The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.
Humans ; Hernia, Ventral/surgery* ; Surgical Mesh/adverse effects* ; Quality of Life ; Incisional Hernia/prevention & control* ; Surgical Stomas/adverse effects* ; Evidence-Based Medicine ; Colostomy/adverse effects* ; Randomized Controlled Trials as Topic

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*

Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage after rectal cancer surgery. It is of concern that about 1 in 5 defunctioning stomas will not be restored, that is, becoming permanent. And that is usually beyond expectation by physicians and patients, which deserves enough attention. The causes are complex, including anastomotic complications, tumor progression, perioperative death, poor anal function and patient willingness. Possible risk factors include symptomatic anastomotic leakage, age, tumor location, neoadjuvant therapy, anal function, TNM stage, ASA score, hospital factors, etc. Those factors may occur in various stages of patient referral such as before neoadjuvant therapy, prior to surgery, intra or post-operative period, and follow-up. Adequate physician-patient communication and shared decision-making, comprehensive tumor and patient function assessment, rational treatment strategy, careful manipulation during operation and good quality control, and meticulous perioperative management are important steps to reduce the permanent stoma. When shared decision-making, patients' needs should be fully considered while unnecessary expectations of anal preservation should be avoided. The risk of perpetuation of defunctioning stoma should be fully informed. Safe operation, especially anastomosis, is the key to avoid permanent stoma. And attention should be paid to the early detection and intervention of postoperative anastomotic stenosis.
Humans ; Anastomotic Leak/etiology* ; Surgical Stomas/adverse effects* ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Risk Factors ; Postoperative Complications/prevention & control*

Objective: To explore the value of a two-stitch continuous suture in single- lumen ileostomy. Methods: This was a retrospective cohort study. Data for 98 patients who underwent single-lumen enterostomy were retrospectively collected between 1 January 2021 and 1 May 2022 at Zhujiang Hospital of Southern Medical University. All patients met the indications for prophylactic single-lumen ileostomy. Those older than 80 years of age, with complex underlying diseases, extremely poor systemic conditions who could not tolerate surgery, poor blood supply at the end of the bowel, and severe edema or severe infection at the end of the bowel were excluded. Among the included patients, patients who underwent surgery before 1 October 2021 underwent ileostomy with interrupted suture (control group, n=60), and patients operated on and after 1 October 2021 routinely underwent two-stitch continuous suture ileostomy (two-stitch stoma group, n=38). Two-stitch continuous suture ileostomy is performed as follows: the first continuous suture is used to suture the intestinal seromuscular layer, peritoneum, posterior sheath, and anterior sheath from deep to superficial layers. The bowel wall is then opened. The second continuous suture is used to suture the full thickness of the bowel and the skin. The differences in postoperative ostomy-related complications and operation time were compared between the groups. Results: There were no significant differences in baseline data between the groups (all, P>0.05). The operative time in the two-stitch stoma group was shorter than that of the control group (16.6±2.2 minutes vs. 25.1±2.4 minutes, respectively; t=-17.874;P<0.001). The incidences of mucocutaneous separation, dermatitis, and stoma rebound in the two-stitch stoma group were lower than those of the control group [5.3% (2/38) vs. 31.7% (19/60), χ²=9.633, P=0.002;5.3% (2/38) vs. 28.3% (17/60), χ²=7.923, P=0.005; and 2.6% (1/38) vs. 18.3% (11/60), P=0.026, respectively], while the incidences of parastomal hernia and stoma prolapse, and the postoperative visual analog scale scores in the two groups were similar (all P>0.05). Conclusion: Compared with traditional single-lumen ileostomy, two-stitch continuous suture ileostomy has the advantages of short operation time, simplicity, esthetic appearance of the stoma, and a significant reduction in the postoperative complications associated with ileostomy.
Humans ; Ileostomy/adverse effects* ; Retrospective Studies ; Suture Techniques/adverse effects* ; Surgical Stomas ; Sutures/adverse effects* ; Postoperative Complications/epidemiology*

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

Parastomal hernia is a common complication after abdominal ostomy. Although the European Hernia Society guidelines recommend surgical treatment for parastomal hernia, there is still no "gold standard" procedure. The exploration and practice of parastomal hernia repair surgery has been carried out for many years, from the earlier hernia ring suture and stoma relocation repair, to the reinforcement of meshes (such as the Keyhole repair technique and the Sugarbaker repair technique) and the application of laparoscopic technique, and then to the combination of various methods. The intervention of single-port laparoscopic technique and robot-assisted surgery, the prevention of parastomal hernia, the specialization of treatment, multidisciplinary cooperation, and the improvement of diagnostic methods will all provide more optimal solutions for stoma patients. This article will review and summarize the development process and evaluation of parastomal hernia surgical techniques.
Humans ; Herniorrhaphy/methods* ; Surgical Mesh ; Incisional Hernia/surgery* ; Surgical Stomas/adverse effects* ; Laparoscopy/methods*

The rate of sphincter-preserving surgery for mid-low rectal cancer is increasing, but anastomotic leakage remains to be one of the common serious complications after operation. How to reduce the morbility and mortality of anastomotic leakage is always a hot and difficult point in colorectal surgery. Protective ostomy is a common method to deal with the above problems in clinical practice. However, some problems such as inappropriate stoma and stoma-related complications etc. become the current clinical challenges. The purpose of this consensus focusing on indication of ostomy, clinical value, ostomy skills, prevention of stoma complications, reversion of stoma and stoma nursing aims to provide guidance for the clinical practice of protective ostomy in the operation of mid-low rectal cancer in China.
Anastomosis, Surgical/adverse effects* ; Anastomotic Leak/etiology* ; Consensus ; Humans ; Ostomy/adverse effects* ; Rectal Neoplasms/surgery* ; Risk Factors ; Surgical Stomas

OBJECTIVETo explore the application of three-stitch preventive transverse colostomy in anterior resection of low rectal cancer.

