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Diverting loop ileostomy is performed after colectomy to allow for anastomotic healing, and prevention of pelvic sepsis when an anastomotic leak occurs. There is no consensus on the optimal timing of ileostomy closure, and there is limited data on complications associated with ileostomy closure greater than 12 months after creation. The aim of this study is to investigate outcomes of delayed loop ileostomy closure greater than 12 months after creation. Patients undergoing loop ileostomy closure between 2013 and 2023 at Carilion Medical Center, in Roanoke, VA were reviewed. Cohorts compared were defined as Control Group (closure < 4 months) and Delayed Group (closure > 12 months). Demographics and outcomes were compared. Statistical comparisons were performed using either Wilcoxon rank sum test, Pearson's Chi-squared test or Fisher's exact test. Statistical modeling included binary logistic regression for 30-day readmissions and a generalized linear modeling for days till bowel function returns. Adjusted odds ratios, confidence intervals, and p-values were calculated. There were 135 patients in the Control Group and 19 patients in the Delayed Group. Demographics were similar between the groups except for a higher percentage of patients with diabetes, renal failure and history of cancer in Delayed Group (all p < 0.05). Operative time was longer for Delayed loop ileostomy closure (p < 0.05). Patients in the Delayed Group demonstrated a higher hospital readmission rate within 30 days (p < 0.05). Both groups had similar return of bowel function on post-operative day 2, similar length of stay, and similar rates of postoperative ileus (p = NS). Delayed loop ileostomy closure more than 12 months after creation does not delay return of bowel function but may lead to higher hospital readmission rates within 30 days. [ABSTRACT FROM AUTHOR]

Purpose: Diverting ileostomy is related to postoperative high-output stoma (HOS) leading to kidney injury. The purpose of our study was to clarify the risk factors for ileostomy-associated kidney injury, which is kidney injury starting after the first operation to ileostomy closure after colorectal tumor surgery with diverting ileostomy. Methods: Between January 2013 and December 2020, 442 patients who underwent colorectal tumor surgery (cancer, neuroendocrine tumor, and leiomyosarcoma) following diverting ileostomy formation were included. We used the KDIGO (Kidney Disease Improving Global Outcomes) guidelines, which defines the acute kidney injury (AKI) to classify patients with ileostomy-associated kidney injury. The definition of AKI was (i) serum creatinine (sCr) ≥ 0.3 mg/dL or (ii) sCr ≥1.5-fold the preoperative level. Multivariate analyses were performed to identify the independent risk factors for kidney injury. Results: Kidney injury developed in 99/442 eligible patients (22.4%). Patients in the kidney injury group were older age, male sex, high American Society of Anesthesiologists Physical Status Classification System (ASA-PS) score, hypertension, cardiovascular diseases, diabetes. The preoperative hemoglobin, albumin, prognostic nutritional index (PNI), and creatinine clearance (CCr) were lower, and the maximum wound length was more extended than the non-kidney injury group. The median highest daily stoma output was significantly higher in the kidney injury group. The postoperative white blood cell (WBC) and C-reactive protein (CRP) levels were also high in the kidney injury group. The univariate analysis showed older age, male sex, high ASA-PS score, hypertension, cardiovascular diseases, and diabetes were the risk factors for kidney injury. The multivariate analysis revealed that age 70 or older, ASA-PS III/IV, hypertension, and HOS ≥2000 ml/day were independent risk factors for kidney injury. Conclusions: Surgeons should consider diverting colostomy creation for patients with risk factors such as age 70 or older, ASA-PS III/IV, and hypertension. [ABSTRACT FROM AUTHOR]

Objective To investigate the safety and clinical effect of prophylactic ileostomy using right lower abdominal specimen extraction incision in laparoscopic rectal low anterior resection and its impact on ileostomy closure. Methods A retrospective analysis was conducted on 127 patients who underwent laparoscopic low anterior resection of rectal cancer combined with prophylactic ileostomy in Department of General Surgery in our hospital from January 2020 to December 2023. Patients were divided into observation group (n = 60) and control group (n = 67) based on whether with prophylactic ileostomy using the right lower abdominal specimen extraction incision or not. Relevant data and clinical data of ileostomy closure were compared between the two groups. Results (1) There was no significant difference in baseline clinical data between the two groups (P > 0.05). (2) In terms of operation time, pain score within three days after surgery and postoperative first exhaust time, the observation group was better than the control group, showing statistical difference ( P < 0.05 ). In the observation group, the average length of the incision was longer than that in the control group, and it was significantly different between the two groups (P < 0.05). There was no significant difference between the two groups in terms of blood loss, postoperative feeding time and postoperative hospital stay (P > 0.05). (3) There was no significant difference between the two groups in postoperative and ostomy-related complication S (P > 0.05). (4) The observation group was better than the control group in terms of postoperative pain score and postoperative first exhaust time, indicating statistical significance (P < 0.05). There were no significant differences in surgical time, abdominal adhesion, blood loss, postoperative hospital stay and postoperative complications between the two groups (P > 0.05). Conclusion The patients undergoing laparoscopic rectal low anterior resection who needs prophylactic ileostomy using right lower abdominal specimen extraction incision can improve the appearance of the incision, shorten operation time, reduce postoperative pain of the patients but does not increase postoperative complications and the difficulty of ileostomy closure. It is safe and feasible, which worthy for clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the third most common cancer and the second highest cause of cancer mortality in Australia. Despite advances in colorectal surgery, anastomotic leak still occurs in low‐risk patients and is a substantial cause of morbidity and mortality. Many operative strategies are used to assess anastomotic integrity such as an air leak test or intraoperative flexible sigmoidoscopy, however an objective anastomotic checklist is yet to be developed and studied. This study aims to develop a photodocumentary anastomotic specific checklist and determine its feasibility for implementation. Methods: Patients undergoing left sided colorectal resections with primary anastomosis without a de‐functioning ileostomy were prospectively included between May 2021 and December 2022. A photographic checklist assessing anastomotic perfusion, integrity via either air test or endoscopic image, evidence of complete operative doughnut specimens and the assessment of tension was implemented. The feasibility of an anastomotic checklist was externally validated by four independent colorectal surgeons from Australia, New Zealand and United States of America. Results: The anastomotic checklist was completed in 44 patients. Mean age was 62 years, with 43% male and mean BMI 28. Operations included high anterior resection (45%), low anterior resection (18%), ultra‐low anterior resection (20%), reversal of Hartmann's (11%). Median length of stay was 4 days. Complications post operatively were documented in six patients with anastomotic leak in 2% and wound infection in 6.8%. Intraclass correlation coefficients were poor amongst all reviewers with air leak and tension having no inter‐reviewer correlation. Conclusion: The introduction of an anastomotic checklist was a feasible tool to systematically assess and document anastomotic integrity. Unfortunately, with the small sample size there was significant discrepancy in inter‐observer variability, and this led to poor correlation regarding which patients were typically high risk requiring a temporary ileostomy. Larger studies on the implementation of an anastomotic checklist will be needed to evaluate if it is an inherently feasible approach and if there is an effect on anastomotic leak. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement. Method: This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a largerdiameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%). Results: TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred. Conclusions: The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed. [ABSTRACT FROM AUTHOR]

