BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and...BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.展开更多
Objective The most important complication after low anterior resection(LAR) for mid-low rectal cancer is symptomatic anastomotic leakage(AL). More than one-third of patients with rectal cancer who underwent LAR will h...Objective The most important complication after low anterior resection(LAR) for mid-low rectal cancer is symptomatic anastomotic leakage(AL). More than one-third of patients with rectal cancer who underwent LAR will have functional stomas during primary operation. The aim of this retrospective study was to evaluate the risk factors associated with clinical AL following LAR without diversional stomas.Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The associations between AL and 14 patient-related and surgical variables were examined by both univariate chi-square test and multivariate logistic regression analysis.Results The AL rate was 7.27%(42 of 578). Univariate and multivariate analyses showed that male sex(P = 0.018), mid-low rectal cancer(located 10 cm or less above the anal verge)(P = 0.041), presence of diabetes(odds ratio = 2.117), longer duration of operation(odds ratio = 1.890), and intraoperative contamination(odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and independently predictive of clinical AL. Nearly 83.3%(35 of 42) of leakage could be cured by persistent pelvic irrigation-suction-drainage without surgical intervention. Only 7 patients(16.7%) with severe complications, such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and male sex were independent risk factors for developing clinical AL after LAR without diversional stomas, as well as longer duration of operation, presence of diabetes, and contamination of the operative field. Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective, and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage.展开更多
BACKGROUND Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related co...BACKGROUND Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related complications in colorectal cancer patients who underwent stoma creation.METHODS Patients with stoma was prospectively recorded in the established stoma system.Data was collected from this stoma management system from November 2021 through May 2024.The rates of stoma-related complications were assessed,and potential risk factors were analyzed using univariate and multivariate logistic regression models.RESULTS A total of 734 patients were included in the analysis.The results showed that 12.3%of patients experienced stoma-related complications,with mucocutaneous separation,edema,and skin excoriation being the most common complications.The majority(90%)of complications were classified as grade 2 according to the Clavien-Dindo classification.Surgical factors,such as blood loss volume greater than 500 mL and open surgery,were significantly associated with stoma complications.Additionally,stoma features like location,shape,color,height,and edema were important factors in the association with complications.Body mass index over 30 kg/m²was also found to be a significant risk factor.CONCLUSION These findings highlight the need for a holistic approach to preventing and managing stoma complications,considering both patient-related and surgical factors.展开更多
BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early...BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.展开更多
BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in d...BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.展开更多
BACKGROUND Children with critical acute abdominal conditions often undergo intestinal stoma surgery.AIM To explore the impact of a visual mobile terminal-based extended care model on caregiver competence for children ...BACKGROUND Children with critical acute abdominal conditions often undergo intestinal stoma surgery.AIM To explore the impact of a visual mobile terminal-based extended care model on caregiver competence for children with enterostomies.METHODS One hundred twenty children with enterostomies and their caregivers in a children's hospital in Beijing were divided into a control group and a study group.The control group(60 cases)received traditional telephone follow-up for continuity of care,while the study group(60 cases)used a visualization mobile terminal-based care model.The incidence of stoma-related complications,caregiver burden scale,and competence scores of children with stoma were compared between the two groups.RESULTS The primary caregiver burden score in the study group(37.22±3.17)was significantly lower than that in the control group(80.00±4.47),and the difference was statistically significant(P<0.05).Additionally,the caregiving ability score of the study group(172.08±3.49)was significantly higher than that of the control group(117.55±4.28;P<0.05).The total incidence of complications in the study group(11.7%,7/60)was significantly lower compared to the control group(33.3%,20/60;χ2=8.086,P=0.004).CONCLUSION The visual mobile terminal-based care model reduces caregiver burden,improves home care ability,lowers the incidence of complications and readmission rates,and supports successful second-stage reduction surgery for children with enterostomies.展开更多
BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient sel...BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.展开更多
Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study ...Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.展开更多
Through scanning electron microscope and optical microscope, a compara- tive study on morphological features and anatomical characters of the leaves of some pear cultivars （strains） was carried out. The results show...Through scanning electron microscope and optical microscope, a compara- tive study on morphological features and anatomical characters of the leaves of some pear cultivars （strains） was carried out. The results showed that the size and shapes of leaf epidermal cells were different, stomatal apparatuses were distributed in the hypodermis, the shapes of stornas were mainly oval, and these of ＇Jinxiang- shui＇ were long oval; the stomatal type was irregular, the cultivar with the maximum density of leaf stomas was ＇Jinxiangshui＇, and the minimum was ＇Aishanli＇. The thickness of palisade tissues and spongy tissues of different pear cultivars （strains） was different, the maximum thickness of palisade tissues of ＇Aishanli＇ was 105.5 iJm, and the maximum thickness of spongy tissues of ＇Jinxiangshui＇ was 98.4 IJm. The ratios of palisade tissues to spongy tissues from high to low were ＇Qiuyueli＇, ＇Zaoxiangshui＇, ＇Aishanli＇, ＇Hongjinqiu＇ and ＇8404＇. The differences on these mi- cromorphological characters among different pear cultivars （strains） had important significance to the identification of the cultivars and the early choice of breeding.展开更多
AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who h...AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.展开更多
BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard p...BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard procedure is restorativeproctocolectomy (RPC) with ileal pouch-anal anastomosis, commonly performedas two- or three-stage RPC with diverting ileostomy. Postoperative stoma outletobstruction (SOO) is frequent, but the causes are not well known.AIM To identify the risk factors for SOO after stoma surgery in patients with UC.METHODS We retrospectively reviewed the files of 148 consecutive UC patients whounderwent surgery with stoma construction. SOO was defined as small bowelobstruction symptoms and intestinal dilatation just below the penetrating part ofthe stoma on computed tomography. Patients were divided into two groups:Those who developed SOO within 30 d after surgery and those who did not.Patient characteristics, intraoperative parameters, the stoma site, and rectusabdominis muscle thickness were collected. Moreover, we identified the patientswho repeatedly developed SOO. Univariate and multivariate analyses wereperformed to identify risk factors for SOO and recurring SOO.RESULTS Eighty-nine patients who underwent two-stage RPC were included betweenJanuary 2008 and March 2020. Postoperatively, SOO occurred in 25 (16.9%)patients after a median time of 9 d (range 2-26). Compared to patients withoutSOO, patients with SOO had a significantly higher rate of malignant tumors ordysplasia (36.0% vs 17.1%, P = 0.032), lower total glucocorticoid dose one monthbefore surgery (0 mg vs 0 mg, P = 0.026), higher preoperative total protein level(6.8 g/dL vs 6.3 g/dL, P = 0.048), higher rate of loop ileostomy (88.0% vs 55.3%, P= 0.002), and higher maximum stoma drainage volume (2300 mL vs 1690 mL, P =0.004). Loop ileostomy (OR = 6.361;95%CI 1.322–30.611;P = 0.021) and maximumstoma drainage volume (OR = 1.000;95%CI 1.000–1.001;P = 0.015) wereconfirmed as independent risk factors for SOO. Eighteen patients with SOO weretreated conservatively without recurrence (sSOO group). Seven (28.0%) patientsrepeatedly developed SOO (rSOO group) during the observation period. Asignificant difference was observed in the rectus abdominis muscle thicknessbetween the two groups (sSOO 9.3 mm, rSOO 12.7 mm, P = 0.006). Musclethickness was confirmed as an independent risk factor for recurring SOO (OR =2.676;95%CI 1.176-4.300;P = 0.008).CONCLUSION In this study, high maximum stoma drainage volume and loop ileostomy areindependent risk factors for SOO. Additionally, among patients with a thickrectus abdominis muscle, the risk of SOO recurrence is high.展开更多
BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and recurrence.Although transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects...BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and recurrence.Although transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects are controversial.AIM To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.METHODS A systematic literature search was performed using the PubMed,Embase,and Cochrane Library databases.We included randomized controlled trials(RCTs)and prospective cohort studies(PCSs)in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated.The results of the studies were synthesized using the Mantel-Haenszel randomeffects model,and a two-tailed P value>0.05 was considered statistically significant.RESULTS Three RCTs and two PCSs were included in this study.Symptomatic AL was examined in all 1417 patients(712 with TDT),and TDTs did not reduce the symptomatic AL rate.In a subgroup analysis of 955 patients without a diverting stoma,TDT reduced the symptomatic AL rate(odds ratio=0.50,95%confidence interval:0.29–0.86,P=0.012).CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer surgery.However,patients without a diverting stoma may benefit from TDT placement.展开更多
Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mor...Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.展开更多
Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoa...Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.展开更多
Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery. Exact determination of the borderline of the viable bowel with the help of an objective test c...Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery. Exact determination of the borderline of the viable bowel with the help of an objective test could result in a decrease of postoperative ischemic complications. An accurate, reproducible and cost effective method is desirable in every operating theater dealing with abdominal operations. Numerous techniques assessing various parameters of intestinal viability are described by the studies. However, there is no consensus about their clinical use. To evaluate the available methods, a systematic search of the English literature was performed. Virtues and drawbacks of the techniques and possibilities of clinical application are reviewed. Valuable parameters related to postoperative intestinal anastomotic or stoma complications are analyzed. Important issues in the measurement and interpretation of bowel viability are discussed. To date, only a few methods are applicable in surgical practice.Further studies are needed to determine the limiting values of intestinal tissue oxygenation and flow indicative of ischemic complications and to standardize the methods.展开更多
AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODS A 10-year retrospective cohort study(2008-2017) investigated newborns that und...AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODS A 10-year retrospective cohort study(2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study(corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis(NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson's χ2 test or Fisher's exact test for categorical variables and the Wilcoxon-Mann-Whitney U-Test for continuous variables. RESULTS In total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC(Group 1) were significantly older at enterostomy for-mation than the neonates of Group 2 [median(range), 11(2-75) d vs 4(1-101) d, P = 0.004)]. Significantly more ileostomies were created in Group 1 [47(92.2%) vs 16(64.0%), P = 0.007], whereas colostomies were performed significantly more often in Group 2 [2(3.9%) vs 8(32.0%), P = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median(range), 5(3-13) vs 3(1-9), P < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2(P = 0.073). Most patients suffered from two complications(23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2(P = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients(30.6% in Group 1 and 16.7% in Group 2, P = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48(65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification(CDC) < Ⅲ], while 25(34.2%) required surgery to address the complications(CDC ≥Ⅲ). Early reversal of the enterostomy was performed significantly more often(P = 0.003) and the time to full enteral nutrition after closure was significantly longer [median(range), 7(3-87) d vs 12(5-93) d, P = 0.006] in infants with a CDC grading ≥Ⅲ than in infants with a CDC grading < Ⅲ. CONCLUSION Complications occur in almost all infants with enterostomies. The majority of these complications are minor and do not require surgical treatment. There is a clear trend that neonates with NEC have a higher risk for developing complications than those without NEC.展开更多
AIM: To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.METHODS: Prospectively collected data of consecutive subjects who had anastomotic le...AIM: To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.METHODS: Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae(stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma(PS)and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage.RESULTS: Structural sequelae after anastomotic leakage were identified in 29 patients(39.7%).Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio(OR) = 6.741; P = 0.017].Fourteen patients(17.7%) had permanent stoma during the follow-up period(median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma(OR = 0.751; P = 0.045).CONCLUSION: Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.展开更多
AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched ...AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated. RESULTS:Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI:0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI:0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI:0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI:0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI:0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13). CONCLUSION:SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.展开更多
