Undergoing Stoma Formation Research Articles

1190 Clinical Features and Outcomes from the Acute PresentatiOn of coLorectaL Cancer – an internatiOnal Snapshot (APOLLO) – an International Prospective Audit

Abstract Aim The APOLLO study aimed to describe the international variation in the presentation, management and outcomes of patients presenting acutely with colorectal cancer. Method APOLLO was an international prospective, multicentre cohort study delivered through the EuroSurg student and trainee-led collaborative network. Adult patients presenting acutely with colorectal cancers were included. The primary outcome was 90-day mortality. Country-level variation was analysed using funnel plots. Results 1414 patients (216 centres, 39 countries) were enrolled (median age 70 years; 645 females [45.6%]; ASA Grade I-II: 689 [48.7%]). Common presentations were bowel obstruction (n=774, 54.7%), gastrointestinal haemorrhage (n=297, 21.0%),bowel perforation (n=161, 11.4%). Overall, 56.9% of patients presented with a new diagnosis of cancer (n=804), 13.9% presented while awaiting elective surgery (n=196), and 9.3% while undergoing neoadjuvant therapy (n=132). Most cases were managed with curative intent (n=805, 56.9%). Of the 1022 patients undergoing surgery, 813 underwent surgical resection (79.5%), 582 underwent stoma formation (56.9%), and 498 (48.7%) underwent primary anastomosis. Only 57 patients underwent colonic metallic stenting (4.0%). Overall, 90-day mortality was 19.4%; 90-day surgical mortality was 13.9% and 90-day non-operative mortality was 33.7%. There was significant variation in overall mortality, but not surgical mortality, between countries after case-mix adjustment. Conclusions Emergency colorectal cancer presentations carry significant mortality with and without surgery. Many acute presentations are in patients with known colorectal cancer awaiting treatment. Operative mortality is similar globally, but overall mortality varies between countries. Further work is needed to guide individualised decision making on who benefits from acute surgery with curative-intent.

UK neonatal stoma practice: a population study

ObjectiveThe optimal time for neonatal stoma closure is unclear and there have been calls for a trial to compare early and late surgery. The feasibility of such a trial will...

P1060 Diverting Ostomy for Crohn’s Pancolitis in Pediatric Patients

Abstract Background Childhood-onset Crohn’s disease (CD) is characterized by extensive anatomic involvement, with high rates of panenteric CD. Given the fact that total colectomy for these patients result in permanent loss of colonic absorption of nutrients, ostomy can be a good surgical option for children with Crohn’s pancolitis requiring surgical intervention. The purpose of this study was to retrospectively review the outcome of diverting ostomy for Crohn’s pancolitis in children. Methods Children with Crohn’s disease involving total colon with or without small intestine who underwent surgery were included. Preoperative patient features including extent of disease using Paris classification, nutritional status and medications were recorded. Outcomes analyzed included postoperative medication changes, nutrition and growth changes, postoperative complications and need for further operative interventions. Results We identified 13 patients with a median age of 11 years (range 5 months-15 years), all of whom had pancolitis at the time of surgery. All 13 patients underwent stoma formation, initially. Three patients received colectomy after median 24 months. Takedown rate was 38% (n=5) and the time from stoma formation to takedown was median 13 months (range 10-34 months). Weight and height z-score have been improved after ostomy. Conclusion Children with CD pancolitis could benefit from diverting ostomy which offers an opportunity to spare the large intestine partially or completely which could improve nutrition and growth. Outcome comparison between diverting ostomy and colectomy should be discussed with larger study populations.

OC-001 THE ISOLATION, CULTURE AND CHARACTERISATION OF HUMAN RECTUS SHEATH FIBROBLASTS: THE BIRTH OF TISSUE ENGINEERING THE ABDOMINAL WALL AND A LIVING MESH?

