer size (25 versus 16 cm2, p < 0.01). After correction for the ulcers' size, there was no association to outcome parameters such as overall success, healing time or adverse events. The presence of a diverting stoma alters the microbial flora of an anus-near decubitus slightly without impact on the healing process.

Do colorectal cancer patients with a postoperative stoma have sexual problems? A pooling up analysis of 2566 patients

This study aimed to evaluate the effect of the stoma on sexual function in colorectal cancer patients. Search strategy was conducted in four databases including PubMed, Embase, the Cochrane Library, and Medline on Nov 20, 2022. After that, the quality of eligible studies was assessed by the Newcastle Ottawa Scale (NOS) and the Agency for Healthcare Research Quality (AHRQ). In order to evaluate the sexual function between the stoma group and the non-stoma group, mean values and standard deviation were pooled for scores in questionnaires, and odds ratio and 95% confidence intervals were pooled for self-designed problems. Results were shown in forest plots; Egger's test and the trim and fill analysis were used for assessing the publication bias. All the data analyses above were performed by STATA 16.0 software. Six cohort studies and three cross-sectional studies were included for this pooling up analysis. As for the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C38), male patients with stomas had more sexual problems (mean differences = 0.32, 95% confidence intervals = 0.01 to 0.63, I2 = 67.80%, P = 0.05); however, other indicators including sexual functioning, sexual enjoyment, and female sexual problems had little difference between the two groups. As for other questionnaires and problems, stoma did not have an impact on sexual function. The stoma after surgery was not significantly associated with the sexual function of female patients with colorectal cancer and was associated with worse scores on only sexual problems for males.

Deterioration in renal function after stoma creation: a retrospective review from a Middle Eastern tertiary care center.

Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR). Evaluate changes in GFR after stoma creation by stoma type and identify how different types of stoma affect GFR. Retrospective, analytical cohort SETTING: Tertiary care center in Saudi Arabia PATIENTS AND METHODS: The colorectal surgery database was reviewed for all adult patients who underwent stoma creation (permanent and temporary ileostomies and colostomies) or reversal in 2000-2015. GFR was estimated at the first encounter, before the index surgery, at the time of stoma reversal, and upon the last follow-up. Patients with renal impairment, including low GFR before stoma creation, patients who had a temporary stoma converted to a permanent stoma, and patients who died with a stoma were excluded. We studied the association of several demographic and clinical factors on changes in GFR by univariate and multivariate analysis. Estimated GFR at the last clinic visit for the permanent stoma group and at stoma closure for the temporary stoma group. 394 patients (149 ileostomates, 245 colostomates) RESULTS: Thirty-three (8.4%) of the 394 patients had a low GFR: 11 (7.4%) in the ileostomy group and 22 (9%) in the colostomy group (P= .579). The rate of readmissions with ileostomies was higher (11.4%) than with colostomies (3.3%) (P≤.001). The number of temporary ileostomies (n=9, 7.0%) differed from temporary colostomies (n=2, 1.9%) but the difference was not statistically significant (P=.06). In the multivariate analysis, stoma permanency, hypertension, chemotherapy and nephrotoxic drugs were risk factors associated with low GFR. Ileostomies were not associated with a high rate of renal function deterioration in comparison to colostomies, but had a significantly higher rate of readmission due to dehydration and electrolytes imbalance possibly due to the hot climate in Saudi Arabia. Retrospective nature and limited sample size which may have resulted in a type 2 statistical error. None.

Postoperative complications and prognosis based on type of surgery in ulcerative colitis patients with colorectal cancer: A multicenter observational study of data from the Japanese Society for Cancer of the Colon and Rectum.