This review aimed to highlight the etiology,diagnosis,treatment,and prevention of obstructive and secretory complications associated with diverting ileostomy(DI).Obstructive complications at the stoma site are termed ...This review aimed to highlight the etiology,diagnosis,treatment,and prevention of obstructive and secretory complications associated with diverting ileostomy(DI).Obstructive complications at the stoma site are termed stoma outlet obstruction(SOO)or stoma-related obstruction(SRO).The incidence of SOO/SRO is 5.4%-27.3%,and the risk factors are multifactorial;however,the configuration of the stoma limb and the thickness of the rectus abdominis muscle(RAM)may be of particular concern.Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%.A thick RAM may carry the risk of recurrence.Surgical refinement,including a wider incision of the anterior sheath and adequate stoma limb length,avoids tension and immobility and may decrease SOO/SRO.Secretory complications of DI are termed high output stoma(HOS).Persistent HOS lead to water and sodium depletion,and secondary hyperaldosteronism,resulting in electrolyte imbalances,such as hypomagnesemia.The incidence of HOS is 14%-24%,with an output of 1000-2000 mL/d lasting up to three days.Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction,antimotility and antisecretory drug therapies,and magnesium supplementation.Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.展开更多
基金The study was reviewed and approved by the Science and Research Office of Tong Ren Hospital(Shanghai), No. AF/SC-08/04.0.
文摘BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.
基金Supported by a grant from the Education Department of Sichuan Province(No.16ZA0197)
文摘Objective The most important complication after low anterior resection(LAR) for mid-low rectal cancer is symptomatic anastomotic leakage(AL). More than one-third of patients with rectal cancer who underwent LAR will have functional stomas during primary operation. The aim of this retrospective study was to evaluate the risk factors associated with clinical AL following LAR without diversional stomas.Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The associations between AL and 14 patient-related and surgical variables were examined by both univariate chi-square test and multivariate logistic regression analysis.Results The AL rate was 7.27%(42 of 578). Univariate and multivariate analyses showed that male sex(P = 0.018), mid-low rectal cancer(located 10 cm or less above the anal verge)(P = 0.041), presence of diabetes(odds ratio = 2.117), longer duration of operation(odds ratio = 1.890), and intraoperative contamination(odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and independently predictive of clinical AL. Nearly 83.3%(35 of 42) of leakage could be cured by persistent pelvic irrigation-suction-drainage without surgical intervention. Only 7 patients(16.7%) with severe complications, such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and male sex were independent risk factors for developing clinical AL after LAR without diversional stomas, as well as longer duration of operation, presence of diabetes, and contamination of the operative field. Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective, and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage.
基金Beijing Municipal Administration of Hospitals Incubating Program,No.PZ20200272018 Beijing Talent Incubating Funding,No.2018-4+3 种基金National Natural Science Foundation of China,No.81773214Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support,No.ZYLX202116the National Key R&D Program of China,No.2021YFF1201104Science Foundation of Peking University Cancer Hospital-2023,No.JC202310.
文摘BACKGROUND Stoma creation is a common procedure in colorectal cancer surgery,however,stoma-related complications remain a significant concern.AIM To investigate the incidence,types,and risk factors of stoma-related complications in colorectal cancer patients who underwent stoma creation.METHODS Patients with stoma was prospectively recorded in the established stoma system.Data was collected from this stoma management system from November 2021 through May 2024.The rates of stoma-related complications were assessed,and potential risk factors were analyzed using univariate and multivariate logistic regression models.RESULTS A total of 734 patients were included in the analysis.The results showed that 12.3%of patients experienced stoma-related complications,with mucocutaneous separation,edema,and skin excoriation being the most common complications.The majority(90%)of complications were classified as grade 2 according to the Clavien-Dindo classification.Surgical factors,such as blood loss volume greater than 500 mL and open surgery,were significantly associated with stoma complications.Additionally,stoma features like location,shape,color,height,and edema were important factors in the association with complications.Body mass index over 30 kg/m²was also found to be a significant risk factor.CONCLUSION These findings highlight the need for a holistic approach to preventing and managing stoma complications,considering both patient-related and surgical factors.
