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Extraperitoneal colostomy is often selected to reduce the risk of parastomal hernia. However, its closure surgery is rare and seldom reported. Here, we report our unique experience with robotic left hemicolectomy and extraperitoneal colostomy closure. An 83‐year‐old female was diagnosed with descending colon cancer with stenosis. She had previously undergone abdominoperineal resection with extraperitoneal colostomy. After improving the intestinal obstruction with a self‐expanding stent, we performed robotic left hemicolectomy and extraperitoneal colostomy closure. Thanks to the multijoint function of the robot, which enables the forceps to be angled up to 90° in all directions, we could dissect the stoma from the abdominal wall up to just beneath the rectus abdominis in an intra‐abdominal procedure without enlarging the skin incision. This case suggests that robotic surgery with the articulating function is beneficial for procedures near the abdominal wall ceiling and effective for extraperitoneal colostomy closure. [ABSTRACT FROM AUTHOR]

Aims: To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure. Materials and Methods: Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage. Results: A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2–3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously. Conclusion: ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications.

Aims: To study the safety and feasibility of enhanced recovery after surgery (ERAS) protocol in pediatric colostomy closure. Materials and Methods: Retrospective observational study of children who underwent colostomy closure. Data were collected from the electronic medical records and telephonic follow-up calls of patients from October 2013 to October 2023, in the Department of Pediatric Surgery of a Tertiary level Medical College. The parameters obtained were age, gender, type of stoma, primary diagnosis, discrepancy in luminal diameters, time to reach full feeds, postoperative hospital stay, and complications. The protocol followed for colostomy closure included the following-no bowel preparation or nasogastric tube, no overnight fasting, single dose of antibiotic prophylaxis, avoiding opioids, packing proximal stoma till mobilization and starting early oral feeds postoperatively. The continuous parameters were expressed as mean ± standard deviation or median (range) while the descriptive parameters were expressed as number and percentage. Results: A total of 90 patients were included in the study. Most of the patients had colostomy for anorectal malformation. Five of them had significant luminal discrepancy of 4 or more times. Full feeds were reached within 2 days in 79 patients. Postoperative hospital stay was 2-3 days in 62 patients. Six patients stayed for more than 5 days, due to complications requiring further management. We noted surgical site infection in 6 patients all of whom were managed with regular wound dressings and fecal fistula in 4 cases, two of which resolved spontaneously. Conclusion: ERAS protocol in colostomy closure reduces the hospital stay and is cost effective, with early recovery and no added complications. [ABSTRACT FROM AUTHOR]

Background: Colostomy is one of the common surgical procedures performed in pediatric surgical practice. The aim of this study was to retrospectively review our experience with colostomy and closure (reversal) in children. Patients and Methods: A retrospective review of the data of all children aged 15 years and below who had colostomy and colostomy closure in the past 5 years. Results: Of the 67 children who had colostomy 42 (62.7%) boys and 25 (37.3%) girls, with an age range between 13 months and 8 years. Fifty-six (83.6%) of the children were <2 years. Anorectal malformation 53 (79.1%) was the common indication. Divided colostomy was performed in 62 (92.5%) patients and loop colostomy was performed in 5 (7.5%) patients. All the patients had intraperitoneal colostomy closure. A complication rate of 26.4% was seen. Duration of hospital stay ranged between 4 and 10 days. No mortality was recorded. Conclusion: Colostomy reversal is a safe procedure but morbidity may ensure and can easily manage. [ABSTRACT FROM AUTHOR]