Patients with ulcerative colitis are reported to be at increased risk of colorectal cancer and are also at high risk of postoperative complications. However, the incidence of postoperative complications in these patients and how the type of surgery performed affects prognosis are not well understood. Data collected by the Japanese Society for Cancer of the Colon and Rectum on ulcerative colitis patients with colorectal cancer between January 1983 and December 2020 were analyzed according to whether total colorectal resection was performed with ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), or permanent stoma creation. The incidence of postoperative complications and the prognosis for each surgical technique were investigated. The incidence of overall complications was not significantly different among the IAA, IACA, and stoma groups (32.7%, 32.3%, and 37.7%, respectively; p=0.510). The incidence of infectious complications was significantly higher in the stoma group (21.2%) than in the IAA (12.9%) and IACA (14.6%) groups (p=0.048); however, the noninfectious complication rate was lower in the stoma group (13.7%) than in the IAA (21.1%) and IACA (16.2%) groups (p=0.088). Five-year relapse-free survival was higher in patients without complications than in those with complications in the IACA group (92.8% vs. 75.2%; p=0.041) and the stoma group (78.1% vs. 71.2%, p=0.333) but not in the IAA group (90.3% vs. 90.0%, p=0.888). The risks of infectious and noninfectious complications differed according to the type of surgical technique used. Postoperative complications worsened prognosis.

Defunctioning stoma before neoadjuvant treatment or resection of endoscopically obstructing rectal cancer

AimTo investigate whether patients with endoscopically untraversable rectal cancer may benefit from a defunctioning stoma created before neoadjuvant therapy or resectional surgery.MethodsThis retrospective study comprise patients diagnosed with rectal cancer during 2007–2020 in Region Västerbotten, Sweden. The primary outcome was time between diagnosis and any treatment, while survival and the incidence of complications were secondary outcomes. Excluded were patients without endoscopic obstruction, patients already having a stoma, patients with recurrent disease, palliative patients, and patients receiving a stoma shortly after diagnosis due to any urgent bowel-related complication. Data were obtained from the Swedish Colorectal Cancer Registry and medical records. Kaplan–Meier failure curves were drawn, and a multivariable Cox regression model was employed for confounding adjustment.ResultsOut of 843 patients, 57 remained after applying exclusion criteria. Some 12/57 (21%) patients received a planned stoma before treatment, and the remainder received upfront neoadjuvant therapy or surgery. Median time to any treatment was 51 days for the planned stoma group and 36 days for the control group, with an adjusted hazard ratio of 0.28 (95% confidence interval: 0.12–0.64). Complications occurred at a rate of 5/12 (42%) and 7/45 (16%) in the planned stoma group and control group, respectively. Survival was similar between groups.ConclusionA planned stoma results in treatment delay, but it remains unclear whether this is clinically relevant. Complications were more common in the planned stoma group, although the data are limited. While larger studies are needed, it seems feasible to avoid defunctioning stomas even in endoscopically obstructing rectal cancers.

Long-term incidence of depression in rectal cancer patients with or without stoma: a population-based cohort study.

Significant improvements have been made in the surgical treatment of rectal cancer with a higher sphincter-saving rate without compromising oncologic results. There have been studies about the quality of life of rectal cancer patients after surgery. However, no study has reported the long-term annual incidence of depression after rectal cancer surgery according to stoma status. The objective of this study was to determine the annual incidence of depression after rectal cancer surgery and the factors affecting it, especially the prevalence of depression according to the presence or duration of a stoma. Using the Korea National Health Insurance Service database, patients who underwent radical surgery for rectal cancer from 2002 to 2019 were searched. We analyzed the incidence and risk factors of depression in patients who underwent radical surgery for rectal cancer according to stoma status. Annual incidence of depression in rectal cancer patients was decreasing annually for 15 years after surgery. There was no statistically significant difference in the incidence of depression according to the stoma status. However, the diagnosis of depression within 1 year after surgery was statistically significantly increased in the permanent stoma group. There was no difference in the overall incidence of depressive disorders among patients with rectal cancer based on their stoma status. However, a permanent stoma seems to increase the incidence in the first year after surgery. Education and intensive assessments of depressive disorders in patients with permanent stoma within 1 year after surgery are needed, particularly for female patients who are under 50 years old.

The role of transanal tube after low anterior resection in patients with rectal cancer treated with neoadjuvant chemoradiotherapy: A propensity score-matched study