Background: Most people with a stoma worry about leakage, and a quarter experience leakage of stomal effluent outside the baseplate on a monthly basis. Leakage has additional physical and psychosocial consequences, for instance, peristomal skin complications, feeling unable to cope, and self-isolation. Method: An interventional, single-arm, multi-centre study was undertaken in the United Kingdom to evaluate a novel digital leakage notification system for ostomy care, including a support service (=test product) for 12 weeks in patients with a recent stoma formation (≤9 months). Patients completed questionnaires at baseline and after 4, 6, 8, 10, and 12 weeks, evaluating leakage episodes, Ostomy Leak Impact (tool containing three domains), and patient self-management (by PAM-13). Additionally, mental well-being (by WHO-5) and health-related quality of life (QoL) (by EQ-5D-5L) were assessed. Outcomes between baseline and final evaluation were compared by generalised linear and linear mixed models. Results: 92 patients (ITT population) with a mean age of 49.4 years (range 18–81 years) were recruited. Of these, 80% had an ileostomy, and 53% were female. After 12 weeks of using the test product, a significant decrease in mean episodes of leakage outside the baseplate (1.57 versus 0.93, p < 0.046) was observed. Ostomy Leak Impact scores improved across all three domains (p < 0.001), indicating less embarrassment, increased engagement in social activities, and increased control. Patient self-management also improved significantly (PAM-13 score: ∆6.6, p < 0.001), as did the WHO-5 well-being index (∆8.0, p < 0.001). Lastly, EQ-5D-5L profile scores tended to improve (p = 0.075). Conclusions: A new digital leakage notification system demonstrated strong improvements to patients' stoma self-care, mental well-being, and QoL. Registration number on ClinicalTrials.gov: NCT05135754. [ABSTRACT FROM AUTHOR]

Subtotal colectomy is often performed on patients with synchronous colorectal cancer. However, compared with colorectal anastomosis, ileorectal anastomosis with subtotal colectomy is more likely to result in bowel dysfunction. The Deloyers procedure is useful in preserving bowel function in a patient with synchronous colorectal cancer. An 87‐year‐old man presented with bloody stool. Colonoscopy showed masses in the cecum, transverse colon, rectosigmoid, and rectum above the peritoneal reflection. Computed tomography scan revealed no evidence of regional lymph node swelling and distant metastasis. Therefore, robot‐assisted low anterior resection, laparoscopic extended left hemicolectomy, laparoscopic cecal resection, and diverting ileostomy were performed. The patient was discharged from the hospital without complications. There was no recurrence, and the patient did not have complaints such as urgency, fecal incontinence, and excretory dysfunction. Hence, minimally invasive coloproctectomy using the Deloyers procedure can be safe and useful in preserving postoperative bowel function in elderly patients. [ABSTRACT FROM AUTHOR]

Background: This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery. Methods: PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus were searched through November 2023. Main outcomes were efficacy and safety of mesh. Efficacy was assessed by the rates of clinically and radiologically detected hernias and the need for surgical repair, while safety was assessed by the rates of overall complications. Results: 19 systematic reviews were assessed; 7 included only patients with end colostomy and 12 included patients with either ileostomy or colostomy. The use of mesh significantly reduced the risk of clinically detected parastomal hernias in all reviews except one. Seven reviews reported a significantly lower risk of radiologically detected parastomal hernias with the use of mesh. The pooled hazards ratio of clinically detected and radiologically detected parastomal hernias was 0.33 (95%CI: 0.26–0.41) and 0.55 (95%CI: 0.45–0.68), respectively. Six reviews reported a significant reduction in the need for surgical repair when a mesh was used whereas six reviews found a similar need for hernia repair. The pooled hazards ratio for surgical hernia repair was 0.46 (95%CI: 0.35–0.62). Eight reviews reported similar complications in the two groups. The pooled hazard ratio of complications was 0.81 (95%CI: 0.66-1). Conclusions: The use of surgical mesh is likely effective and safe in the prevention of parastomal hernias without an increased risk of overall complications. [ABSTRACT FROM AUTHOR]

Hepatic mobilization is essential in debulking surgery for resecting diaphragmatic lesions in advanced ovarian cancer. However, hepatic mobilization potentially induces postoperative portal vein thrombosis and hepatic infarction. No reports exist regarding these postoperative complications of gynecological surgeries. Thus, we reported a case of portal vein thrombosis and hepatic infarction after ovarian cancer surgery with upper abdominal surgery. The 51‐year‐old female patient who had been diagnosed with advanced ovarian and early endometrial cancer underwent primary debulking surgery. Ultimately, she underwent the following surgical procedures: a hysterectomy, bilateral salpingo‐oophorectomy, total parietal peritonectomy, low anterior resection, ileostomy, and appendicectomy. The hepatic enzymatic and D‐dimer levels were elevated, postoperatively. Contrast‐enhanced computed tomography revealed portal vein thrombosis and an infarction of the hepatic S3 region. The portal vein thrombosis resolved post‐administration of unfractionated heparin. The hepatic infarction improved. Meticulous intra‐ and postoperative management should encompass the deliberation of the potential risk of these postoperative complications. [ABSTRACT FROM AUTHOR]

Background: A significant number of patients experience complications of the Kock pouch (KP) warranting revision or excision. This systematic review aimed to assess the pooled prevalence and risk factors for complications and failure of the KP. Methods: This Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review (CRD42023416961) searched PubMed, Scopus, and Web of Science for studies on adult patients with Kock continent ileostomy published after the year 2000. The main outcome measures were revision, complications, and failure of the KP. Risk factors for complications and failure were assessed using a meta-regression analysis. Risk of bias was assessed using the ROBINS-1 tool. A proportional meta-analysis of the main outcomes was performed. Results: A total of 19 studies (2042 patients) were included. The weighted mean prevalence of complications was 60.4% [95% confidence interval (CI): 46.1–74.7%], of pouch revision was 46.6% (95% CI: 38.5–54.7%), and of pouch failure was 12.9% (95% CI: 9.3–16.4%). Studies conducted in the USA had a mean failure prevalence of 12.6% (95% CI: 6.2–18.9%) comparable to studies conducted in Europe (11.1%; 95% CI: 7.5–14.7%). Factors associated with higher complications were increased body mass index (BMI) and previous ileoanal pouch anastomosis (IPAA); however, these factors were not associated with increased pouch failure. Conclusions: The KP is a highly complex operation as shown by a pooled complication prevalence of 60%, and thus, it should be only performed by experienced surgeons. Despite the high prevalence of complications and need for revisional surgery, patients are keen to preserve their KP. Increased BMI and a previous failed IPAA are risk factors for pouch complications, but not failure. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch‐anal anastomosis (IPAA).This was a retrospective study including all patients operated (2015–2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health‐related QoL was evaluated with the SF‐36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL.Among 179 eligible patients, 150 responded (84%): S− (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S− and S+ group, respectively: 18 [12.5–31] versus 18 [11–31], p = 0.48 for LARS; 9 [7–11] versus 9 [7–12], p = 0.23 for Wexner's score; 6 [3–13] versus 8 [5–11], p = 0.22 for Öresland's score, 6 [3–13] versus 6.8 [4–12], p = 0.174 for PFS score, and 40 [35–45] versus 46 [42–51], p = 0.045 for IPSS score. The SF‐36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001).DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients. [ABSTRACT FROM AUTHOR]

