OBJECTIVETo explore the clinical application of aoptimizedtechniquebased onpreviouslyreported protecting stoma with no need forreversal.

METHODSThetechniquealso used "the assembly of drainage device" to performprotecting ileostomy. The original method includes enterotomy at the terminal ileum to placedrainage device, which was optimized as follows: two intestinal pursestring with 0.5 cm distance were placed 5 cm away from the ileocecal valve. Transverse enterotomy was performed in the anti-mesenteric side. The assembly was placed at the root of the appendix between two pursestring, and then the intestine purse suture was tighten. Ligation of the small intestine anastomosis between the anastomosis ring at both ends was carried out, and theanastomosis ring was deployed. From the root of the appendix in the cecum wall, the assembly was embedded about 2 cm and pulled out of abdominal cavitythough the Trocar hole.

RESULTSSeventeen cases of ultra-low rectal cancer completed protecting stoma, including 11 cases through ileocecal protective stoma. All the anastomosis healed well. Defecation drainage tube was removed 3-5 weeks after anastomosis ring degradation. Drainage nozzle healed after 3 to 5 days, and no complications occurred.

CONCLUSIONThe optimized ileocecal protective ileostomy has the following advantages: (1)wound healing time is significantly shorter. (2)secondary intestinal fistula can be prevented. (3)no need to fix ileum and less chance of subsequent volvulus, intestinal obstruction.

Anastomosis, Surgical ; Defecation ; Drainage ; Humans ; Ileostomy ; methods ; Ileum ; surgery ; Intestinal Fistula ; Rectal Neoplasms ; Surgical Stomas

PURPOSE: Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. METHODS: This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. RESULTS: Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). CONCLUSION: After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.
Cicatrix ; Humans ; Ileostomy* ; Incidence ; Methods ; Patient Satisfaction ; Skin* ; Surgical Stomas ; Wound Infection ; Wounds and Injuries*

In order to prevent and reduce the severity of anastomotic leakage after low rectal cancer surgery, prophylactic ileostomy is often performed by the clinician simultaneously. There are many controversies about prophylactic ileostomy in medicine, such as ileostomy indications, ileostomy complications, ileostomy reversal time, ileostomy reversal method and technique. Based on relevant literature and our own experience, we discussed the timing, method and complications of ileostomy reversal in this article to improve the diagnosis and treatment of ileostomy reversal as well as the life quality of the patients after ileostomy reversal.
Humans ; Ileostomy/methods* ; Anastomosis, Surgical/adverse effects* ; Anastomotic Leak/etiology* ; Rectal Neoplasms/complications* ; Rectum/surgery*

PURPOSE: Currently, many operations are performed using the single-incision laparoscopic method. Although there have been recent reports on single-incision laparoscopic ileostomy, none have compared this method to conventional laparoscopic ileostomy. This study aimed to assess the safety and feasibility of single-incision laparoscopic ileostomy for anastomotic leakage following laparoscopic low anterior resections. METHODS: From April 2012 to April 2017, 38 patients underwent laparoscopic ileostomy (single-incision; 19 patients referred to as group A, conventional laparoscopy; 19 patients referred to as group B) for anastomotic leakage following laparoscopic low anterior resection. We analyzed surgical and clinical outcomes between the 2 groups. Patients in whom a protective ileostomy was carried out during the initial laparoscopic low anterior resection were excluded from this study. RESULTS: No significant differences were observed between the 2 groups in terms of patient demographics and initial operation details. Incisional surgical site infections occurred less in group A than in group B (2 of 19 vs. 9 of 19, P = 0.029). The median ileostomy operation time, amount of intraoperative bleeding, parastomal hernia ratio, hospital stay duration after ileostomy, postoperative pain score were not significantly different between the 2 groups. CONCLUSION: Single-incision laparoscopic ileostomy is safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection.
Anastomotic Leak* ; Demography ; Hemorrhage ; Hernia ; Humans ; Ileostomy* ; Laparoscopy ; Length of Stay ; Methods* ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Surgical Wound Infection

