Humans ; Surgical Stomas

Humans ; Rectal Neoplasms ; Surgical Stomas

This paper describes the background of Chinese expert consensus on protective ostomy for middle and low rectal cancer in China, interprets some key issues such as unification of relevant terminology and concepts, clinical value and indications of protective stoma, and clarifies surgical principles and details and perioperative ostomy care.
China ; Consensus ; Humans ; Ostomy ; Rectal Neoplasms/surgery* ; Surgical Stomas

Colon, Sigmoid/surgery* ; Colostomy ; Humans ; Ostomy ; Prolapse ; Surgical Stomas

Stoma is a commonly used surgical procedure in clinic practice. However, for obese patients with thick abdominal wall, short and thickened mesentery, and for patients with intestinal obstruction and abdominal distension (difficult stoma), establishing a tension- free and well blood-supplied stoma is still a great challenge. Careful preoperative planning, including stoma location marking, careful consideration of all alternatives and attention to technical details, will help to make an optimal stoma under challenging conditions. For enterostomy of obese patients, the pullout intestine must be free of tension and must have sufficient blood supply, the structure of the abdominal wall should be incised vertically, and the intestine should be pulled out vertically as well. For enterostomy of patients with intestinal obstruction, the diameter of the stoma incision should not exceed 3 cm to avoid parastomal hernia, which commonly occurs after bowel retraction.
Humans ; Surgical Stomas ; Incisional Hernia ; Enterostomy ; Intestinal Obstruction ; Obesity

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

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

European Hernia Society issued a guideline for the prevention and treatment of parastomal hernias in 2017, which is the first international guideline for the parastomal hernia. This guideline proposed 12 problems about incidence, diagnosis and treatment, and discussed these problems in depth. The main contents of this guideline are summarized as follows: (1) End colostomy is associated with a higher incidence of parastomal hernia compared to other types of stomas. (2) Clinical examination is necessary for the diagnosis of parastomal hernia, whereas computed tomography scan or ultrasonography may be performed in cases of diagnostic uncertainty. (3) The use of the European Hernia Society classification for uniform research reporting is recommended. (4) There is insufficient evidence on the policy in watchful waiting. (5) There is insufficient evidence on the route and location of stoma construction, and the size of the aperture. (6) The use of a prophylactic synthetic non-absorbable mesh upon construction of an end colostomy is strongly recommended. No such recommendation can be made for other types of stomas at present.(7) It is strongly recommended to avoid performing a suture repair for elective parastomal hernia. (8) So far, there is no sufficient comparative evidence on specific techniques, open or laparoscopic surgery and specific mesh types. However, most data in this guideline were retrospective without high level evidence. A lot of questions remain controversial and more high-level evidence are expected to solve these problems.
Colostomy ; Hernia, Ventral ; prevention & control ; surgery ; Humans ; Postoperative Complications ; Retrospective Studies ; Surgical Mesh ; Surgical Stomas

OBJECTIVETo evaluate wound healing after pancreaticojejunostomy of three anastomotic methods.

METHODSFifty-four domestic piglets were divided into three groups according to the types of anastomoses: group of end-to-end pancreaticojejunal invagination (EE group), group of binding pancreaticojejunostomy (BP group) and group of inkwell pancreaticojejunostomy (IP group). Bursting pressure, breaking strength and histopathological findings of anastomosis were assessed on operative day and on the 5th and 10th day after operation.

RESULTSBursting pressure was (67+/-8) mm Hg, (96+/-11) mm Hg and (131+/-9) mm Hg in EE group on day 0, 5 and 10; and (140+/-8) mm Hg, (179+/-10) mm Hg and (269+/-13) mm Hg in BP group; and (102+/-10) mm Hg, (171+/-18) mm Hg and (254+/-24) mm Hg in IP group. Compare to EE group, bursting pressure of BP group and IP group were all increased with significant differences (P<0.05). Another significant difference was observed between BP group and IP group after anastomoses on operative day. Breaking strength was (4.6+/-0.6) N, (5.8+/-0.5) N and (7.1+/-0.6) N in EE group on 0 d, 5 d and 10 d; and (4.5+/-0.4) N, (6.6+/-0.4) N and (10.0+/-0.6) N in BP group; and (4.6+/-0.3) N, (6.5+/-0.4) N and (9.1+/-0.9) N in IP group. A similar value of anastomoses was shown in BP group and IP group on day 0, day 5 and day 10, but significant increase was demonstrated compared to EE group on day 5 and 10. Anastomotic site was well repaired by connective tissue and the cut surface of pancreatic stump was covered by mucosal epithelium in BP group and IP group on day 10, but the cut surface was incompletely repaired by granulation tissue and no regeneration of the epithelium was found in EE group.

CONCLUSIONSWound healing of binding pancreaticojejunostomy and inkwell pancreaticojejunostomy is more rapid and better than end-to-end pancreaticojejunal invagination, but breaking strength of inkwell pancreaticojejunostomy is weaker than binding pancreaticojejunostomy.

Anastomosis, Surgical ; methods ; Animals ; Female ; Male ; Pancreaticojejunostomy ; adverse effects ; methods ; Surgical Stomas ; pathology ; Swine ; Wound Healing

Anastomotic leakage (AL) is one of the most serious complications of anterior resection for rectal cancer with morbidity about 10%. Distance of anastomosis to anal margin, underlying disease, surgical technique and perioperative situations are associated with AL. The transanal drainage tube (TDT) after anastomosis is gradually proved to be useful in prevention of AL. Most of the literatures suggest that TDT is simple and safe, and can reduce the incidence of AL. The materials and the operating process of TDT have been universalized gradually: application of silicone or rubber material, large lumen with several side holes, placement at a distance of 3 to 5 cm above the anastomosis for 5 to 7 days. However, selection bias existed in previous studies, and the main problems were disunity of enrolling standard and exclusion of patients with high AL risk, which would not fully reflect the value of TDT. Defunctioning stoma (or diverting stoma, DS) is a common method to prevent and treat the AL. At present, efficacy comparison between TDT and DS remains controversial. Thus, randomized, double-blind, controlled trials are needed to investigate the value of TDT in prevention of AL after anterior resection, especially for middle and low rectal cancer.
Anal Canal ; Anastomosis, Surgical ; Anastomotic Leak ; prevention & control ; Drainage ; Humans ; Rectal Neoplasms ; surgery ; Surgical Stomas