Background: Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications. Methods: The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board. Results: Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%). Conclusions: This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one‐stage operation.A single‐center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S‐ICR group‐patients who underwent two‐stage ICR. 1S‐ICR group‐patients who underwent one‐stage ICR.The cohort included 191 patients (mean age 33.4, range 15–70), with 40 and 151 patients in the 2S‐ICR and 1S‐ICR groups, respectively. The 2S‐ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre‐operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre‐operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S‐ICR had a longer post‐operative length‐of‐stay (14 vs. 6 days, P < 0.001) and higher rates of 30‐day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow‐up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.Two‐stage ICR with a temporary ileostomy does not change long‐term CD recurrence rates compared with one‐stage ICR. [ABSTRACT FROM AUTHOR]

Introduction: Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit. Methods: In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the "Hydration follow-up scale" to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management. Results: In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5%, a significant reduction in dehydration-related readmissions was observed in the bundle group compared to the pre-bundle group (2% vs. 22%, p = 0.002). Univariate analysis identified high stoma output (> 800 ml/24 h) (p < 0.001), chronic renal failure (CRF) (p = 0.01), postoperative ileus (p = 0.03), higher ASA status (p = 0.04), extended hospital stays (p = 0.03), and small bowel resections (especially in J-pouch patients) (p < 0.001) as significant predictors of readmission. Multivariate analysis revealed that the mean ileostomy output before discharge was the sole significant predictor of dehydration-related readmission (OR 1.01), with an optimal cutoff of 877.5 ml/day identified with an area under the curve (AUC) of 0.947, demonstrating high sensitivity (92.3%) and specificity (86.8%) in predicting readmission risk. Conclusion: The Prospective Ileostomy-induced Dehydration Prevention Bundle Project significantly reduced readmission rates after colorectal surgery. [ABSTRACT FROM AUTHOR]

Purpose: Diverting Loop Ileostomy (DLI) with intraoperative colonic lavage has emerged as a potential alternative to Total Abdominal Colectomy (TAC) for treating Fulminant Clostridium Difficile Colitis (FCDC). This study aims to provide an updated review comparing DLI with TAC in managing FCDC. Methods: A systematic literature search was conducted using PubMed, Scopus, and Embase to identify retrospective and prospective studies comparing DLI with TAC for fulminant CDC treatment. A meta-analysis was performed to evaluate postoperative mortality rates and complications using R Studio version 4.4.1, calculating odds ratios (ORs) with 95% confidence intervals via the Mantel-Haenszel method. Heterogeneity was assessed using the Cochrane Q test and I2 statistics. Results: Our search yielded 228 relevant citations, of which 7 studies with a total of 7,048 patients were included. Of these, 1,728 underwent DLI. The mean age was 63.33 years in the DLI group and 65.74 years in the TAC group. Compared to TAC, DLI had significantly lower postoperative mortality (OR 0.75; 95% CI 0.62–0.90; P = 0.002; I2 = 34%). Trial sequential analysis for postoperative mortality rates showed the benefit of DLI with a sufficiently powered sample. The DLI group also had a significantly higher rate of ostomy reversal (OR 5.68; 95% CI 2.35–13.72; P < 0.001; I2 = 36%). Postoperative complications, such as thromboembolic events, surgical site infections, urinary tract infections, renal failure, and pneumonia, were not significantly different. Conclusion: DLI shows a lower postoperative mortality rate and higher ostomy reversal rate than TAC, suggesting it as a potential organ-preserving, minimally invasive alternative. Further high-quality studies and trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

This document provides summaries of three different research studies related to colorectal disease. The first study aims to validate the effectiveness of a surgical technique called Transanal Transection and Single Stapled (TTSS) in reducing anastomotic leaks in patients with rectal cancer. The second study compares the efficacy of the Fistula Laser Closing (FiLaC™) technique with the Rectal Advancement Flap (RAF) technique in treating anal fistulas. The third study seeks to determine whether loop ileostomy or loop colostomy is superior as a protective stoma after anterior rectal resection. These studies are ongoing and will provide valuable insights into the treatment and management of colorectal diseases. [Extracted from the article]

Colouterine fistulas are generally seen in post-menopausal patients and present with abdominal pain and non-physiologic vaginal drainage. A history of uterine pathology or diverticulitis is generally lacking. Visualization of the passage of contrast from the gastrointestinal tract to the uterus is not necessary to make the diagnosis. We present the case of a 44-year-old woman successfully treated for a colouterine fistula due to sigmoid diverticulitis. A variety of surgical approaches have been described to correct this fistula, and a minimally invasive colectomy without ileostomy or colostomy appears to be a safe approach. [ABSTRACT FROM AUTHOR]

Loop ileostomy is commonly performed by colorectal and general surgeons to protect newly created large bowel anastomoses. The optimal timing for ileostomy closure remains debatable. Defining the timing associated with the best postoperative outcomes can significantly improve the clinical results for patients undergoing ileostomy closure. The LILEO study was a prospective multicenter cohort study conducted in Poland from October 2022 to December 2023. Full data analysis involved 159 patients from 19 surgical centers. Patients were categorized based on the timing of ileostomy reversal: early (<4 months), standard (4–6 months), and delayed (>6 months). Data on demographics, clinical characteristics, and perioperative outcomes were analyzed for each group separately and compared. No significant differences were observed in length of hospital stay (p = 0.22), overall postoperative complications (p = 0.43), or 30-day reoperation rates (p = 0.28) across the three groups. Additional analysis of Clavien–Dindo complication grades was performed and did not show significant differences in complication severity (p = 0.95), indicating that the timing of ileostomy closure does not significantly impact perioperative complications or hospital stay. Decisions on ileostomy reversal timing should be personalized and should consider individual clinical factors, including the type of adjuvant oncological treatment and the preventive measures performed for common postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to establish whether implement ation of the ERAS protocol has a beneficial effect postoperatively after ileostomy reversal. Introduction: Loop ileostomy is commonly performed during anterior rectal resection with total mesorectal excision to protect the newly created anastomosis. Ileostomy reversal is performed after rectal anastomoses are completely healed and can be associated with complications. The use of the ERAS protocol in elective colorectal surgery has been shown to significantly reduce the complication rate and length of hospital stay without an increased readmission rate. Methods: After PROSPERO registration (CRD42023449551), a systematic review of the following databases was carried out: MEDLINE/PubMed, EMBASE, Web of Science, and Scopus. This meta-analysis involved studies up to December 2023 without language restrictions. A random effects model meta-analysis was performed to assess complications, readmissions, and length of stay (LOS) in ileostomy reversal patients with and without ERAS protocol implementation. Results: Six articles were analyzed, and each study reported on the elements of the ERAS protocol. There was no significant difference between the ERAS and non-ERAS groups in terms of complications rate (OR = 0.98; 95%CI: 0.64–1.52; I2 = 0%). Postoperative ileus was the most prevalent adverse event in both groups. The readmission rate did not differ significantly between the groups (OR = 1.77; 95%CI: 0.85–3.50, I2 = 0%). In comparison to the control group, the LOS in the ERAS group was noticeably shorter (MD = −1.94; 95%CI: −3.38–−0.49; I2 = 77%). Conclusions: Following the ERAS protocol can result in a shorter LOS and does not increase complications or readmission rates in patients undergoing ileostomy reversal. Thus, the ERAS protocol is recommended for clinical implementation. [ABSTRACT FROM AUTHOR]