Abstract Aim To isolate human rectus sheath fibroblasts (hRSFs) from tissue samples, and characterise those cells - establishing their capacity to contract collagen matrix. Methods Samples of posterior rectus sheath were taken from 3 patients undergoing stoma formation. Samples underwent collagenase digestion, and isolated cells grown in culture media. Cultures were grown to confluence at 2nd passage, then cryopreserved. Cells were successfully thawed and re-animated at 3rd passage. 3 Cell lines of hRSFs and one of human dermal fibroblasts (HDFs) were all studied. Cell lines were assessed for their morphology and underwent immunofluorescent staining for Vimentin and α-smooth muscle actin. Cell lines were also seeded into collagen matrices to assess stromal contraction. Results Our protocol produced confluent clusters of fibroblasts within 2 weeks, and healthy cultures of cells into their 3rd passage within 6 weeks. Cells were successfully cryopreserved in liquid nitrogen after 3rd passage and were thawed and reanimated thereafter. Notable differences in morphology were observed between different cell lines – all of which stained positively for vimentin and α-smooth muscle actin. All cell lines induced a different speed of contraction within a collagen matrix from the HDFs achieving 82% contraction after 5 days, to 54% in the slowest RSF group. Conclusion Our work is the first to describe the isolation and characterisation of human rectus sheath fibroblasts and prove the concept of their introduction into 3D tissue models. This work opens exciting future prospects of both forming 3D models of rectus sheath tissue and in vitro mesh testing.

EP-215 COVID-19: Influence on Stoma Outcomes & Post-Operative Mortality

IntroductionThe COVID-19 pandemic resulted in cessation of elective surgery and a shift towards emergency surgery, often non-curative with stoma formation. Our hospital stoma database scores surgical complications (retraction, prolapse, stenosis and hernia) and patient symptoms (leakage, soiling, skin changes and odour), recorded by the specialist nurse at varying post-operative points.AimTo compare stoma scores and post-operative mortality pre- and mid-pandemic.MethodsThe stoma database (Microsoft Access) was interrogated for two periods: 16/03/19–16/09/19 (pre-pandemic) and 16/03/20–16/09/20 (mid-pandemic). Mortality at 6 and 12 months was extracted from electronic patient records (Clinical Portal).ResultsPre-pandemic, 28 patients underwent stoma formation. Median stoma score at post-operative day 3, day 10, 6 months and 12 months was 0(0–4), 0(0–4), 1(0–8) and 1(0–3) respectively. Post-operative mortality was 21% at 6 months and 36% at 12 months.Mid-pandemic, 19 patients underwent stoma formation. Median stoma score at equivalent time intervals was 0(0–2), 1(0–8), 0(0–5) and 4 (n=1 patient score recorded). There was a relative paucity of data recorded mid-pandemic with a maximum of 9 patient scores recorded at any one time. Post-operative mortality was 16% at 6 months and 26% at 12 months.ConclusionsWhile acute surgery during the pandemic does not appear to be associated with increased stoma complications and post-operative mortality was less during the pandemic, limited data recording makes true comparison of pre- and mid-pandemic stoma outcomes difficult. Assessing the impact of the COVID-19 pandemic on surgical outcomes may be limited by poor quality of data collected.

Relationship between diversional stoma and mortality rate in Fournier's gangrene: a systematic review and meta-analysis.

Fournier's gangrene (FG) is a rare potentially lethal necrotising infection of the perineum. While the gold standard management is early and aggressive surgical debridement, the evidence in the literature is unclear as to the role and outcomes of diversional stoma. A systematic review was conducted to identify studies investigating the relationship between stoma formation and FG. Meta-analyses were performed using a random-effects model. Twenty-seven studies (n=1482) were included. There was no significant difference in disease severity scores between the stoma and no stoma groups. Mortality rate was significantly higher in patients who required diversional stoma (OR 1.71, 95% CI 1.13-2.59, p=0.01). Significantly more surgical procedures were performed on patients who underwent stoma formation, and the total hospital cost was also higher in this group. This study may have been limited by bias in patients with more fulminant course or sphincter damage requiring stoma as a medical necessity. These findings suggest that the use of diversional stoma in FG is a predictor of poor outcomes. This study demonstrated that mortality rate remained high and a diversional stoma did not reduce risk of mortality as suggested by smaller case series. Its use should therefore be individualised based on disease severity and sphincter damage.

The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients.