BackgroundThe protective efficacy of transanal tube for anastomosis was compared with that of diverting stoma in patients with rectal cancer treated with neoadjuvant chemoradiotherapy. MethodsWe included consecutive patients with rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery from January 2013 to December 2019. The patients were grouped into transanal tube or diverting stoma, according to the protection methods they received. Propensity score-matching with 1:1 ratio was done. The primary outcome was the incidence of anastomotic leakage. ResultsOf the 656 eligible patients, 207 (31.6%) and 385 (58.7%) patients were grouped into transanal tube and diverting stoma, respectively, and 64 (9.7%) patients who did not undergo either transanal tube or diverting stoma were excluded. After matching, the incidence of anastomotic leakage was 9.7% and 10.6% in diverting stoma and transanal tube, respectively (P = .871). The overall morbidity was 23.2% and 15.0% in diverting stoma and transanal tube, respectively (P = .045). In the multivariate analysis, tumor size >2.5 cm and level of anastomosis <4 cm were significant risk factors for anastomotic leakage. In a subgroup analysis for patients with the level of anastomosis >4 cm, the incidence of anastomotic leakage was not significantly different between the transanal tube and diverting stoma groups. However, for patients with a level of anastomosis <4 cm, the incidence of grade C anastomotic leakage was significantly greater in the transanal tube than in the diverting stoma group (2.5% vs 9.9%, P = .040). ConclusionThe protective efficacy of transanal tube may be comparable to diverting stoma, especially for those with a level of anastomosis >4 cm.

Is a Defunctioning Stoma Necessary After Left Colectomy in High-risk Patients for Anastomotic Leak?

Left colectomy is associated with a 7% risk of anastomotic leak. In 2011, a prediction score for AL [the colon leakage score (CLS)] was developed. The aim was to evaluate the impact of a defunctioning stoma on AL and its consequences after left colectomy in high-risk patients. From January 2012 to June 2019, high-risk patients who underwent a left colectomy with anastomosis were included in this retrospective, single-center study. Two groups of patients were defined: patients undergoing a left colectomy with an anastomosis without a defunctioning stoma (no-stoma group) and those with a defunctioning stoma (stoma group). The primary endpoint was the rate of anastomotic leakage. Ninety-two patients were included in this study. The anastomotic leakage rate was 16.4% in the no-stoma group and 21.6% in the stoma group ( P =0.5). A conservative approach was applied to 11.2% in the no-stoma group and 50% in the stoma group ( P =0.1). The severe morbidity rate was 14.5% in the no-stoma group and 21.6% in the stoma group ( P =0.4). The rate of unplanned admissions was 7% in the no-stoma group and 27% in the stoma group ( P =0.01). A defunctioning stoma does not appear to reduce the rate of AL in high-risk patients, but its impact on the management of AL remains unclear.

A two-stitch continuous suture method for single-lumen ileostomy

Objective: To explore the value of a two-stitch continuous suture in single- lumen ileostomy. Methods: This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, n=60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, n=38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. Results: There were no significant differences in baseline data between the groups (all, P>0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; t=-17.874;P<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ2=9.633, P=0.002;5.3% (2/38) vs. 28.3% (17/60), χ2=7.923, P=0.005; and 2.6% (1/38) vs. 18.3% (11/60), P=0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all P>0.05). Conclusion: Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.

Palliative stenting for malignant colorectal stenosis in the elderly.

ObjectivesSelf‐expandable metal stents are widely used for the treatment of malignant colorectal stenosis (MCS). In elderly individuals with MCS, self‐expandable metal stents are often used as a palliative treatment, but prophylactic stent placement is not recommended. We investigated the efficacy and safety of self‐expandable metal stents for the elderly in a palliative setting, specifically in a prophylactic setting.MethodsElderly patients with MCS who received a palliative stent (the stent group) or palliative stoma (the stoma group) were retrospectively enrolled between April 2017 and June 2022, and the prognosis and complication rates were assessed. Additionally, patients in the stent group were divided into symptomatic and asymptomatic subgroups, and prognosis, stent patency, and complication rates were evaluated.ResultsDuring the study period, 31 patients with a mean age of 85.4 years and 12 patients with a mean age of 82.0 years were enrolled in the stent and stoma groups, respectively. While overall survival and complication rates were comparable, the length of hospital stay was significantly shorter in the stent group. Of the 31 patients in the stent group, 16 asymptomatic patients received prophylactic stenting, which was not associated with increased complication rates.ConclusionsPalliative stents for MCS appear to be effective and safe even in the elderly, and thus, prophylactic stents can be considered for asymptomatic patients.

Survey on Mental Health Status and Quality of Life and Correlation among Patients with Permanent Stoma of Colorectal Tumor.