Aim: This paper describes a robotic approach to combined gastrointestinal continuity restoration and complex abdominal wall reconstruction after Hartmann's procedure complicated by large midline and parastomal hernias. Methods: A robotic Hartmann reversal is performed, followed by robotic retromuscular abdominal wall reconstruction of all ventral defects with bilateral posterior component separation using the double‐docking approach. Surgical steps are thoroughly described, and the accompanying video highlights critical steps of the procedure, anatomical landmarks and technical details relevant to successful completion. Results: Complete restoration of the anatomy was achieved with an operative time of 6.5 h. Mobilization occured on day 1, and bowels were opened on day 3. Surgical discharge was possible on day 5. No intra‐operative surgical complication occurred and follow‐up at 6 months showed no recurrence or mid‐term complication. Conclusion: Combined minimally invasive reconstruction of the gastrointestinal tract and abdominal wall was feasible using a robotic system. In addition, potential advantages of postoperative rehabilitation and reduced surgical site complications are suggested. Prospective evaluation of the technique is ongoing. [ABSTRACT FROM AUTHOR]

• What is currently known about this topic? • Quality evidence is insufficient regarding the use of mechanical bowel preparation prior to colostomy closure in pediatric patients. • What new information is contained in this article? • This study, which is, to our knowledge, one of the largest randomized clinical trials on this topic, indicates that omitting mechanical bowel preparation is safe and efficient in pediatric patients. Mechanical bowel preparation (MBP) is largely used worldwide prior to colostomy closure in children, although its benefits are questioned by scientific evidence, and its use can cause adverse reactions. We hypothesized that colostomy closure procedures in children are not associated with increased complications (surgical site infection [SSI] and anastomotic leakage) when performed without MBP. Thus, we conducted a noninferiority trial to compare the safety and efficacy of colostomy takedown with and without MBP. A randomized noninferiority clinical trial was conducted at Hospital Infantil de Mexico in Mexico City from 2015 to 2019, in which the experimental group did not receive MBP prior to colostomy closure. A total of 79 patients were analyzed, and the primary outcomes were safety-related. Data were analyzed using the chi-squared test, Student's t -test, or Mann–Whitney U test as appropriate. The demographics in both groups were comparable. Statistical analysis revealed equivalence in safety outcomes (superficial SSI, 22.5% vs 15.3% p = 0.420; deep SSI, 7.5% vs 0% p = 0.081; reoperation, p = 0.320; intestinal occlusion, p = 0.986); no anastomotic leakage was observed in any group. Secondary outcomes such as fasting time and length of hospital stay after surgery were also similar between the groups. However, patients who received MBP were admitted 2 days before surgery. Our findings indicate that withholding MBP prior to colostomy takedowns in children is not associated with increased complications. Omitting MBP also leads to less discomfort and shortens hospital length of stay, suggesting that it has safer and more effective procedures. Randomized controlled clinical trial with adequate statistical power. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric colorectal studies have shown enhanced recovery after surgery (ERAS) protocols can safely improve outcomes. This study sought to determine the impact of an ERAS pathway on the outcomes of children with colorectal conditions who underwent colostomy closure or Malone procedure. Methods: A single-institution, retrospective cohort study of children who underwent colostomy closure or Malone procedure between 2016 and 2020 was performed. Differences in outcomes between pre-ERAS and ERAS cohorts were tested. A sub-analysis based on procedure type was performed. Results: There were 96 patients included: 22 prior to ERAS implementation and 74 after. Patients who underwent ERAS had shorter mean time (hours) to oral intake, mean days until regular diet, post-operative opioid volume, and median length of stay (p < 0.05). There was no difference in complication rates in the ERAS and pre-ERAS cohort (12.2 vs 9.1%, p = 0.99). Patients who underwent colostomy closure after ERAS had lower post-operative opioid use, but no differences were seen in those who underwent Malone. Conclusion: Implementation of an ERAS protocol resulted in quicker time to oral intake, normal diet, and decreased opioid use without increasing complication rates. Differences seen based on procedure type may reflect that the effect of an ERAS protocol is procedure specific. [ABSTRACT FROM AUTHOR]