Objective:To document our experience of the primary anterior sagittal anorectoplasty (ASARP) in female patients with lower and wide fistula in term of the early post operative outcome.Methods:A retrospective descriptive study was conducted in one surgical unit of the National Institute of Child Health Karachi, from January 2010 to April 2018. The study included female patients with diagnosis of imperforate anus with wide Vestibular or Perineal fistula with minimal or no straining during defecation and no excoriation of perineum. All patients underwent primaryASARP. Data regarding the age of the patients, site of fistula, the difficulties in dissection, post operative complications, stoma and re-do ASARP needed, were documented. Wound assessment was done during hospital stay, at two weeks and then at three months after surgery. Outcome was documented in terms of complications of surgery and cosmetic appearance of perineum. Data was analyzed on SPSS version 20.Results:A total of 70 patients underwent primary surgery, 48(68.57%) females had perineal fistula while 22(31.42%) had vestibular fistula. Age ranges between three months to 276 months with median of 6±39.73 months. No major injury to the rectal or vaginal wall occurred during surgical procedure. In early post-operative period, 12(17.14%) patients had wound infection with or without various extent of disruption. A total of seven (10.11%) patients underwent stoma formation, six (8.57%) patients because of wound disruption with in a week of primary surgery and in one patient due to severe anal stenosis and retraction of anal segment within three month follow up. Median hospital stay was 5±1.52 days. In 38(54.28%) paients complete wound healing occurred with no per or post operative complications. In 25(35.71%) patients, minor complications were noted and treated accordingly and results were labelled satisfactory with acceptable perineal appearance.Conclusion:The single stage procedure can be a good choice for both vestibular and perineal fisula. In majority of cases wound heals completely with minimal or no scaring and give good cosmetic results.

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients.

Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. We conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003-2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. We identified 10481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41924 nonsurgical age- and sex-matched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P<0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P<0.001; two or more surgeries, 7.53 (5.99-9.46), P<0.001] and depression [one surgery, 6.15 (5.57-6.80), P<0.001; two or more surgeries, 6.88 (5.66-8.36), P<0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P<0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P<0.001] and depression [1.23 (1.05-1.45), P=0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P=0.01] and depression [1.19 (1.03-1.45), P=0.01] than other surgical patients. IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services.

Methods of stent placement in patients with upper-third and middle-third esophageal cancer

Relevance. At that moment of diagnosis patients with esophageal cancer (EC) are often inoperable due to locally advanced disease. Life expectancy in such cases augmented with dysphagia comprises 90 days in average. Curative treatment can be performed only in 20-30 % of patients with a 5-year survival rate varying from 10,3 to 35%.Objective. Assessing short-term and long-term outcomes of patients with stents with EC depending on the localization of the primary tumor.Materials and methods. We analyzed our experience of using intraesophageal self-expanding stents in ЕС patients. 49 of patients them had tumor in upper-third of esophagus and 73 patients had middle-third esophageal tumor location as compared to those who underwent stoma formation (53 patients) in EC patients.Results. All patients who were stented had significantly lower grade of dysphagia and could eat in the ordinary way. It also improved quality of life, and many of such patients had an opportunity to continue treatment. It has been revealed that stenting of inoperable cancer patients with upper and middle-third esophageal cancer gives benefit to patients as it allows to continue to eat naturally and thereby significantly improves the quality of life in contrast to stoma placement. Patients with upper-third esophageal cancer who were not stented because of fistula formation had significantly better long-term survival than EC patients with stoma and similar cancer patients with middle-third esophageal tumors. Survival rate of patients with cancer of upper-third of esophagus after stenting not because of fistula was significantly better. Patients with cancer of the middle esophagus, who experienced stent placement because of fistulae, had the same long-term survival rate as cancer patients with middle esophageal tumors and with fistula who were not stented. It shows high efficacy of stenting in cancer of the middle-third esophagus with presence of fistula.Conclusion. Stent placement in case of inoperable cancer of upper and middle-third of esophagus shows significant benefit. It allows patients to eat in an ordinary was, and thereby significantly improves the quality of life in comparison with stoma formation.