文摘BACKGROUND Postoperative enterostomy is increasing in patients with colorectal cancer,but there is a lack of a model that can predict the probability of early complications.AIM To explore the factors influencing early postoperative stoma complications in colorectal cancer patients and to construct a nomogram prediction model for predicting the probability of these complications.METHODS A retrospective study of 462 patients who underwent postoperative ostomy for colorectal cancer in the Gastrointestinal Department of the Anhui Provincial Cancer Hospital.The patients’basic information,surgical details,pathological results,and preoperative inflammatory and nutritional indicators were reviewed.We used univariate and multivariate logistic regression to analyze the risk factors for early postoperative stoma complications in colorectal cancer patients and constructed a nomogram prediction model to predict the probability of these complications.RESULTS Binary logistic regression analysis revealed that diabetes[odds ratio(OR)=3.088,95%confidence interval(CI):1.419-6.719],preoperative radiotherapy and chemotherapy(OR=6.822,95%CI:2.171-21.433),stoma type(OR=2.118,95%CI:1.151-3.898),Nutritional risk screening 2002 score(OR=2.034,95%CI:1.082-3.822)and prognostic nutritional index(OR=0.486,95%CI:0.254-0.927)were risk factors for early stoma complications after colorectal cancer surgery(P<0.05).On the basis of these results,a prediction model was constructed and the area under the re-ceiver operating characteristic curve was 0.740(95%CI:0.669-0.811).After internal validation,the area under the receiver operating characteristic curve of the validation group was 0.725(95%CI:0.631-0.820).The calibration curves for the modeling group and validation group are displayed.The predicted results have a good degree of overlap with the actual results.CONCLUSION A previous history of diabetes,preoperative radiotherapy and chemotherapy,stoma type,Nutritional risk screening 2002 score and prognostic nutritional index are risk factors for early stoma complications after colorectal cancer surgery.The nomogram prediction model constructed on the basis of the results of logistic regression analysis in this study can effectively predict the probability of early stomal complications after colorectal cancer surgery.
基金Supported by Suqian Science and Technology Project Contract,No.S201910。
文摘BACKGROUND Abdominal cocoons(ACs)lack characteristic clinical manifestations and are main-ly intestinal obstructions that are difficult to distinguish from intestinal obstruc-tion caused by other causes,resulting in difficult preoperative diagnosis and misdiagnosis and mistreatment.There are no reports of enterostomy occlusion caused by ACs in the literature at home and abroad.CASE SUMMARY Here,we report a 16-year-old female patient with intestinal obstruction due to AC.She was treated with abdominal surgery three times.First,she underwent a laparotomy for peritonitis after trauma from a traffic accident.During the pro-cedure,pelvic empyema,severe intestinal adhesions,and damage to the serous layer of the rectum were found,but no significant intestinal rupture and perfo-ration were found.As a precaution,she underwent a prophylactic ileostomy after a flush in her abdomen.The second and third surgeries were for treatment of recurrent stoma obstruction.The patient’s condition was complicated for a long period,but after comprehensive treatment by our department,the patient was successfully discharged from the hospital and is currently recovering well.CONCLUSION Currently,abdominal contrast-enhanced computed tomography is the best imaging modality for pre-operative evaluation of AC,but most patients are diagnosed only after intrao-perative exploration.For the treatment of typical or severe ACs,the primary me-thod of removal and healing of ACs is complete removal of the abdominal fibrous membrane.Finding a breakthrough in the anatomy is the key to the success of the surgery.
基金Supported by Project of the Health Bureau of the Logistics and Security Department of the Central Military Commission,No.145BHQ090003076XMilitary Family Planning Special Fund,No.21JSZ18.