Introduction Perforation represents the most critical manifestation of complicated diverticulitis. In 2008, it was estimated that about 2,000 cases of perforated diverticulitis (PD) were diagnosed in the United Kingdom (UK). Management of PD is evolving with considerable variation in approaches between hospitals and countries with an increased trend towards a conservative approach. Objective Our aim is to provide a comprehensive overview of the management strategies and treatment outcomes for PD, with a particular focus on the influence of abscess size and the presence of distant air (DA) on the success of conservative management. Methods Data from 112 patients admitted with PD to a single district hospital in the UK between 2013 and 2018 were retrospectively analysed. CT scan reports and images were examined to assess the size and number of abscesses, as well as the presence of DA. Failed initial management was defined as the need for an alternative therapeutic option after 48 hours during the index admission or readmission within 12 weeks. Follow-up data were also reviewed to evaluate the need for elective resection and stoma reversal. Result In this cohort of 112 patients with PD, a variety of treatment strategies were employed. Antibiotic therapy alone was successful in 46 patients (41%). Radiological management was successful in only six patients (5%). Surgical washout was required in 12 cases (11%), while resection was performed in 40 cases (36%). Best supportive care was provided to eight patients (7%) who were considered unfit for invasive interventions. The success rate was higher in cases with smaller abscesses and no DA (p <0.05). Specifically, 30 out of 45 patients (66.6%) with abscesses less than 4 cm and no DA were managed successfully with conservative treatment, whereas the success rate dropped to 14 out of 30 patients (47%) when DA was present (p<0.05). For abscesses larger than 4 cm, the success rate was seven out of 20 patients (35%) without DA and significantly lower at two out of 20 patients (10%) with DA (p=0.01). The data also show a shift towards increased conservative management over the six-year period, with a steady reduction in the number of surgical interventions. However, 12 patients (19%) were readmitted with complicated diverticulitis after the initial non-resectional management. Conclusion We observed a shift towards more conservative, non-operative management of acute complicated diverticulitis with perforation over the six-year period, likely influenced by advancements in diagnostic and interventional radiology, antibiotic therapy, and minimally invasive techniques. Our data also stress that cases of PD with distant extraluminal air or larger abscesses are less suited to conservative treatment, often necessitating traditional surgical interventions. Long-term follow-up showed a moderate rate of readmissions after non-resectional management, and while stoma reversal was successful in a proportion of patients, many either opted to live with the stoma or were deemed unsuitable for reversal. A larger, multicentre prospective study would likely provide more robust data on this subject., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Quality Governance and Compliance Department at North West Anglia NHS Foundation Trust issued approval 2934. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Patel et al.)

Hartmann's reversal (HR) is considered a technically demanding procedure and is associated with high morbidity rates. Aim: The aim of this study is to compare the perioperative results of the open approach (OA) with the laparoscopic approach (LA) for HR, and to determine the risk factors associated with postoperative morbidity. Material and Methods: Consecutive patients undergoing HR between January 2007 and December 2016 at a university hospital were included. Patients with large incisional hernias that required an open approach a priori were excluded from the analysis. Demographic and perioperative variables were recorded. Analytical statistics were carried out to compare both groups, and a logistic regression was performed to identify risk factors associated with postoperative morbidity in the series. Results: A hundred and one HR were performed during the study period. Fourteen cases were excluded due to large incisional hernias, so 87 cases (46 OA and 41 LA) were analyzed. Ten patients in the LA group (24.4%) required conversion, mainly due to adhesions. The total morbidity of the series was 36.8%, being higher in the OA group (50% vs. 21.9%, p = 0.007). There was one case of anastomotic leakage in each group. The length of stay was 5 (3-52) days for LA and 7 (4-36) days for OA (p < 0.001). In the logistic regression, the OA was the only independent risk factor associated with postoperative morbidity in HR (OR 2.89, IC 95% 1.11-7.49; p = 0.029). Conclusion: A laparoscopic approach is associated with less morbidity and a shorter length of stay compared to the open approach for Hartmann's reversal. An open approach was the only factor independently associated with postoperative morbidity in our series. [ABSTRACT FROM AUTHOR]