Peristomal pyoderma gangrenosum: 12‐year experience in a single tertiary referral centre

Peristomal pyoderma gangrenosum (PPG) is an unusual but potentially devastating condition that is difficult to diagnose and manage. This was a single centre, retrospective review of a prospectively collected database. Included were consecutive patients referred to a stoma therapy clinic at a single institution between 2005 and 2016. Main outcomes of interest were management strategies and outcome of patients with PPG including time to healing and recurrence. Of 1295 consecutive patients who underwent stoma formation, 12 patients with PPG were identified. The mean age at the time of diagnosis of PPG was 43.5 years (range 19-72 years). Five cases (41.7%) were associated with Crohn's disease and five cases (41.7%) with ulcerative colitis. The median duration of days between stoma formation and PPG diagnosis was 101.5 days (mean duration was 670 days (range 14-2641 days)). Nearly all patients (91.7%) were referred to a dermatologist. Majority (66.7%) were managed in an outpatient setting. For those requiring inpatient management, the mean length of stay was 13.5 days (range 3-31 days). Five patients had a biopsy and seven patients were diagnosed with PPG by dermatologist without biopsy. A range of oral and topical steroids, steroid injections, dressings, anti-inflammatories, antibiotics, tacrolimus and analgesia was used in the management of PPG. All patients achieved complete healing of PPG, with only one patient developing a recurrence of PPG. The mean duration of time to achieve complete healing of PPG was 282 days (range 28-1751 days). Medical management of PPG was effective with complete healing and low recurrence. The average duration to complete healing of PPG was approximately 9 months.

Loop colostomies are safe in anorectal malformations

Aim of the studyDivided colostomy (DC) has been recommended in anorectal malformations (ARMs) with previously reported advantages of decreasing overflow into the distal limb and urinary tract infections (UTIs). Skin bridge loop colostomy (LC) is a technically easier alternative without an increase in these complications. We report our institutional experience of LC in ARM. MethodsRetrospective study (Institution-approved Clinical Audit) reviewing the clinical records of all patients with ARM undergoing stoma formation in a single UK tertiary pediatric surgical center (2000–2015). Data collected included type of ARM, associated anomalies, type and level of colostomy, time to stoma closure, complications and UTIs. ResultsOne hundred and eighty-two (95 female) patients underwent colostomy formation for ARM. The vast majority (171/ 94%) underwent LC; 9 (5%) had a divided colostomy (DC) and 2 (1%) had no available data. The spectrum of defects in girls included rectovestibular (62/65%), rectovaginal (4/4%) and cloaca (29/31%). In boys, 71 (82%) had a fistula to the urinary tract and 16 (18%) presented with a perineal fistula. Urological abnormalities coexisted in 87 (47.8%) patients. Thirty five (21%) patients developed UTIs. Among the 19 girls who developed UTI, 8 had rectovestibular fistula and 11 had cloaca. Of the 16 boys who developed UTI, 14 had a fistula to the urinary tract and 11 had an independent urological abnormality. The mean time from stoma formation to stoma closure was 10 (3–52) months. Complications were reported in 22 (12%) LCs. Fifteen patients (9%) developed a stoma prolapse following LC with 10 (6%) requiring surgical revision. ConclusionsThis is the largest reported series of outcomes following LC for ARM. LC is easier to perform and to close, requiring minimal surgical access, with comparable complications and outcomes to those published for DC. Type of studyRetrospective comparative study. Level of evidenceIII.

Implications of Stoma Formation as Part of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Formation of protective stoma as part of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) may be an effective tool in reducing anastomotic leak incidence. Our aim was to evaluate the incidence and implications of stoma formation during CRS-HIPEC and to examine whether a creation of protective stoma reduces the postoperative morbidity. A cohort retrospective analysis of all CRS-HIPEC procedures performed between 2004 and 2016 was conducted. Predicting factors for stoma formation were assessed by comparing all patients who underwent stoma formation to those who did not; both groups were then restricted to cases with ≥2 bowel anastomoses and compared in terms of perioperative outcomes in order to determine whether protective stoma confers a morbidity benefit. One hundred and ninety-nine CRS-HIPEC procedures were performed on 186 patients. Thirty-four patients (17%) underwent stoma formation, 24 of them as protective stoma. Formation of a stoma was correlated with higher peritoneal carcinomatosis index score (13.6±8 vs. 9.5±7.7, p=0.007), larger number of organs resected (p<0.001), greater number of anastomoses (p<0.001), prolonged operative time (8.1±2.7 vs. 6.6±2.2h, p=0.002), and prolonged hospital stay (12 vs. 8.5days, p=0.001). In procedures requiring ≥2 anastomoses, formation of protective stoma reduced the anastomotic leak rate (6 vs. 37%, p=0.025), the morbidity rate (6 vs. 41%, p=0.017), and reoperation rate (0 vs. 28%, p=0.03). Overall, 15 patients (44%) underwent stoma reversal, 3 of whom had a complication treated non-operatively. Protective stoma should be considered in extensive CRS-HIPEC procedures requiring two or more bowel anastomoses in order to reduce the postoperative morbidity rate.