文摘BACKGROUND Children with critical acute abdominal conditions often undergo intestinal stoma surgery.AIM To explore the impact of a visual mobile terminal-based extended care model on caregiver competence for children with enterostomies.METHODS One hundred twenty children with enterostomies and their caregivers in a children's hospital in Beijing were divided into a control group and a study group.The control group(60 cases)received traditional telephone follow-up for continuity of care,while the study group(60 cases)used a visualization mobile terminal-based care model.The incidence of stoma-related complications,caregiver burden scale,and competence scores of children with stoma were compared between the two groups.RESULTS The primary caregiver burden score in the study group(37.22±3.17)was significantly lower than that in the control group(80.00±4.47),and the difference was statistically significant(P<0.05).Additionally,the caregiving ability score of the study group(172.08±3.49)was significantly higher than that of the control group(117.55±4.28;P<0.05).The total incidence of complications in the study group(11.7%,7/60)was significantly lower compared to the control group(33.3%,20/60;χ2=8.086,P=0.004).CONCLUSION The visual mobile terminal-based care model reduces caregiver burden,improves home care ability,lowers the incidence of complications and readmission rates,and supports successful second-stage reduction surgery for children with enterostomies.
基金Supported by Beijing Natural Science Foundation,No.L222054 and No.4232058.
文摘BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.
文摘Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.
文摘Through scanning electron microscope and optical microscope, a compara- tive study on morphological features and anatomical characters of the leaves of some pear cultivars （strains） was carried out. The results showed that the size and shapes of leaf epidermal cells were different, stomatal apparatuses were distributed in the hypodermis, the shapes of stornas were mainly oval, and these of ＇Jinxiang- shui＇ were long oval; the stomatal type was irregular, the cultivar with the maximum density of leaf stomas was ＇Jinxiangshui＇, and the minimum was ＇Aishanli＇. The thickness of palisade tissues and spongy tissues of different pear cultivars （strains） was different, the maximum thickness of palisade tissues of ＇Aishanli＇ was 105.5 iJm, and the maximum thickness of spongy tissues of ＇Jinxiangshui＇ was 98.4 IJm. The ratios of palisade tissues to spongy tissues from high to low were ＇Qiuyueli＇, ＇Zaoxiangshui＇, ＇Aishanli＇, ＇Hongjinqiu＇ and ＇8404＇. The differences on these mi- cromorphological characters among different pear cultivars （strains） had important significance to the identification of the cultivars and the early choice of breeding.
文摘AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.
文摘BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard procedure is restorativeproctocolectomy (RPC) with ileal pouch-anal anastomosis, commonly performedas two- or three-stage RPC with diverting ileostomy. Postoperative stoma outletobstruction (SOO) is frequent, but the causes are not well known.AIM To identify the risk factors for SOO after stoma surgery in patients with UC.METHODS We retrospectively reviewed the files of 148 consecutive UC patients whounderwent surgery with stoma construction. SOO was defined as small bowelobstruction symptoms and intestinal dilatation just below the penetrating part ofthe stoma on computed tomography. Patients were divided into two groups:Those who developed SOO within 30 d after surgery and those who did not.Patient characteristics, intraoperative parameters, the stoma site, and rectusabdominis muscle thickness were collected. Moreover, we identified the patientswho repeatedly developed SOO. Univariate and multivariate analyses wereperformed to identify risk factors for SOO and recurring SOO.RESULTS Eighty-nine patients who underwent two-stage RPC were included betweenJanuary 2008 and March 2020. Postoperatively, SOO occurred in 25 (16.9%)patients after a median time of 9 d (range 2-26). Compared to patients withoutSOO, patients with SOO had a significantly higher rate of malignant tumors ordysplasia (36.0% vs 17.1%, P = 0.032), lower total glucocorticoid dose one monthbefore surgery (0 mg vs 0 mg, P = 0.026), higher preoperative total protein level(6.8 g/dL vs 6.3 g/dL, P = 0.048), higher rate of loop ileostomy (88.0% vs 55.3%, P= 0.002), and higher maximum stoma drainage volume (2300 mL vs 1690 mL, P =0.004). Loop ileostomy (OR = 6.361;95%CI 1.322–30.611;P = 0.021) and maximumstoma drainage volume (OR = 1.000;95%CI 1.000–1.001;P = 0.015) wereconfirmed as independent risk factors for SOO. Eighteen patients with SOO weretreated conservatively without recurrence (sSOO group). Seven (28.0%) patientsrepeatedly developed SOO (rSOO group) during the observation period. Asignificant difference was observed in the rectus abdominis muscle thicknessbetween the two groups (sSOO 9.3 mm, rSOO 12.7 mm, P = 0.006). Musclethickness was confirmed as an independent risk factor for recurring SOO (OR =2.676;95%CI 1.176-4.300;P = 0.008).CONCLUSION In this study, high maximum stoma drainage volume and loop ileostomy areindependent risk factors for SOO. Additionally, among patients with a thickrectus abdominis muscle, the risk of SOO recurrence is high.