Sacral agenesis is a rare developmental disorder, in which there is absence of part or all of two or more sacral vertebral bodies. It is mostly associated with dysfunction of bowel, bladder and neuromuscular system of lower limbs. Voiding impairment (neurogenic bladder), Vescico-Ureteric Reflux (VUR) together with urinary tract infection contribute to renal injury. Here authors are reporting an 11-year-old female, who was diagnosed to have sacral agenesis with anorectal malformation at the age of six month, leading to anal trans-positioning done at that age, she presented to the Urology Department with acute kidney injury. On evaluation, she was found to have overactive bladder with increased bladder capacity and bilateral grade 5 VUR. After recovery from acute kidney injury with conservative management and catherization, she was discharged with the advice of clean intermittent catheterization and anticholinergic drug. On follow-up, she was doing well. Early diagnosis and long term follow-up is required in the patients having sacral agenesis with multidisciplinary team including urologist, as these patients may develop lower urinary tract symptoms, VUR and kidney injury at any time in their growth period.

Aim of the Study: The aim of this study is to assess the role of early feeding after elective colorectal surgery in children and compare the outcome of feeding practice early versus traditional feeding. Study Design: A randomized controlled, single-center study was conducted over a period of 3 years (November 2015–October 2018) at a tertiary care center. Materials and Methods: Patients (n = 147), after colostomy closure (as elective colorectal surgery), were randomly selected for postoperative feeding initiation and were divided into two groups, namely the control (traditional feeding) group and study group (early feeding). In early group, feeding was initiated on the postoperative day 1 after the removal of nasogastric tube (removed after 16 h of surgery). Postoperative hospital stay and complications were compared among them. Statistical Analysis Used: Data were tabulated and analyzed in Microsoft Excel 2010. Results: Among 147 patients (boys[70] and girls [77]), the average age of colostomy closure was 4.36 years. Forty-five patients had early feeding and 102 traditional feeding. Average postoperative hospital stay was noted 5.62 ± 1.11 days for “Study group” and 8.1 ± 1.04 days for “Control group.” Postoperative complications were found in 17 patients; 11 (7.5%) superficial surgical site infection (9 [8.8%] in control and 2 [4.4%] in study group) and 6 (4%) minor fecal fistulae (5 [4.9%] in control group and 1 [2.2%] in study group). None required any further surgical intervention. No mortality was reported. Conclusions: Early feeding initiation after elective colorectal surgery is safe, and postoperative hospital stay is significantly reduced. It is definitely a step forward in the era of fast track surgery in pediatric population.

Aim of the Study: The aim of this study is to assess the role of early feeding after elective colorectal surgery in children and compare the outcome of feeding practice early versus traditional feeding. Study Design: A randomized controlled, single-center study was conducted over a period of 3 years (November 2015–October 2018) at a tertiary care center. Materials and Methods: Patients (n = 147), after colostomy closure (as elective colorectal surgery), were randomly selected for postoperative feeding initiation and were divided into two groups, namely the control (traditional feeding) group and study group (early feeding). In early group, feeding was initiated on the postoperative day 1 after the removal of nasogastric tube (removed after 16 h of surgery). Postoperative hospital stay and complications were compared among them. Statistical Analysis Used: Data were tabulated and analyzed in Microsoft Excel 2010. Results: Among 147 patients (boys[70] and girls [77]), the average age of colostomy closure was 4.36 years. Forty-five patients had early feeding and 102 traditional feeding. Average postoperative hospital stay was noted 5.62 ± 1.11 days for "Study group" and 8.1 ± 1.04 days for "Control group." Postoperative complications were found in 17 patients; 11 (7.5%) superficial surgical site infection (9 [8.8%] in control and 2 [4.4%] in study group) and 6 (4%) minor fecal fistulae (5 [4.9%] in control group and 1 [2.2%] in study group). None required any further surgical intervention. No mortality was reported. Conclusions: Early feeding initiation after elective colorectal surgery is safe, and postoperative hospital stay is significantly reduced. It is definitely a step forward in the era of fast track surgery in pediatric population. [ABSTRACT FROM AUTHOR]