Study on the time taken for patients to achieve the ability to self-care their new stoma.

Stoma formation in colorectal surgery is a recognized independent cause of prolonged hospital stay. It has been shown that preoperative stoma education and siting leads to a reduction in the length of hospital stay. Despite this, the length of time to independent stoma management and the variables that affect this has not been well studied. We conducted a prospective case series to analyse this. A total of 107 consecutive colorectal surgery patients undergoing stoma formation at two separate large metropolitan hospitals, one private funded and the other government funded, were enrolled in a prospective case series. The primary outcome evaluated was independent management of stoma at discharge from hospital. Logistic regression analysis was performed to determine the factors associated with achieving independent stoma management at discharge. The median length of stay was 9 days (range: 4-71). In our study, 71% of patients achieved self-care at the time of discharge from hospital (76/107 patients). The median length of time taken to achieve independent management of a stoma was 7 days (interquartile range: 6-9). Factors associated with increased chance of independent management of stoma at discharge included younger age, male, preoperative siting and treatment in a public hospital. Our study supports that preoperative stoma education in combination with post-operative stoma education is superior to post-operative stoma education alone. Interestingly, treatment in a private hospital is associated with a higher likelihood of failure to achieve independent stoma management at discharge. This is unexpected and not explained by our data.

Coping: teenagers undergoing stoma formation.

Stoma-forming surgery can raise a number of challenges for patients of any age, including psychosocial impact, altered body image and altered body function. Adolescents may experience additional challenges as they are already adapting to changes in body image and personal identity while striving for independence. Healthcare professionals supporting adolescents with stomas need to have awareness of specific issues that may be encountered and the support required to aid and promote coping and adjustment. This case study considers adolescents coping and adjusting to living with a stoma and the role of the Stoma Care Clinical Nurse Specialist.

Care of patients undergoing stoma formation: what the nurse needs to know.

Rationale and key points This article provides an overview of the various types of abdominal stoma and surgical procedures that result in stoma formation. It outlines the enhanced recovery pathway that is used to guide postoperative care, and some of the areas that should be incorporated in postoperative stoma care. These areas include training in the practical care of the stoma and its appliance, dietary advice and reintegrating lifestyle activities. In addition, the article briefly examines stoma reversal, and explores the role of the stoma specialist nurse. » Nurses require an understanding of the various surgical procedures that might result in the formation of a stoma. » An understanding of the stoma appliances that are available is essential to enable nurses to provide effective care for patients with a newly formed stoma. » Effective postoperative care that incorporates support and education enables patients to adapt quickly to having a stoma. » Enabling patients to understand changes that occur as a result of stoma formation will increase their confidence in managing their stoma alongside the effect on their quality of life.

Preoperative care of patients undergoing stoma formation: what the nurse needs to know.

Rationale and key points This article addresses preoperative care of patients for whom surgery to form a stoma is planned. It discusses conditions that may result in the formation of a stoma, explores preoperative investigations that may be necessary before surgery, outlines various types of stoma and stoma appliances, and offers guidance on preparing patients to manage this lifestyle transition. The stoma specialist nurse has the principal role in providing patient education. However, nurses in all practice settings may encounter patients who are due to undergo surgery to form a stoma, and can provide preoperative support and education. » Nurses require an understanding of the enhanced recovery pathway to support patients who are due to undergo surgery to form a stoma. » Optimal siting of the stoma is essential to enable patient self-care. » Effective preoperative care of patients undergoing planned surgery to form a stoma enables patients to gain independence quickly following stoma formation. » Enabling patients to self-care for their stoma is associated with improved quality of life and enhanced body image.

Meeting the needs of new ostomists: a patient evaluation survey.