Background: Reversal of ileostomy is associated with morbidity including wound infection and prolonged wound healing. Negative pressure wound therapy (NPWT) has been shown to reduce time to wound healing by secondary intention. The aim of this study was to determine whether NPWT improved wound healing rates, compared with simple wound dressings, in patients undergoing reversal of ileostomy where the skin wound is closed with a purse‐string suture. Methods: This was a dual‐centre, open‐label, randomized controlled trial with two parallel intervention arms. Patients undergoing elective loop ileostomy reversal were randomized 1:1 to receive NPWT or simple wound dressings. The primary endpoint of the study was assessment of complete wound healing at day 42 post reversal of ileostomy and the secondary endpoints were patient‐reported wound cosmesis using a visual analogue scale and rates of surgical site infection (SSI). Results: The study was conducted from June 2018 to December 2021. The trial was approved by the local ethics committee. We enrolled 40 patients, 20 in each arm. One patient in each arm was lost to follow up. Nine patients (9/19, 47.36%) in the simple dressing group had wound healing vs. 13 patients (13/19, 68.42%) in the NPWT group (P = 0.188). There was no significant difference in patient‐ reported wound cosmesis or SSI. Conclusion: There was no difference in wound healing rates when comparing NPWT to simple wound dressings at early and late time points post reversal of ileostomy, where the skin wound was closed with a purse‐string suture. [ABSTRACT FROM AUTHOR]

Background: An intestinal stoma is an opening of the intestinal tract onto the abdominal wall constructed surgically or appearing inadvertently. Method: This study entitled "Complications of Intestinal Stoma: A Prospective Hospital Based Observational Study" is a prospective study and was conducted at Govt. Medical College, Srinagar in the Postgraduate Department of General Surgery over a period of eighteen months. Postoperative complications were noted Results: In our study, a total of 56 patients were included in which stomas were made for 28 (50%) benign conditions and 28 (50%) malignant conditions. Out of 28 complications in ileostomy procedures, most common complication was peristomal skin excoriation followed by electrolyte disturbance. Out of 9 complications in colostomy procedures, most common complications seen were stoma retraction and peristomal abscess. Conclusion: Our study found, peristomal skin excoriation and electrolyte imbalance as the most common post-operative complications in intestinal stomas. Emergency procedures increased the risk of complications in intestinal stomas and Stoma related complications resulted in longer hospital stay. [ABSTRACT FROM AUTHOR]

Background: Needlescopic surgery is a minimally invasive procedure that uses thin trocars with 3-mm diameter. We used Turnbull–Cutait pull-through and delayed coloanal anastomosis in needlescopic surgery to avoid diverting ileostomy during intersphincteric resection for low rectal cancer. In this study, we aim to assess the diverting ileostomy avoidance rate and technical safety of this "minimal skin incision and no stoma" procedure. Methods: This single-center retrospective study was conducted at the Cancer Institute Hospital, a tertiary referral center in Japan. Between January 2017 and December 2020, 11 patients underwent needlescopic intersphincteric resection with diverting ileostomy (NSI group), and 19 patients underwent needlescopic intersphincteric resection with delayed coloanal anastomosis (NSD group) for low rectal cancer. Data regarding patient backgrounds and short-term outcomes, including diverting ileostomy avoidance rate, pathological results, and postoperative defecatory function, were compared between the groups. Results: There were no statistically significant differences between the NSI and NSD groups with respect to patient background, operation time (239 min versus 220 min, p = 0.68), estimated blood loss (45 g versus 25 g, p = 0.29), R0 resection rate (100% versus 100%, p = 1.00), and length of postoperative hospital stay (16 days versus 17 days, p = 0.42). The diverting ileostomy avoidance rate was 94.4% in the NSD group. The LARS and Wexner scores 12 months after surgery were not significantly different between the two groups. Conclusions: Needlescopic intersphincteric resection and delayed coloanal anastomosis can be safely performed in selected patients with a high rate of diverting ileostomy avoidance and comparable short-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks. Methods: In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation. Results: In total, 168 patients were included. The median age of the patients was 38 years (IQR 27–51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41–61] vs. 37 [IQR 27–50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006). Conclusion: Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery. [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing enterocolitis (NEC) is a severe gastrointestinal problem that predominantly affects premature babies. The aim of this retrospective study was to evaluate patients who underwent surgical treatment for NEC and newborns who initially recovered with medical treatment but later developed a stricture and required surgery. Materials and Methods: We analyzed patients diagnosed with NEC between January 2009 and December 2021. Our study included patients who developed strictures after initially receiving medical treatment for NEC and subsequently underwent surgery. Demographic findings, mother's age, gestational weeks, birth weight, type of birth, postnatal age at NEC diagnosis, pH, first C-reactive protein (CRP) after onset of symptoms, leukocytes, hemoglobin and thrombocytes at the onset of NEC, echocardiography results, age at surgery, blood values before surgery, surgery technique, and outcomes were retrospectively analyzed. Results: Out of 40 patients who underwent primary surgery for NEC during the newborn period, 6 patients underwent surgery after initially receiving medical treatment. The female-to-male ratio was 15/31, and the median gestational age was 29 weeks. The median mother's age was 30 years, and the median birth weight was 1097g. The median postnatal age at NEC onset was 6 days (range 2-39). Echocardiography was performed in 43 patients, with 6 showing normal results and 28 having congenital cardiac anomalies. The median surgery day for patients who underwent primary surgery for NEC was 19 days (range 2-90). Ileostomy was performed in 26 patients, colostomy in 8 patients, and ileostomy plus colostomy in 1 patient. Surgery was conducted in 6 out of 392 patients who developed post- NEC strictures after initial medical treatment. Comparison between post-NEC stricture patients and those who underwent surgery for NEC revealed significant differences only in the age at surgery (p=0.024). Conclusion: Patients who clinically experience NEC should be considered for the development of strictures, especially in cases of prolonged feeding intolerance, distention, gastric residual, and rectal bleeding. Therefore, close follow-up and multidisciplinary approaches are crucial, and contrast barium radiography should be the initial diagnostic step. [ABSTRACT FROM AUTHOR]