文摘BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and recurrence.Although transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects are controversial.AIM To reveal the effect of TDT in patients with symptomatic AL after rectal cancer surgery.METHODS A systematic literature search was performed using the PubMed,Embase,and Cochrane Library databases.We included randomized controlled trials(RCTs)and prospective cohort studies(PCSs)in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was evaluated.The results of the studies were synthesized using the Mantel-Haenszel randomeffects model,and a two-tailed P value>0.05 was considered statistically significant.RESULTS Three RCTs and two PCSs were included in this study.Symptomatic AL was examined in all 1417 patients(712 with TDT),and TDTs did not reduce the symptomatic AL rate.In a subgroup analysis of 955 patients without a diverting stoma,TDT reduced the symptomatic AL rate(odds ratio=0.50,95%confidence interval:0.29–0.86,P=0.012).CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer surgery.However,patients without a diverting stoma may benefit from TDT placement.
文摘Every colorectal surgeon during his or her career is faced with anastomotic leakage(AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
基金Supported by NBCRI,Symptomatic Breast Unit,University Hospital Galway
文摘Thirty per cent of all colorectal tumours develop in the rectum.The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions.Most patients with early rectal cancer can be adequately managed by surgery alone.However,a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery.Neoadjuvant therapy involves a variety of options including radiotherapy,chemotherapy used alone or in combination.Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery.The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes,within an intact mesorectal package,in order to minimise local recurrence.It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties.Pre-operative staging including CT thorax,abdomen,pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential.Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy.While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure,which includes patients with nodal involvement,extramural venous invasion and threatened circumferential margin.The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.
文摘Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery. Exact determination of the borderline of the viable bowel with the help of an objective test could result in a decrease of postoperative ischemic complications. An accurate, reproducible and cost effective method is desirable in every operating theater dealing with abdominal operations. Numerous techniques assessing various parameters of intestinal viability are described by the studies. However, there is no consensus about their clinical use. To evaluate the available methods, a systematic search of the English literature was performed. Virtues and drawbacks of the techniques and possibilities of clinical application are reviewed. Valuable parameters related to postoperative intestinal anastomotic or stoma complications are analyzed. Important issues in the measurement and interpretation of bowel viability are discussed. To date, only a few methods are applicable in surgical practice.Further studies are needed to determine the limiting values of intestinal tissue oxygenation and flow indicative of ischemic complications and to standardize the methods.