Nottingham University Hospitals (NUH) NHS Trust provides a care pathway for patients undergoing stoma formation surgery, with the stoma care nurse specialists providing ongoing support for patients, alongside the rest of the multidisciplinary team, from the preoperative consultation through to their community follow-up. In the past, the community service offered has not always been well-received and the whole pathway has not been evaluated in depth to date. This article reports on a patient evaluation survey of the stoma care pathway at NUH. The results showed that overall patients are very complimentary of the service offered to them by the stoma care team. They highly commend the stoma care nurse specialist. Two areas for amendment in the pathway have been identified: information provision and the length of time available for the stoma care nurse specialist to spend one-to-one with each patient. The results of this survey will aid the team in implementing positive changes to the stoma care pathway.

Interstitial cells of Cajal are decreased in patients with gastroschisis associated intestinal dysmotility

BackgroundGastroschisis associated intestinal dysmotility (GAID) is poorly understood. Animal experiments suggest that interstitial cells of Cajal (ICC), play an important role. MethodsInfants with gastroschisis (GS) and GAID (time to full feed >42days) were selected. Age matched GS and control (NEC, ileal atresia, malrotation, and volvulus) samples from primary (T1) and secondary (T2) time points underwent standard histopathology and immunohistochemistry for identification of ICC, followed by evaluation of ICC numbers, distribution, morphology, relation to ganglion cells, and myenteric plexus architecture.Groups were compared using parametric and nonparametric tests. Main ResultsTwelve patients had samples available for histopathological evaluation. GAID patients had a significantly lower total number of ICCs than controls (3 vs. 8, P<0.0029). ICC number at T1 was 2.5 vs. 6 (P=0.0629) and significantly lower at T2. (3.5 vs. 11, P=0.0124). GAID patients did not show a significant increase of ICC from T1 to T2. Controls showed a significant increase of ICC over time (6 vs. 11, P=0.0408). ConclusionIntestinal samples from infants with GAID who underwent stoma formation demonstrated fewer ICC than controls. There was no improvement or cell recovery during the study period. The ability to modulate ICC may have significant implications for the management of GAID.

Which Operative Repair is Associated with a Higher Likelihood of Reoperation after Rectal Prolapse Repair?

The rate of reoperation after transabdominal as compared with transperineal repair for rectal prolapse is unknown. We evaluated all patients who underwent surgical treatment for rectal prolapse performed through transabdominal or transperineal repair from the trackable California Inpatient data files and Revisit Analyses during the time period of January 1, 2005, through December 31, 2007. We specifically evaluated rates of reoperation and stoma formation during the 36-month study period. A total of 3400 patient discharges with rectal prolapse from California during the 36-month study period was identified. Of this cohort, 1772 patients had one or more prolapse repairs. Procedures were more likely to be performed through a transabdominal (1035 [58%]) as compared with a transperineal approach (737 [42%]). There was no difference in reoperation for transabdominal (11%) as compared with transperineal procedures (11%; P = 0.9). However, a significantly larger proportion of patients underwent stoma formation after transabdominal (8%) as compared with transperineal repair (5%; P < 0.02). Time to reoperation was not significantly different for patients treated with transabdominal (295 ± 254 days) as compared with transperineal repair (271 ± 246 days; P = 0.6). In conclusion, the risk of reoperation is substantial for both transabdominal and transperineal procedures for rectal prolapse.

Parastomal Hernias as the Predominant Stoma Complication After Laparoscopic Colorectal Surgery

Many colorectal procedures can be performed laparoscopically and frequently involve the formation of a stoma. This study aims to demonstrate whether there is an association between stoma complications and the operative technique: laparoscopic or open. A review was conducted of all patients undergoing stoma formation at a single center throughout 2009. Forty-four had a stoma formed after an open procedure and 33 using laparoscopic technique alone. The most common stoma complication was parastomal hernias; these occurred after 18% of laparoscopic compared with 2% after open procedures (P = 0.04). The highest rate of parastomal hernia was seen when the resected specimen was removed from the site that was later used to create a stoma (60%). This study has suggested that the use of laparoscopic surgery may influence the rate of stoma complications. One potential method of reducing the incidence of parastomal hernias is to remove the resected specimen through a separate incision.