Background: Despite widespread adoption of robotic-assisted surgery (RAS) in rectal cancer resection, there remains limited knowledge of its clinical advantage over laparoscopic (Lap) and open (OS) surgery. We aimed to compare clinical outcomes of RAS with Lap and OS for rectal cancer. Methods: We identified all patients aged ≥ 18 years who had elective rectal cancer resection requiring temporary or permanent stoma formation from 1/2013 to 12/2020 from the PINC AI™ Healthcare Database. We completed multivariable logistic regression analysis accounting for hospital clustering to compare ileostomy formation between surgical approaches. Next, we built inverse probability of treatment-weighted analyses to compare outcomes for ileostomy and permanent colostomy separately. Outcomes included postoperative complications, in-hospital mortality, discharge to home, reoperation, and 30-day readmission. Results: A total of 12,787 patients (OS: 5599 [43.8%]; Lap: 2872 [22.5%]; RAS: 4316 [33.7%]) underwent elective rectal cancer resection. Compared to OS, patients who had Lap (OR 1.29, p < 0.001) or RAS (OR 1.53, p < 0.001) were more likely to have an ileostomy rather than permanent colostomy. In those with ileostomy, RAS was associated with fewer ileus (OR 0.71, p < 0.001) and less bleeding (OR 0.50, p < 0.001) compared to Lap. In addition, RAS was associated with lower anastomotic leak (OR 0.25, p < 0.001), less bleeding (OR 0.51, p < 0.001), and fewer blood transfusions (OR 0.70, p = 0.022) when compared to OS. In those patients who had permanent colostomy formation, RAS was associated with fewer ileus (OR 0.72, p < 0.001), less bleeding (OR 0.78, p = 0.021), lower 30-day reoperation (OR 0.49, p < 0.001), and higher discharge to home (OR 1.26, p = 0.013) than Lap, as well as OS. Conclusion: Rectal cancer patients treated with RAS were more likely to have an ileostomy rather than a permanent colostomy and more enhanced recovery compared to Lap and OS. [ABSTRACT FROM AUTHOR]

Background: The objective of this report is to identify and characterize cases of fibrosing colonopathy, a rare and underrecognized adverse event, associated with cysteamine delayed-release (DR) in patients with nephropathic cystinosis. Methods: We searched the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the medical literature for postmarketing reports of fibrosing colonopathy associated with cysteamine through August 2, 2023. Results: We identified four cases of fibrosing colonopathy reported with the use of cysteamine DR. The time to onset ranged from 12 to 31 months. In one case, the patient required surgery to have a resection of a section of the strictured colon and a diverting ileostomy. Fibrosing colonopathy was diagnosed by histopathology in two of the cases. Conclusions: Our case series identified the risk of fibrosing colonopathy in patients taking cysteamine DR and prompted regulatory action by the FDA. As outlined in changes to the U.S. prescribing information for cysteamine DR, healthcare professionals should be aware of the potential risk of fibrosing colonopathy with cysteamine DR, especially as symptoms can be non-specific leading to misdiagnosis or delayed diagnosis. If the diagnosis of fibrosing colonopathy is confirmed, consideration should be given to permanently discontinuing cysteamine DR and switching to cysteamine immediate-release treatment. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic portal venous gas is an extremely rare symptom of gas accumulation in the portal venous system. This disease has an acute onset, a rapid progression, and an extremely high mortality rate. This report describes a patient with mesenteric and hepatic portal venous gas caused by intestinal microbiota disturbance–induced gut-derived infection after ileostomy. The patient recovered and was discharged after conservative treatment. Nursing management of patients with mesenteric and hepatic portal venous gas is discussed. Clinical Findings: A 76-year-old patient developed septic shock, paralytic intestinal obstruction, and mesenteric and hepatic portal venous gas after undergoing ileostomy. Diagnosis: Mesenteric and hepatic portal venous gas was diagnosed on the basis of abdominal contrast-enhanced computed tomography findings. Interventions: The treatment plan included early control of infection, early identification and nursing care of gut-derived infection caused by intestinal microbiota disturbance, early identification of paralytic intestinal obstruction, relief of intestinal obstruction and prevention of intestinal ischemia, and early nutritional support. Outcomes: On day 18 of hospitalization, the patient was transferred to the general ward and resumed eating, producing gas, and defecating. His abdominal signs and infection indicator levels were normal. On day 27, the patient was discharged home. Conclusion: This case provides an in-depth understanding of the care of patients with mesenteric and hepatic portal venous gas and emphasizes the important role of bedside nurses in evaluating and treating these patients. This report may help nurses care for similar patients. [ABSTRACT FROM AUTHOR]

Stoma patients require continuous support throughout their entire journey with a stoma. Although many Stoma Care Services across the UK offer patient follow-up pathways, there is not one unified pathway. Patients may not be prepared for life with a stoma because, depending on their stoma type, they will have specific needs, and if patients and healthcare professionals are not prepared to manage these stoma-specific needs, complications and hospital readmissions may occur, worsening patients' outcomes and quality of life. Ileostomy patients are known to be more likely to experience complications, including hospital readmissions, and therefore, special care should be taken when preparing these patients for life with a stoma. They should be informed and educated to prevent complications, and if this is not always possible, thye should at least be able to recognise and manage early signs and symptoms of complications. This will empower them to self-care and know when to seek medical attention. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal stomas are one of the most common parts of pediatric surgical care, and complications arising from it have significant impact on overall patient outcomes. However, data on major complications in low–middle-income countries remain limited. This pilot retrospective cohort study aimed to investigate the prevalence, types, and management of major stoma complications in pediatric patients at a tertiary government hospital in the Philippines. Methods: Medical records of pediatric patients with major stoma complications classified as Clavien–Dindo III–V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications. Results: Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung’s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed. Conclusions: This study provides useful insights into stoma complications in pediatric patients in a low–middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications. [ABSTRACT FROM AUTHOR]

Background: For patients with rectal cancer, the utilization of temporary ileostomy (TI) has proven effective in minimizing the occurrence of severe complications post-surgery, such as anastomotic leaks; however, some patients are unable to reverse in time or even develop a permanent stoma (PS). We aimed to determine the preoperative predictors associated with TS failure and develop and validate appropriate predictive models to improve patients' quality of life. Methods: This research included 403 patients with rectal cancer who underwent temporary ileostomies between January 2017 and December 2021. All patients were randomly divided into either the developmental (70%) or validation (30%) group. The independent risk factors for PS were determined using univariate and multivariate logistic regression analyses. Subsequently, a nomogram was constructed, and the prediction probability was estimated by calculating the area under the curve (AUC) using receiver operating characteristic (ROC) analysis. A calibration plot was used to evaluate the nomogram calibration. Results: Of the 403 enrolled patients, 282 were randomized into the developmental group, 121 into the validation group, and 58 (14.39%) had a PS. The development group consisted of 282 patients, of whom 39 (13.81%) had a PS. The validation group consisted of 121 patients, of whom, 19 (15.70%) had a PS; 37 related factors were analyzed in the study. Multivariate logistic regression analysis demonstrated significant associations between the occurrence of PS and various factors in this patient cohort, including tumor location (OR = 6.631, P = 0.005), tumor markers (OR = 2.309, P = 0.035), American Society of Anesthesiologists (ASA) score (OR = 4.784, P = 0.004), T4 stage (OR = 2.880, P = 0.036), lymph node metastasis (OR = 4.566, P = 0.001), and distant metastasis (OR = 4.478, P = 0.036). Furthermore, a preoperative nomogram was constructed based on these data and subsequently validated in an independent validation group. Conclusion: We identified six independent preoperative risk factors associated with PS following rectal cancer resection and developed a validated nomogram with an area under the ROC curve of 0.7758, which can assist surgeons in formulating better surgical options, such as colostomy, for patients at high risk of PS. [ABSTRACT FROM AUTHOR]