Sacral agenesis is a rare developmental disorder, in which there is absence of part or all of two or more sacral vertebral bodies. It is mostly associated with dysfunction of bowel, bladder and neuromuscular system of lower limbs. Voiding impairment (neurogenic bladder), Vescico-Ureteric Reflux (VUR) together with urinary tract infection contribute to renal injury. Here authors are reporting an 11-year-old female, who was diagnosed to have sacral agenesis with anorectal malformation at the age of six month, leading to anal trans-positioning done at that age, she presented to the Urology Department with acute kidney injury. On evaluation, she was found to have overactive bladder with increased bladder capacity and bilateral grade 5 VUR. After recovery from acute kidney injury with conservative management and catherization, she was discharged with the advice of clean intermittent catheterization and anticholinergic drug. On follow-up, she was doing well. Early diagnosis and long term follow-up is required in the patients having sacral agenesis with multidisciplinary team including urologist, as these patients may develop lower urinary tract symptoms, VUR and kidney injury at any time in their growth period. [ABSTRACT FROM AUTHOR]

Aim: Temporary colostomy is commonly performed for diseases requiring multi-stage surgery in pediatric surgical practice such as for anal atresia and Hirschsprung's disease. Through this study, we aimed to decrease the diameter difference between the proximal and distal colon and subsequently provide surgical ease and to investigate the effect of 1-month application of pure olive oil, which is considered a trophic factor, to prevent distal colonic atrophy. Materials and Methods: In total, 24 pediatric patients who were treated at our clinic between June 2017 and November 2018 and who were scheduled to undergo colostomy closure were prospectively followed up. The patients were grouped into the following two groups: control group (n = 10), patients who were administered 5 cc 0.9% physiological saline solution twice a day for a month and olive oil group (n = 9), patients who were administered 5 cc pure olive oil as a trophic agent twice a day for a month. Results: There were significant differences in terms of mucosal thickness, muscular thickness, wall thickness, and colonic lumen diameter between the proximal and distal colon in the control group. On the other hand, in the olive oil group, there was no significant difference between the proximal and distal colon. However, there was a significant difference between the two groups in terms of first bowel movement and discharge times. Conclusion: Administration of olive oil from the distal colon opening prior to performing colostomy closure can decrease the diameter difference between the proximal and distal colons and provide easier surgical performance. [ABSTRACT FROM AUTHOR]

Toxic megacolon complicating pseudomembranous colitis is a very rare condition that confirms by a few reports. In our case report probably described a case after extraperitoneal preventive colostomy closure toxic megacolon was developed with fatal final.

Objectives: The aim of this study was to determine the difference in outcomes between pediatric patients undergoing preoperative bowel preparation and those with no bowel preparation before colostomy closure. Differences in morbidity and mortality were measured in this study between these two groups. Material and Methods: This is a prospective randomized study. Eighty-five patients undergoing a colostomy reversal were included in this study over the period of two years from August 2015 to July 2017. They were randomly divided into two groups No bowel preparation (NBP) 42 and bowel preparation (BP) 43. Parent's refusal, any known allergy or contraindication to polyethylene glycol, hepatic, renal or cardiopulmonary abnormality, bleeding diathesis, local skin site infections were excluded from this study. Patients were admitted to the hospital two days before surgery and initiated on intravenous fluids at a weight based maintenance rate. Bowel preparation was started 2 days before surgery with normal saline distal loop wash and Movicol sachet per oral. Patients remained NPO overnight prior to surgery in accordance with anesthesia protocol. All patients received intravenous ceftriaxone and metronidazale - 1 h prior to incision and continued for 3 to 5days post operatively. Postoperatively, surgeon's judgment dictated the removal of the Naso-gastric tube (NGT) and advancement of diet. Complications or morbidities were noted at the time of discharge. Initial follow up was scheduled in two weeks to OPD. At 4-6 weeks postoperatively the patients were evaluated in OPD to determine postoperative progress and to assess for any complications. Results: Total of 85 patients were included in the study, 42 in No Bowel Preparation group (NBP) and 43 in Bowel Preparation Group (BP). In NBP 10(23.80%) suffered skin infection, 3(7.10%) intra-abdominal abscesses and 2(4.7%) anastomotic leaks while in BP group there were 2(4.7%) patients with skin infection, no intra-abdominal abscess and 2(4.7%) anastomotic leaks. Conclusion: Preoperative bowel preparation is safer and effective before colostomy closure. Large multicentre prospective trials need to be done to establish the significant difference between BP versus NBP. [ABSTRACT FROM AUTHOR]

Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities. [ABSTRACT FROM AUTHOR]

There have been very few studies on applying fast-track principles to colostomy closures. We believe that outcome may be significantly improved with multimodal interventions in the peri-operative care of patients undergoing this procedure. A retrospective study was carried out comparing patients who had undergone colostomy closures by the fast-track and traditional care protocols at our centre. We intended to analyse peri-operative period and recovery in colostomy closures to confirm that fast-track surgery principles improved outcomes. Twenty-six patients in the fast-track arm and 24 patients in the traditional care arm had undergone colostomy closures. Both groups were comparable in terms of their baseline parameters. Patients in the fast-track group were ambulatory and accepted oral feeding earlier. There was a significant reduction in the duration of stay (4.73 ± 1.43 days vs. 7.21 ± 1.38 days, p = 0.0000). We did not observe a rise in complications or 30-day re-admissions. Fast-track surgery can safely be applied to colostomy closures. It shows earlier ambulation and reduction in length of hospital stay. [ABSTRACT FROM AUTHOR]

Objective: To define the incidence of, and factors contributing to the complications of colostomy and colostomy closure at the University College Hospital, Ibadan, Nigeria. Patients and Method: Retrospective review of hospital records of all the patients that had colostomy/colostomy closure in the hospital from 1985 to 1994 was conducted. Two hundred and sixty nine colostomies were performed, 154 of which were fully evaluated. Loop colostomies on the sigmoid (35.7%) and transverse colon (27.3%) were most commonly performed. Indications for colostomy in adults were rectal carcinoma, acquired fistulae, colorectal injury and colonic obstruction. Anorectal anomalies and Hirschsprung's disease were the indications in children. Complications and deaths related to colostomy and colostomy closures were noted. Results: Death rate was 17.6% mostly from sepsis. Mortalities were higher (p

Background: Colostomy site, which is a potentially contaminated wound, is traditionally closed with interrupted skin stitches and placement of intraperitoneal or parietal or both drains; often with poor cosmetic outcome in our country. This study aims at prospective evaluation of colostomy closure wounds by different techniques. Patients and Methods: This study was carried out in all infants and children with colostomy (for different pathologies) admitted for colostomy closure in our institute from August 1, 2006 to February 29, 2008. Patients were divided into two groups: Group A with colostomy closure without any drain and subcuticular skin closure and Group B with colostomy closure with both intraperitoneal and parietal drain and interrupted skin closure. Patient′s details, including age, sex, body weight, diagnosis, preoperative bowel preparation, peroperative antibiotics, postoperative wound infection, anastomotic leaks, duration of hospitalisation and postoperative follow-up for wound assessment, were recorded. By the end of February 2008, 151 cases of colostomy closure were recorded, 70 in Group A and 81 in Group B. Results: Statistical analysis of the data showed no statistically significant difference in wound infection and anastomotic leak between the two groups. On postoperative follow-up, wound assessment showed significantly better cosmesis in the no drain subcuticular group. Conclusion: This study shows that closing colostomies without any drain and subcuticular skin closure does not result in any increased incidence of wound infection and has better cosmetic results.