Background Colorectal cancer is one of the malignant tumors of the digestive system relatively hidden onset with unobvious early clinical symptoms. Most patients have developed into middle and late stages when they were diagnosed, missing the best period of operation. Advanced colorectal cancer has strong diffusion and metastasis with short survival time, which seriously threatens the life safety of patients. Objective To investigate the mental health status and quality of life and the relationship between them in patients with permanent stoma of colorectal cancer. Methods In this study, a case-control study was conducted to select 80 patients (stoma group) with colorectal cancer treated by permanent stoma surgery in our hospital from January 2020 to June 2021 and 80 patients (control group) with colorectal cancer treated by sphincter-preserving surgery at the same time. The psychological health degree and quality of life of the two groups of patients were evaluated by the psychological resilience scale (CD-RISC), the positive psychological capital questionnaire (PPQ), and the cancer patient quality of life-specific scale (QOL-LC), and a linear correlation model was used to analyze the correlation of CD-RISC score, PPQ score, and QOL-LC score. Results The total scores of tenacity, optimism, self-improvement, and resilience of the patients in the stoma group were significantly lower than those in the control one, and the difference between them was statistically significant (P < 0.05); the four dimensions of self-efficacy, optimism, hope, and resilience and the total score of PPQ of patients in the stoma group were significantly lower than those in the control group, and all of the differences were statistically significant (P < 0.05); the somatic function, psychological function, symptoms of side effects, social function, and the total QOL-LC score of patients in the stoma one were significantly lower than those in the control one, and all of the differences were statistically significant (P < 0.05); the total QOL-LC score of patients in the stoma group showed a significant positive correlation with PPQ score and CD-RISC score (r = 0.511 and r = 0.608, P < 0.01). Conclusion The overall level of mental health and life quality of patients with permanent stoma of colorectal cancer was worse than that of patients without stoma measures, and there was a certain correlation between patients' mental health and quality of life.

Midline stoma via the umbilicus versus traditional diverting loop ileostomy

Diverting loop ileostomies have traditionally been fashioned in the right iliac fossa, but a novel technique of midline loop ileostomy at the umbilical port site during colorectal surgeries have been described. We aim to compare outcomes after creation and reversal of these two types of ileostomy. Using a retrospective study design, 10 consecutive patients who underwent a midline loop ileostomy were compared with 10 consecutive patients who underwent a traditional right iliac fossa stoma. Baseline characteristics, operating time, length of stay and complications for the initial operation as well as reversal of stoma operation were compared between the two groups. There was no significant difference in duration of operation or complication rate after the initial stoma formation, but length of hospital stay was longer in the traditional stoma group (10 vs 4.5 days, p = 0.04). After reversal of ileostomy, the traditional stoma group had a significantly higher perioperative complication rate compared to the midline stoma group (50 vs 0%, p = 0.03), but there was no difference in operation time or length of hospital stay.

Comparison of colonic stenting and stoma creation as palliative treatment for incurable malignant colonic obstruction.

Background and AimSelf‐expandable metal stent (SEMS) is a favorable therapeutic option for patients with incurable malignant colonic obstruction (MCO). However, their long‐term efficacy and safety compared with those of stoma creation have not been well investigated. This study aimed to compare these long‐term outcomes between these two techniques in patients with incurable MCO.MethodsThis retrospective cohort included patients with incurable MCO with SEMS insertion (n = 105) and stoma creation (n = 97) between January 2009 and December 2019. The primary outcomes were patency after the procedure and 1‐year re‐intervention rates.ResultsThe patency of the SEMS group was lower than that of the stoma group (88.9 vs 93.2% at 6 months, 84.1 vs 90.5% at 12 months, and 65.8 vs 90.5% at 18 months; log‐rank test, P = 0.024), but 1‐year re‐intervention rates were not different between the groups (10 vs 8%, P = 0.558). The median patency durations were 190 days for SEMS insertion and 231 days for stoma creation. Majority (84%) of SEMS patients did not require any re‐intervention until death. The early complication rate did not differ between the groups (P = 0.377), but SEMS insertion had fewer late minor complications than stoma creation (5 vs 22%, P = 0.001).ConclusionSEMS insertion is a safe and effective treatment for patients with incurable MCO. Although SEMS insertion had a lower patency than stoma creation, especially after 1 year, the 1‐year re‐intervention rates were not different, and SEMS durability was sufficient in most patients.