Purpose: Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. Methods: UK paediatric surgery centres were invited to recruit patients aged 6–16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. Results: Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1–17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). Conclusion: Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma. [ABSTRACT FROM AUTHOR]

Background: In this study, we aimed to identify the risk factors in patients with rectal anastomotic re-leakage and develop a prediction model to predict the probability of rectal anastomotic re-leakage after stoma closure. Methods: This study was a single-center retrospective analysis of patients with rectal cancer who underwent surgery between January 2010 and December 2020. Among 3225 patients who underwent Total or Partial Mesorectal Excision (TME/PME) surgery for rectal cancer, 129 who experienced anastomotic leakage following stoma closure were enrolled. Risk factors for rectal anastomotic re-leakage were analyzed, and a prediction model was established for rectal anastomotic re-leakage. Results: Anastomotic re-leakage after stoma closure developed in 13.2% (17/129) of patients. Multivariable analysis revealed that neoadjuvant chemoradiotherapy (odds ratio, 4.07; 95% confidence interval, 1.17–14.21; p = 0.03), blood loss > 50 ml (odds ratio, 4.52; 95% confidence interval, 1.31–15.63; p = 0.02), and intersphincteric resection (intersphincteric resection vs. low anterior resection: odds ratio, 6.85; 95% confidence interval, 2.01–23.36; p = 0.002) were independent risk factors for anastomotic re-leakage. A nomogram was constructed to predict the probability of anastomotic re-leakage, with an area under the receiver operating characteristic curve of 0.828 in the cohort. Predictive results correlated with the actual results according to the calibration curve. Conclusions: Neoadjuvant chemoradiotherapy, blood loss > 50 ml, and intersphincteric resection are independent risk factors for anastomotic re-leakage following stoma closure. The nomogram can help surgeons identify patients at a higher risk of rectal anastomotic re-leakage. [ABSTRACT FROM AUTHOR]

Background: We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. Methods: A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. Results: Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). Conclusions: Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center. [ABSTRACT FROM AUTHOR]

Background. To examine the latest guidelines for the diagnostics and treatment of acute diverticulitis and to formulate recommendations for the diagnostics and management of acute diverticulitis based on them. Research material and methods. A selection of the latest guidelines for the diagnostics and treatment of acute diverticulitis in the PubMed medical database in English and German, during 2012–2024 period, was performed based on the requirements criteria of the PRISMA literature review and the PICO data selection me thod. Key words used in the search: “acute”, “diverticulitis”, “guidelines”, “diverticulosis”, “diagnostics”, “treatment”. Results. Although different guidelines disagree on the order of UG and CT with intravenous contrast, 6/6 guidelines agree on UG and 7/7 on the appropriateness of CT with contrast in the diagnostics of acute diverticulitis. 7/8 guidelines agree that routine antibiotic therapy is unwarranted in the treatment of uncomplicated diverticulitis. 6/6 guideline authors agree on the treatment of small abscesses with antibiotic therapy, and 7/7 on the treatment of large abscesses with antibiotic therapy and drainage. 5/7 guidelines support Hinchey III antibiotic therapy and primary anastomosis treatment with/without preventive ileostomy. Hinchey IV recommendations for tactics in the treatment of acute diverticulitis are distinguished. Planned surgery after a complicated episode of diverticulitis is routinely recommended by 3/7 guidelines, 2/7 guidelines – when strictures or fistulas are formed, 2/7 – the decision should be made based on the patient’s condition. Most guidelines do not recommend conservative secondary prophylaxis after an acute episode of diverticulitis. Conclusions. UG and CT with intravenous contrast are the methods of first choice for the diagnostics of acute diverticulitis. In case of uncomplicated diverticulitis, routine antibiotic therapy is not recommended, drainage is used only for large abscesses, and antibiotics for both small and large abscesses. Primary anastomosis with/without preventive ileostomy is preferred for Hinchey III acute diverticulitis. Recommendations for the treatment tactics of Hinchey stage IV AD differ in the literature. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after surgery for left colonic diverticulitis. Method: This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage. Results: Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted. Conclusion: AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery. [ABSTRACT FROM AUTHOR]

Introduction: Loop ileostomy reversal (LIR) procedure is still associated with a relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. SSI leads to prolonged hospital stays, delays the adjuvant therapy, and increases hospital costs. Aim: The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure. Material and methods: A single-center retrospective analysis was conducted in a tertiary reference center. Finally, 65 patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled in the study. Data were collected retrospectively based on the available medical charts. The study group comprised 23 women (35%) and 42 men (65%) with a mean age of 48.9 ±14.5 years and a mean body mass index of 24.3 ±4.9 kg/m². The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n = 42; 64.6%). Results: The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which influenced e.g. hospitalization after surgery, the need for antibiotic therapy, or C-reactive protein (CRP) values. Nine patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI, hospital stay exceeded 13 days compared to almost 6 days in the group without SSI (P = 0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (P = 0.01). The type of intestinal anastomosis had a significant impact on the operative time (P = 0.0011) and the time of hospital stay after surgery (P = 0.04). Conclusions: Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor increasing the risk of other postoperative complications and significantly increasing the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities which make patients more likely to develop SSI, CRP increase, or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment. [ABSTRACT FROM AUTHOR]

The modified Graham patch repair is a well-established technique for management of perforating foregut injuries, often learned by surgeons during general surgery training. There is, however, little to no data regarding the utilization of this technique for perforation of the distal midgut or in the re-operative field. We present two cases of midgut anastomotic complications successfully managed with modified graham patch repair at our institution. The first case is a 79-year-old female who underwent an emergent right hemicolectomy at an outside institution for management of an iatrogenic perforation during endoscopic polypectomy. Over the course of two years she underwent numerous abdominal operations, due to various complications, ultimately resulting in multiple resections and end ileostomy creation. She then had her ileostomy reversed by laparoscopic single incision (SILS) technique at our institution. This was also complicated by anastomotic leak. Intraoperatively, adequate mobilization of the anastomosis for resection was deemed not safe due to dense fibrosis and adhesions in the re-operative field; therefore, she underwent a SILS modified Graham patch repair of an ileocolic anastomotic defect with diverting loop ileostomy. Post-operatively, she had no radiographic evidence of leak from the repaired anastomosis, which facilitated successful loop ileostomy reversal five months later. Our second case is a 64-year-old male referred to our institution for management of his stage IV colon cancer. He underwent an open right hemicolectomy and hepatic metastectomy, which was complicated by anastomotic leak. The small defect was repaired via a SILS modified Graham patch technique. Five months postoperatively, he had neither radiographic nor endoscopic evidence of a leak; therefore, he successfully underwent ileostomy reversal without complication. We encourage further investigation and reporting of the role of the modified graham patch repair in management of midgut anastomotic complications, particularly when resection and re-anastomosis is unsafe due to a hostile re-operative field. [ABSTRACT FROM AUTHOR]