Background: Despite patient selection, postoperative morbidity after reversal of Hartmann's procedure remains significant. Aim: The objective of this study was to investigate risk factors associated with morbidity after conversion of Hartmann's operation. Patients and methods: We retrospectively analyzed data of 56 patients who underwent reversal procedures between January 2004 and May 2015 in a single center. We evaluated the following variables: demographic characteristics, medical comorbidities, etiology for Hartmann operation, preoperative lab values, intraoperative surgical details and short-term outcomes (hospital stay, medical and surgical complications, mortality). Results: There were 37 men (66.1%) and the mean age was 57 years. The most frequent indications for Hartmann's procedure were colorectal cancer in 25 patients (44.6%) and complicated diverticulitis in 10 patients (17.9%). The mean time to the reversal procedure was 9 months. Morbidity rate was 16.1% (9 patients) with an anastomotic leakage rate of 3.6% (2 patients) and mortality rate was 3.6% (2 patients). The most common medical complication was diarrhea (4 patients, 7.2%). Bivariate analysis demonstrated that the only factor significantly associated with postoperative complications was presence of multiple comorbidities. Conclusions: Multiple medical comorbidities is the only predictive factor for postoperative complications after Hartmann's reversal and therefore patient selection for this type of surgery is critical. [ABSTRACT FROM AUTHOR]

Background: The creation of a stoma is commonplace in colorectal surgery. Circumferential subcuticular wound approximation (CSWA) is a method of wound closure following stoma reversal that has been reported to result in decreased wound infection rates and more desirable aesthetic outcomes. The aim of the present study was to determine the effectiveness of the CSWA method, in terms of wound infection and cosmesis by comparing the technique to the conventional method of wound closure. Methods: All adult patients who presented for stoma reversal at the outpatient clinic of the Division of Colorectal Surgery at the Philippine General Hospital were randomized into two groups, CSWA and conventional. Patients were followed up for up to 30 days postoperatively, photographic documentation of wound appearance was obtained, and wound infections and complications were documented. Patients were asked to complete a satisfaction survey at the end of the follow-up period. Results: A total of 121 patients were included in the study. One (1.6 %) patient in the CSWA group developed wound infection, while six (10 %) patients in the conventional group had a wound infection ( p = 0.061). The CSWA group had a higher total satisfaction score than the conventional group (25 and 24, respectively, p = 0.012). Conclusions: With regard to wound infection rates, the CSWA method was better than the conventional method, although this was found to be borderline significant. With regard to patient satisfaction, the CSWA method proved to be superior to the conventional method, and this was found to be statistically significant. In addition, the technique is applicable to all forms of stoma regardless of the bowel segment involved, trephine size, and indication for diversion. [ABSTRACT FROM AUTHOR]

This prospective study involved one hundred patients with colostomies admitted at the Central Pediatric Teaching Hospital for colostomy closure over the period of two years (Jan.2000- Jan2002). Patients were divided in to two groups according to the technique of colostomy closure. In the first group, the closure was done by single layer of interrupted non-absorbable suture material; in the second group closure was done by double layer suturing technique. All patients were prepared by the same conventional method including fluid diet for three days followed by two days washing enemas before operation with antimicrobial prophylaxis agents. Of these one hundred patients;(48) presented as cases of Hirschsprung`s disease, (50) were cases of ano-rectal malformations, and (2) were cases of traumatic colonic perforation. According to the type of the colostomy; there were (62) loop colostomy, and (38) double-barreled colostomy. According to the site of the colostomy; there were (84) patients with right transverse colostomy, (2) with left descending colostomy, (12) with sigmoidostomy, and (2) with cecostomy. Sixteen patients developed complications following colostomy closure; these were (wound infection, fecal fistula, small bowel obstruction, and other systemic infections). We advise single layer bowel anastomosis for the following reasons: 1-operative time (anesthetic time) theoretically shorter with single layer closure. 2-less tissue handling (less trauma) with single layer closure. 3-less narrowing effect (as less suture material) on the already small bowel lumen. Too many sutures and too many knots leading to comprise blood supply with double layer closure. 4-more cost benefit with single layer closure.