OBJECTIVE: To investigate the safety of the controllable ileostomy with pipe in view of histology. METHODS: Twenty-eight Beagle dogs undergoing controllable ileostomy with pipe were studied. The special fistula tube with balloon was placed into the hole locating at the cecal root opposing the mesenteric side, and fixed by double knot compression method. RESULTS: The fistula tube was removed 14 days after surgery, then the safety of the procedure was preliminarily evaluated by gastrointestinal radiography and anatomical observation. The small intestine tissue at the compression suture was used as the experimental segment, and the small intestine tissue at the proximal non-compression suture was used as the control segment. The histological staining and the immunohistochemical staining of S-100 protein, c-kit protein and α-smooth muscle actin(α-SMA) protein between two segment were compared, while quantitative comparison of myenteric plexus, intestinal Cajal cell(ICC) and smooth muscle cells in intestinal wall was carried out. After removal of fistula tube at 14 days postoperative, the dogs were normal in feeding and defecation. The digestive tract radiography showed that the intestine was patent without obvious stenosis and obstruction. The dogs were dissected 21 days after operation. The abdominal sinus ostium was well healed and the internal sinus was well formed. Under gross inspection, blood supply, morphology and motor function of experimental intestine segment were similar from the proximal and distal segments of control intestine. S-100 immunohistochemical staining showed that the morphology and distribution of S-100 protein positive cells and "blank area" cells in the experimental and control segments were consistent. Myenteric plexus counting showed that the experimental segment was 3.62±1.82/field and the control segment was 3.27±1.62/field, whose difference was not statistically significant(t=1.30, P=0.20). Immunohistochemical staining of c-kit showed that the distribution of c-kit positive cells in both segments was consistent. Counting of the number of ICCs in myenteric plexus revealed that experimental segment was 2.96±2.57/plexus, and control segment was 2.49±1.80/plexus without significant difference(t=1.81, P=0.07). Immunohistochemical staining of α-SMA showed that the morphology and distribution of smooth muscle cells in whole intestinal wall(muscle layer, longitudinal muscle, ring muscle) in experimental and control segments were consistent. The average absorbance(A) value of α-SMA staining in ring muscle layer was detected and quantified. The experimental segment was 0.15±0.03 and control segment was 0.14±0.04 without significant difference(t=1.16, P=0.25). CONCLUSION The technique of controllable ileostomy with pipe is safe in view of histology, which may replace the traditional protective ileostomy.
Animals ; Dogs ; Ileostomy ; methods ; standards ; Intestine, Small ; surgery ; Models, Animal ; Proto-Oncogene Proteins c-kit ; metabolism ; Treatment Outcome

OBJECTIVETo explore the efficacy of different procedures for refractory constipation complicated with megacolon.

METHODSClinical data of 112 patients of refractory constipation complicated with megacolon undergoing surgery in our institute from June 2007 to January 2013 were retrospectively analyzed. Of these 112 patients, the duration of constipation ranged from 4 to 22 years. Seventy-four patients had previous abdominal operations. Surgical procedures: (1)Jinling procedure (subtotal colectomy plus ascending colorectal posterior wall side-to-side anastomosis, n=81), including 24 laparoscopy-assisted procedures, 18 terminal ileostomies. (2)total colectomy plus ileorectal side-to-side anastomosis(n=18). (3)total colectomy plus end ileostomy, and ileorectal posterior wall side-to-side anastomosis 6 months later(n=13). The end ileostomy was reversed 6 months after operation.

RESULTSThe successful rate was 100%, and no surgery-related deaths were found. Postoperative complications included early diarrhea (90 cases, 80.4%), anal pain and incomplete evacuation (22 cases, 19.6%), urinary retention within 24-48 h after catheter removal (16 cases, 14.2%), anastomosis bleeding (9 cases, 8.0%), anastomosis leakage (6 cases, 5.4%), and intestinal obstruction (15 cases, 13.4%). Six patients with intestinal obstruction underwent adhesiolysis, and others were managed by conservative therapy. At the postoperative follow-up at 6 months, the Wexner constipation score was significantly reduced (5.8-8.3 vs. 21.4-28.7, P<0.01), and malnutrition improved as well.

CONCLUSIONSurgical intervention results in good efficacy for refractory constipation complicated with megacolon.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; methods ; Colectomy ; methods ; Constipation ; complications ; surgery ; Female ; Humans ; Ileostomy ; Male ; Megacolon ; complications ; surgery ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: I introduce the use of transanal intestinal long tube (TILT) using nasogastric tube. TILT passes from anus to the anastomosis, helping to decompress a dilated bowel loop. METHODS: TILT procedure was limited to those patients predicting a severe luminal size discrepancy after intestinal anastomosis, and who had postoperative prolonged ileus. We retrospectively reviewed the medical records of 10 infants (7 male an 3 female patients) who were treated using the TILT procedure between 2012 and 2016. RESULTS: Median gestational age was 27⁺⁵ weeks and birth weight was 940 g. The first operation was done at a median of 4.5 days after birth due to necrotizing enterocolitis perforation (4 cases), isolated intestinal perforation (3 cases), meconium related ileus (1 case), congenital ileal volvulus (1 case), and ileal atresia (1 case). Nine cases of ileostomy closure were planned at a median of 130.5 days with a body weight of 3,060 g. For the ileal atresia case, TILT procedure without additional small bowel resection was performed to treat postoperative prolonged ileus. Nine out of ten were well functioned and defecation via anus was observed in a median of 4.5 days. Milk feeding began at a median of 6 days and the long intestinal tube was removed in a median of 14.5 days. CONCLUSION: I suggested that TILT procedure could be a noninvasive operative option, predicting of size mismatched anastomosis causing prolonged ileus. Passive drainage of proximal intestinal contents might be helpful for decompress endoluminal pressure during the time of anastomosis healing with bowel movement recovery.
Anal Canal ; Anastomosis, Surgical ; Birth Weight ; Body Weight ; Decompression ; Defecation ; Drainage ; Enterocolitis, Necrotizing ; Female ; Gastrointestinal Contents ; Gestational Age ; Humans ; Ileostomy ; Ileus ; Infant ; Intestinal Obstruction ; Intestinal Perforation ; Intestinal Volvulus ; Male ; Meconium ; Medical Records ; Methods* ; Milk ; Parturition ; Phenobarbital ; Retrospective Studies