(1) Background: In recent years, there has been a change in practice for diverting stomas in rectal cancer surgery, shifting from routine diverting stomas to a more selective approach. Studies suggest that the benefits of temporary ileostomies do not live up to their risks, such as high-output stomas, stoma dysfunction, and reoperation. (2) Methods: All rectal cancer patients treated with a robotic resection in a single tertiary colorectal centre in the UK from 2013 to 2021 were analysed. In 2015, our unit made a shift to a more selective approach to temporary diverting ileostomies. The cohort was divided into a routine diversion group treated before 2015 and a selective diversion group treated after 2015. Both groups were analysed and compared for short-term outcomes and morbidities. (3) Results: In group A, 63/70 patients (90%) had a diverting stoma compared to 98/135 patients (72.6%) in group B (p = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, p = 0.312) or other complications (p = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, p = 0.312) or reoperation (3.8% vs. 2.6%, p = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% (p = 1.000) of patients were stoma-free. One major reason for the delay in stoma reversal was the COVID-19 pandemic, which only occurred in group B (0% vs. 22%, p = 0.054). (4) Conclusions: A more selective approach to diverting stomas for robotic rectal cancer patients does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours. [ABSTRACT FROM AUTHOR]

In this study, we introduce a novel method for stoma closure, aiming to reduce wound infection rates. This method involves creating the common channel of both limbs of a loop stoma extracorporeally, which is particularly beneficial during laparoscopic stoma closure surgery by potentially avoiding contamination of the wound. We applied this technique in 23 patients undergoing laparoscopic stoma reversal surgery, comprising both loop colostomy and ileostomy cases. Notably, postoperative outcomes were promising: only two patients experienced postoperative ileus, and importantly, there were no instances of wound infection. These findings suggest that our laparoscopic stoma reversal surgery approach is not only safe and feasible but also offers a significant advantage in reducing wound infection rates. [ABSTRACT FROM AUTHOR]

Background: The situation for patients with ostomy can be challenging, probably more in a resource‐constrained environment. Our objective was to evaluate quality of life (QoL) (using EQ5D‐5L) and stoma‐specific QoL (using Stoma QoL) in a high‐ and low‐income setting. Methods: In this cross‐sectional study from the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, and South General Hospital (SGH), Stockholm, patients with a permanent or temporary ostomy at TASH (EthioPerm), (EthioTemp), and patients with ostomy at SGH (SweSto) were included in October 2022–January 2023. Results: Patients N = 66 were included in groups: EthioPerm N = 28, EthioTemp N = 17, and SweSto N = 21. In EthioTemp, 88% used homemade stoma bags. Although morbidity related to the nipple itself was similar in the groups, the overall score from Stoma QoL was significantly lower in EthioPerm, 48/100 than in SweSto, 74/100. Scores were significantly lower for pouch‐related problems and social interactions in Ethiopian patients. In EthioPerm, 71% of the patients worried that they were a burden to the people close to them compared to 14% in SweSto (p < 0.001). Leakage was over four times more common in EthioPerm than in SweSto. Mean overall EQ5D‐5L score was 18 percentage points lower than the national mean score in EthioPerm and 2 percentage points lower in SweSto. Conclusion: QoL was more affected in the Ethiopian study participants than in the Swedish, even when commercial stoma bags were available. The largest problems were leakage, embarrassment with social interactions, and pouch‐related problems. Trial registration: NCT05970458 Clinicaltrials.gov, https://clinicaltrials.gov/study/NCT05970458?locStr=Ethiopia&country=Ethiopia&distance=50&cond=Stoma%20Ileostomy&rank=1. [ABSTRACT FROM AUTHOR]

Introduction. Protective diverting ileostomy is performed with the aim of protecting the intestinal anastomosis after a colorectal resection. This intestinal resection is the most frequently performed extended procedure in patients with ovarian cancer, in order to achieve complete cytoreduction. Knowing the indications, use, techniques and complications of ileostomies is important for multidisciplinary groups that treat these patients. Methods. We conducted a search in PubMed via Medline and an updated narrative review of the main findings on the indications, surgical techniques, complications and use of diverting ileostomy in ovarian cancer. Results. The use of diverting ileostomy in ovarian cancer remains a controversial issue. To date, neither diverting ileostomy nor ghost ileostomy have been associated with a reduction in the incidence of anastomotic leak, but both techniques could decrease its severity. Conclusion. The diverting ileostomy in ovarian cancer is used to protect a distal anastomosis after intestinal resection, in case of anastomotic leak if a previous ostomy has not been performed or in case of intestinal obstruction. [ABSTRACT FROM AUTHOR]

Purpose: Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a reconstructive option. In this context, we aimed to compare both techniques. Methods: PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 >25% considered significant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statistical Computing). Registered number CRD42024509963. Results: One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I2 = 0%). There were no differences in postoperative complications classified as Clavien-Dindo ≥ IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I2 = 34%). Conclusion: TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer. [ABSTRACT FROM AUTHOR]

Background: For high-risk patients receiving right-sided colectomy, stoma formation is a safety strategy. Options are anastomosis with loop ileostomy, end ileostomy, or split stoma. The aim is to compare the outcome of these three options. Methods: This retrospective cohort study included all patients who underwent right sided colectomy and stoma formation between January 2008 and December 2021 at two tertial referral centers in Switzerland. The primary outcome was the stoma associated complication rate within one year. Results: A total of 116 patients were included. A total of 20 patients (17%) underwent primary anastomosis with loop ileostomy (PA group), 29 (25%) received an end ileostomy (ES group) and 67 (58%) received a split stoma (SS group). Stoma associated complication rate was 43% (n = 21) in PA and in ES group and 50% (n = 34) in SS group (n.s.). A total of 30% (n = 6) of patients in PA group needed reoperations, whereas 59% (n = 17) in ES and 58% (n = 39) in SS group had reoperations (P = 0.07). Wound infections occurred in 15% (n = 3) in PA, in 10% (n = 3) in ES, and in 30% (n = 20) in SS group (P = 0.08). A total of 13 patients (65%) in PA, 7 (24%) in ES, and 29 (43%) in SS group achieved stoma closure (P = 0.02). A total of 5 patients (38%) in PA group, 2 (15%) in ES, and 22 patients (67%) in SS group had a stoma-associated rehospitalization (P < 0.01). Conclusion: Primary anastomosis and loop ileostomy may be an option for selected patients. Patients with end ileostomies have fewer stoma-related readmissions than those with a split stoma, but they have a lower rate of stoma closure. Clinical trial registration: Trial not registered. [ABSTRACT FROM AUTHOR]