文摘AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODS A 10-year retrospective cohort study(2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study(corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis(NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson's χ2 test or Fisher's exact test for categorical variables and the Wilcoxon-Mann-Whitney U-Test for continuous variables. RESULTS In total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC(Group 1) were significantly older at enterostomy for-mation than the neonates of Group 2 [median(range), 11(2-75) d vs 4(1-101) d, P = 0.004)]. Significantly more ileostomies were created in Group 1 [47(92.2%) vs 16(64.0%), P = 0.007], whereas colostomies were performed significantly more often in Group 2 [2(3.9%) vs 8(32.0%), P = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median(range), 5(3-13) vs 3(1-9), P < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2(P = 0.073). Most patients suffered from two complications(23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2(P = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients(30.6% in Group 1 and 16.7% in Group 2, P = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48(65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification(CDC) < Ⅲ], while 25(34.2%) required surgery to address the complications(CDC ≥Ⅲ). Early reversal of the enterostomy was performed significantly more often(P = 0.003) and the time to full enteral nutrition after closure was significantly longer [median(range), 7(3-87) d vs 12(5-93) d, P = 0.006] in infants with a CDC grading ≥Ⅲ than in infants with a CDC grading < Ⅲ. CONCLUSION Complications occur in almost all infants with enterostomies. The majority of these complications are minor and do not require surgical treatment. There is a clear trend that neonates with NEC have a higher risk for developing complications than those without NEC.
文摘AIM: To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.METHODS: Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae(stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma(PS)and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage.RESULTS: Structural sequelae after anastomotic leakage were identified in 29 patients(39.7%).Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio(OR) = 6.741; P = 0.017].Fourteen patients(17.7%) had permanent stoma during the follow-up period(median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma(OR = 0.751; P = 0.045).CONCLUSION: Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.
文摘AIM:To investigate the effects of emergent preopera-tive self-expandable metallic stent (SEMS) vs emer-gent surgery for acute left-sided malignant colonic obstruction. METHODS:Two investigators independently searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, as well as references of included studies to identify randomized controlled trials (RCTs) that compared two or more surgical approaches for acute colonic obstruction. Summary risk ratios (RR) and 95% CI for colonic stenting and emergent surgery were calculated. RESULTS:Eight studies met the selection criteria, involving 444 patients, of whom 219 underwent SEMS and 225 underwent emergent surgery. Seven studies reported difference of the one-stage stoma rates between the two groups (RR, 0.60; 95% CI:0.48-0.76; P < 0.0001). Only three RCTs described the follow-up stoma rates, which showed no significant difference between the two groups (RR, 0.80; 95% CI:0.59-1.08; P = 0.14). Difference was not significant in the mortality between the two groups (RR, 0.91; 95% CI:0.50-1.66; P = 0.77), but there was significant difference (RR, 0.57; 95% CI:0.44-0.74; P < 0.0001) in the overall morbidity. There were no significant differences between the two groups in the anastomotic leak rate (RR, 0.60; 95% CI: 0.28-1.28; P = 0.19), occurrence of abscesses, including peristomal abscess, intraperitoneal abscess and parietal abscess (RR, 0.83; 95% CI:0.36-1.95; P = 0.68), and other abdominal complications (RR: 0.67; 95% CI: 0.40-1.12; P = 0.13). CONCLUSION:SEMS is not obviously more advantageous than emergent surgery for patients with acute left-sided malignant colonic obstruction.
文摘This review aimed to highlight the etiology,diagnosis,treatment,and prevention of obstructive and secretory complications associated with diverting ileostomy(DI).Obstructive complications at the stoma site are termed stoma outlet obstruction(SOO)or stoma-related obstruction(SRO).The incidence of SOO/SRO is 5.4%-27.3%,and the risk factors are multifactorial;however,the configuration of the stoma limb and the thickness of the rectus abdominis muscle(RAM)may be of particular concern.Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%.A thick RAM may carry the risk of recurrence.Surgical refinement,including a wider incision of the anterior sheath and adequate stoma limb length,avoids tension and immobility and may decrease SOO/SRO.Secretory complications of DI are termed high output stoma(HOS).Persistent HOS lead to water and sodium depletion,and secondary hyperaldosteronism,resulting in electrolyte imbalances,such as hypomagnesemia.The incidence of HOS is 14%-24%,with an output of 1000-2000 mL/d lasting up to three days.Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction,antimotility and antisecretory drug therapies,and magnesium supplementation.Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.