METHODFrom May 2015 to March 2016, 70 consecutive low rectal cancer patients undergoing anterior resection and preventive transverse colostomy in our department were recruited in this prospective study. According to the random number table method, 70 patients were divided into three-stitch transverse colostomy group(observation group, n=35) and traditional transverse colostomy group(control group, n=35). Procedure of three-stitch preventive transverse colostomy was as follows: firstly, at the upper 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from outside to inside, then the needle belt line went through the transverse edge of the mesangial avascular zone. At the lower 1/3 incision 0.5-1.0 cm distance from the skin, 7# silk was used to suture from inside to outside, then silk went through the transverse edge of the mesangial avascular zone again and was ligatured. Finally, in the upper and lower ends of the stoma, 7# silk was used to suture and fix transverse seromuscular layer and the skin. The operation time and morbidity of postoperative complications associated with colostomy were compared between two groups.

RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). The operative time of observation group was shorter than that of control group [(3.2±1.3) min vs. (15.5±3.4) min, P<0.05]. Incidences of colostomy skin-mucous separation, dermatitis, stoma rebound were significantly lower in observation group [5.7%(2/35) vs. 34.3%(12/35), P=0.007; 8.6%(3/35) vs. 31.4%(11/35), P=0.036; 0 vs. 17.1%(6/35), P=0.025, respectively], while incidences of parastomal hernia and stoma prolapse in two groups were similar (both P>0.05).

CONCLUSIONCompared with traditional transverse colostomy method, the three-stitch preventive transverse colostomy has more operating advantages and can reduce postoperative complications associated with colostomy.

Colostomy ; adverse effects ; methods ; Comparative Effectiveness Research ; Humans ; Operative Time ; Postoperative Complications ; epidemiology ; Prospective Studies ; Rectal Neoplasms ; surgery ; Surgical Stomas ; adverse effects ; Suture Techniques ; adverse effects ; instrumentation ; Sutures ; Treatment Outcome

OBJECTIVETo summarize the perioperative and postoperative complications follow laparoscopic intersphincteric resection (LapISR) in the treatment of low rectal cancer and their management.

METHODSAn observational study was conducted in 73 consecutive patients who underwent LapISR for low rectal cancer between June 2011 and February 2016 in our hospital. The clinicopathological parameters, perioperative and postoperative complications, and clinical outcomes were collected from a prospectively maintained database. Perioperative and postoperative complications were defined as any complication occurring within or more than 3 months after the primary operation, respectively.

RESULTSForty-nine(67.1%) cases were male and 24(32.9%) were female with a median age of 61(25 to 79) years. The median distance from distal tumor margin to anal verge was 4.0(1.0 to 5.5) cm. The median operative time was 195 (120 to 360) min, median intra operative blood loss was 100 (20 to 300) ml, median number of harvested lymph nodes was 14(3 to 31) per case. All the patients underwent preventive terminal ileum loop stoma. No conversion or hospital mortality was presented. The R0 resection rate was 98.6% with totally negative distal resection margin. A total of 34 complication episodes were recorded in 21(28.8%) patients during perioperative period, and among which 20.6%(7/34) was grade III(-IIII( according to Dindo system. Anastomosis-associated morbidity (16.4%,12/73) was the most common after LapISR, including mucosa ischemia in 9 cases(12.3%), stricture in 7 cases (9.6%, 4 cases secondary to mucosa necrosis receiving anal dilation), grade A fistula in 3 cases (4.1%) receiving conservative treatment and necrosis in 1 case (1.4%) receiving permanent stoma. After a median follow up of 21(3 to 60) months, postoperative complications were recorded in 12 patients (16.4%) with 16 episodes, including anastomotic stenosis (8.2%), rectum segmental stricture (5.5%), ileus (2.7%), partial anastomotic dehiscence (1.4%), anastomotic fistula (1.4%), rectovaginal fistula (1.4%) and mucosal prolapse (1.4%). These patients received corresponding treatments, such as endoscopic transanal resection, anal dilation, enema, purgative, permanent stoma, etc. according to the lesions. Six patients (8.2%) required re-operation intervention due to postoperative complications.

CONCLUSIONAnastomosis-associated morbidity is the most common after LapISR in the treatment of low rectal cancer in perioperative and postoperative periods, which must be strictly managed with suitable methods.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; adverse effects ; Blood Loss, Surgical ; statistics & numerical data ; Colectomy ; adverse effects ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; adverse effects ; Intestinal Mucosa ; pathology ; Ischemia ; etiology ; Laparoscopy ; adverse effects ; Lymph Node Excision ; statistics & numerical data ; Male ; Margins of Excision ; Middle Aged ; Necrosis ; etiology ; Operative Time ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; complications ; surgery ; Rectovaginal Fistula ; etiology ; therapy ; Surgical Stomas ; Treatment Outcome