The common causes of rectovaginal fistula include obstetric trauma, local infection, and rectal surgery, while rectovaginal fistula following hemorrhoid surgery is extremely rare. Rectovaginal fistulae (RVF) rarely heal without intervention. Surgical treatment is usually performed, but the optimal surgical method remains controversial. The patient was a 37-year-old woman who was transferred to our hospital due to an unsuccessful repair of a rectovaginal fistula after hemorrhoid surgery in a local hospital. The next day after admission, she had prophylactic ileostomy, fecal diversion and combined treatment with cephalosporin antibiotic to create a clean postoperative area. However, there was still fecal outflow from the vagina, with no significant reduction in excretion compared to previous surgery. Digestive endoscopy confirmed a failure of the repair for rectovaginal fistula. Therefore, preventive ileostomy was continued to reduce the accumulation of bacteria in the fistula and control the inflammation. After 8 weeks, the endoscopic fistula inflammation disappeared, and the condition of endoscopic surgery was considered to be mature. Subsequently, a new surgical method combining transanal endoscopy and transvaginal endoscopy was performed. After 12 weeks of surgery, a follow-up endoscopic examination showed that the fistula had been repaired and healed. During the 1-year follow-up, no serious complication was encountered, no recurrence was found, and the repair effect was satisfactory. In conclusion, a new technique combining transanal endoscopy and transvaginal endoscopy can effectively be used for the surgical repair of rectovaginal fistula after a hemorrhoid operation. [ABSTRACT FROM AUTHOR]

Aim: The standard treatment for low rectal cancer is preoperative chemoradiotherapy followed by surgery with low anterior resection with diverting ileostomy or abdominoperineal resection, both of which have significant long‐term effects on bowel and sexual function. Due to the high morbidity of surgery, there has been increasing interest in nonoperative management for low rectal cancer. The aim of this work is to conduct a pan‐Canadian Phase II trial assessing the safety of nonoperative management for low rectal cancer. Method: Patients with Stage II or III low rectal cancer completing chemoradiotherapy according to standard of care at participating centres will be assessed for complete clinical response 8–14 weeks following completion of chemoradiotherapy. Subjects achieving a clinical complete response will undergo active surveillance including endoscopy, imaging and bloodwork at regular intervals for 24 months. The primary outcome will be the rate of local regrowth 2 years after chemoradiotherapy. Nonoperative management will be considered safe (i.e. as effective as surgery to achieve local control) if the rate of local regrowth is ≤30% and surgical salvage is possible for all local regrowths. Secondary outcomes will include disease‐free and overall survival. Conclusion: The results will be highly clinically relevant, as it is expected that nonoperative management will be safe and lead to widespread adoption of nonoperative management in Canada. This change in practice has the potential to decrease the number of patients requiring surgery and the costs associated with surgery and long‐term surgical morbidity. [ABSTRACT FROM AUTHOR]

Aim: Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. Method: A national retrospective study (2013–2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. Results: A total of 1860 patients were included (age 45 ± 9 years; median follow‐up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny‐four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low‐volume hospital. Conclusion: We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low‐volume hospital. [ABSTRACT FROM AUTHOR]

Aim: Although proximal faecal diversion is standard of care to protect patients with high‐risk colorectal anastomoses against septic complications of anastomotic leakage, it is associated with significant morbidity. The Colovac device (CD) is an intraluminal bypass device intended to avoid stoma creation in patients undergoing low anterior resection. A preliminary study (SAFE‐1) completed in three European centres demonstrated 100% protection of colorectal anastomoses in 15 patients, as evidenced by the absence of faeces below the CD. This phase III trial (SAFE‐2) aims to evaluate the safety and effectiveness of the CD in a larger cohort of patients undergoing curative rectal cancer resection. Methods: SAFE‐2 is a pivotal, multicentre, prospective, open‐label, randomized, controlled trial. Patients will be randomized in a 1:1 ratio to either the CD arm or the diverting loop ileostomy arm, with a recruitment target of 342 patients. The co‐primary endpoints are the occurrence of major postoperative complications within 12 months of index surgery and the effectiveness of the CD in reducing stoma creation rates. Data regarding quality of life and patient's acceptance and tolerance of the device will be collected. Discussion: SAFE‐2 is a multicentre randomized, control trial assessing the efficacy and the safety of the CD in protecting low colorectal anastomoses created during oncological resection relative to standard diverting loop ileostomy. Trial registration: NCT05010850. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work was to compare adjustment between those with a new temporary or permanent ostomy in a cohort of Australian adults. Method: This is a multicentre, longitudinal observational study. Ostomy adjustment was measured using the Ostomy Adjustment Inventory (OAI‐23) at six possible time points ending at 9 months postsurgery or at the time of ostomy closure in those with a temporary stoma. The OAI‐23 includes four domains: anger, acceptance, anxious preoccupation and social engagement. Results: Eligibility criteria were met by 1230 patients, with 849 (69%) recruited and consented. Of these, 108 were excluded as their surgery did not result in the formation of an ostomy and a further 41 were excluded due to there being no data on ostomy type (temporary or permanent). This left a study population of 700, of whom 397 had a temporary and 303 a permanent ostomy. Only small differences were observed between the temporary and permanent ostomy groups at most time points within the four OAI‐23 domains. There were no statistically significant differences found beyond 2 weeks postdischarge and the differences were of small size. While no difference was found between the groups in the domain of anxious preoccupation, both groups demonstrated an increase in anxious preoccupation over time. Neither group regained their presurgery confidence to attend social engagements. Conclusion: We found only minor differences in adjustment in those with a new temporary ostomy compared with a new permanent ostomy. Both groups demonstrated increasing anxious preoccupation and problems with social engagement. This suggests that access to education, training and support should be equitable between these two groups in clinical practice, and needs to incorporate a focus on psychological as well as physical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Preserving the ileocecal valve (ICV) has shown significant benefits. We present our experience with 18 infants who underwent ileocecal valve-preservation ileocecostomy (IVPI) with an extremely short distal ileum after primary ileostomy. Methods: A retrospective analysis was conducted on IVPI cases between 2014 and 2020. Medical records were reviewed, including birth weight, age, primary diseases, length of ileus stump, surgical time and procedure, time to enteral feeding, postoperative hospital stay, and complications. Results: Eighteen patients (male: female = 12:6, median birth weight 1305 (750–4000) g, median gestational age 29 + 5 (27 + 6–39 + 6) weeks) were included in the analysis. Causes of surgery included necrotizing enterocolitis (13), ileocecal intestinal atresia (1), ileum volvulus (2), meconium peritonitis (1), and secondary intestinal fistula (1). The median corrected age of ileostomy closure was 3.2 months (2.0–8.0 months). The distance from the distal ileal stoma to the ICV ranged from 0.5 to 2 cm. The median length of the residual bowel was 90 cm (50–130 cm). ICV-plasty was performed in 3 cases due to secondary ICV occlusion or stenosis. All patients resumed feeding within 6 to 11 days after surgery. The postoperative hospital stay ranged from 12 to 108 days (median: 16.5 days). Complications included incisional infections in 2 cases, anastomotic stricture and adhesive ileus in 1 case, nosocomial sepsis and septic shock in 1 case. All children showed normal growth and development during a 6–65 month follow-up. Conclusions: IVPI is safe and feasible for infants with an extremely short distal ileal stump. ICV-plasty could be applicable for cases with ileocecal occlusion/stenosis. [ABSTRACT FROM AUTHOR]