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Abstract: Background/Purpose: There is little published data on the efficacy of surgical infection prophylaxis in children. The purpose of this study was to assess wound infection rate in children undergoing colostomy closure for imperforate anus and evaluate the impact of bowel preparation and antibiotics. Methods: Children younger than 18 years with imperforate anus who had a colostomy closure between January 1996 and December 2007 were identified. Data collected included demographics, bowel preparation, antibiotics, operative details, and postoperative infections. Comparison of mechanical bowel preparation and intravenous antibiotics with and without oral antibiotics was compared using χ 2 tests. Significance was defined as P < .05. Results: A total of 118 patients were identified. Primary skin closure was done in 97%. Mechanical bowel preparation was used in 93%, intravenous antibiotics in 97%, and oral preoperative antibiotics in 52%. Wound infections occurred in 14% (n = 17). The addition of oral antibiotics to the standard regimen of mechanical bowel preparation with intravenous antibiotics did not alter infection rate (13% versus 17%, P = .64). Conclusion: Wound infection in children undergoing elective colostomy closure for imperforate anus was 14%. Infection rate was not affected by use of oral antibiotics. Future studies may allow specific guideline development for infection prophylaxis in pediatric patients. [Copyright &y& Elsevier]

Restoration of intestinal continuity after Hartmann’s procedure has traditionally required laparotomy. This study compares our experience with laparoscopic and open reversal of Hartmann’s procedure. All laparoscopic and open Hartmann’s reversal procedures performed between January 1998 and June 2006 were reviewed. Patients with laparoscopic reversal were retrospectively matched by age, body mass index (BMI), and indication to controls with open reversal. Demographic data, perioperative course, and postoperative complications were documented. We identified 41 patients who underwent laparoscopic reversal of Hartmann’s procedure and these were matched to 41 patients with open reversal. The groups had similar average age and BMI. The predominant indication for surgery in both groups was diverticular disease. Conversion to laparotomy occurred in eight patients (19.5%), and was due to dense adhesions or difficulty in identification of the rectal stump. Adhesions were significantly greater in the conversion group ( p <0.05), and the rectal stump was not marked in any of these cases. The most common short-term complications were ileus and surgical site infection. There were no anastomotic leaks and no mortalities. The mean operative times in the laparoscopic and open groups were 193 versus 209 min, respectively ( p = 0.33). The laparoscopic group had a significantly lower estimated blood loss of 166 versus 326 mL ( p < 0.0005), shorter time to bowel function return (4.1 versus 5.2 days, p < 0.05), and a shorter hospital stay (6.4 versus 8.0 days, p < 0.05). The major complication rate was also significantly lower in the laparoscopic group than in the open group (4.8% versus 12.1%, p < 0.05). Laparoscopic reversal of Hartmann’s procedure is a safe and practical alternative to open reversal. It can be performed with similar operative time, fewer complications, and a faster recovery time. Conversion during the reversal procedure was significantly impacted by severity of adhesions and marking of the rectal stump. [ABSTRACT FROM AUTHOR]

Background: Adhesion formation is one of the leading causes of morbidity after abdominal surgery. In this study, it is aimed to investigate effects of anti-adhesive hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure in a rat model. Materials and Methods: Thirty male Wistar-Albino rats are randomised into 3 groups: Standard colostomy (Grup A), standart colostomy + hyaluronic acid/carboxymethylcellulose (Grup B), and control group (Grup C). Adhesions were evaluated by means of a scoring system. Bursting pressure values, and hydroxyproline levels were detected. Results: Adhesion score of group A (1.7±0.6) was statistically higher compared to group B (1.1±0.3), and to control group C (1.2±0.4) (p<0.05). There was no statistical difference between bursting pressure values, and hydroxyproline levels. Conclusions: Although hyaluronic acid/carboxymethylcellulose membrane decreased adhesion formation, there was no obvious effect on anastomotic strength and healing. On the other hand, further clinical studies are needed to draw major conclusions. [ABSTRACT FROM AUTHOR]