Stoma has been used in colorectal surgery for various indications. Stoma type and stoma location are associated with stoma complications and quality of life with a stoma. The question regarding how to avoid stoma complication and improve quality of life should be considered when stoma creation is planned. The benefit of stoma should be balanced with complications brought about by stoma creation.
Enterostomy ; adverse effects ; classification ; Humans ; Postoperative Complications ; Quality of Life

Enterostomy-related complications are common in abdominal surgery. The incidence enterostomy-related complications varies according to the type and location of stoma, surgical procedure, and patient characteristics. Currently, there are no uniform criteria wopldwide for the classification of enterostomy complications. Previous classification of enterostomy-related complications were based on time of occurrence, clinical manifestations, or anatomical changes, etc., lacking uniformity and reproducibility. The concept and diagnostic criteria of complications are not yet clearly defined; and it is difficult to accurately determine the relationship between their severity, intervention, and medical cost. Moreover, surgeons and enterostomal therapists differ significantly in their concerns, cognition, and management principles for stoma-related complications. Therefore,the Chinese Ostomy Collaboration Group (COCG), together with the Wound, Ostomy, and Continence Nursing Committee of Chinese Nursing Association, the Colon and Rectal Surgeon Committee of Surgeon Branch of Chinese Medical Doctor Association, the Committee of Colorectal Cancer of Chinese Anti-Cancer Association, and the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, jointly drafted the criteria for the classification and grading of enterostomy complications. We hope this criteria will facilitate prospective data collection, clinical diagnosis, treatment, medical training and education.
Humans ; Reproducibility of Results ; Enterostomy/adverse effects* ; Surgical Stomas ; Rectum ; Colon

The related technology of enterostomy is a professional skill that colorectal surgeons need to master, and it is clinically important to prevent the occurrence of enterostomy-related complications of low rectal cancer. The early complications of enterostomy include stoma retraction, stoma ischemic necrosis, stoma edema and peripheral dermatitis, and the long-term complications include parastomal hernia, stenosis and stoma prolapse. In addition, the rare or easily neglected stoma cancer, difficulty of stoma closure and following social psychological disorders should also be paid attention to by surgeons. Effective reduction of enterostomy complications can lead to better quality of life for patients, which is the best interpretation of the concept of "patient-centered ness" by colorectal surgeons.
Humans ; Quality of Life ; Surgical Stomas/adverse effects* ; Rectal Neoplasms/surgery* ; Enterostomy/adverse effects* ; Constriction, Pathologic/etiology*

Enterostomy ; adverse effects ; methods ; Hernia, Ventral ; etiology ; surgery ; Humans ; Postoperative Complications ; etiology ; surgery

No consensus on standardized technique of enterostomy creation has been made meanwhile high heterogeneity of surgical procedure exists in 'stoma creation' chapters of textbooks or atlases of colorectal surgery. The present article reviews the anatomy of tendinous aponeurotic fibers which is crucial for abdominal wall tension and integrity. Through empirical practice we hypothesize a procedure of enterostomy creation basied on abdominal wall tension plus anchor suture for fascia fixation which could theoretically decrease short-term stoma complication rates and long-term parastomal hernia rates. Surgical techniques are as followed: (1) preoperative stoma site mark for de-functioning ileostomy should be positioned at the lateral border of rectus abdominis muscle (RAM) to decrease the difficulty of stoma reversal and for permanent colostomy should be placed overlying the RAM to promote adhesion; (2)Optimal circular removal or lineal opening of skin, and avoid dissection of subcutaneous tissue; (3) Lineal dissection of natural strong fascia (rectus sheath) at stoma site and blunt separation of muscular fibers. The tunnel of the fascia should be made with appropriate size without undue tension. To prevent the formation of dead space, additional suturing at fascia layer is unnecessary. (4) Anchor suture for fascia fixation at two ends of fascia opening could be considered to avoid delayed fascia disruption and parastomal hernia. (5) After pull-through of ileum or colon loop, 4-8 interrupted seromuscular sutures could be placed to attach loop to skin. For ileostomy, self-eversion of mucosa can be successful in vast majority of cases and a Brooke ileostomy is not necessary. The efficacy and safety of this procedure should be tested in future trials.
Humans ; Abdominal Wall/surgery* ; Surgical Stomas/adverse effects* ; Enterostomy ; Incisional Hernia ; Fascia

OBJECTIVETo explore the surgical methods and the clinical results of chronic radiation enteritis.

METHODSTreatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases.

RESULTSForty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died.

CONCLUSIONSSurgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.

Adult ; Aged ; Anastomosis, Surgical ; Chronic Disease ; Enterostomy ; Female ; Humans ; Inflammatory Bowel Diseases ; etiology ; surgery ; Male ; Middle Aged ; Radiation Injuries ; etiology ; surgery ; Radiotherapy ; adverse effects ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the effect of enterostomy in treatment of locally advanced rectal carcinoma patients with combined chemoradiotherapy and operation.

METHODSClinical data from 51 cases of locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and operation were analyzed.

RESULTSThirty-three patients (64.9%) got staging down of their cancer after preoperative chemoradiotherapy, and 21.6% of patients (11 cases) had complete pathologic response. Thirty-seven patients received enterostomy, including extraperitoneal sigmoidostomy (29 cases), defunctioning ileostomy (8 cases) and double colostomy (3 cases with colon obstruction during preoperative therapy). One case experienced parastomal hernia and one stomal stenosis and 2 cases parastomal infection after enterostomy. No death of enterostomy occurred.

CONCLUSIONColostomy can reduce the pressure of obstructed intestinal tract and contribute much to the preoperative chemoradiotherapy, ileostomy can protect the distal stoma from leakage in sphincter saving operation. Enterostomy could be selected when needed in the favor of locally advanced rectal cancer patients.

Adult ; Aged ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Enterostomy ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; pathology ; surgery ; therapy ; Rectum ; drug effects ; radiation effects ; surgery ; Treatment Outcome