Effect of Biofeedback Therapy during Temporary Stoma Period in Rectal Cancer Patients: A Prospective Randomized Trial

Background: This prospective randomized controlled study was designed to evaluate the effect of biofeedback therapy (BFT) during temporary stoma period to prevent defecation dysfunction after sphincter-preserving surgery (SPS). Methods: Following SPS with temporary stoma, patients were divided according to whether (BFT group) or not (Control group) they received BFT. BFT was performed once or twice a week during the temporary stoma period. Kegel exercise were advised to all the patients. Subjective defecation symptoms were evaluated according to Cleveland Clinic Incontinence Score (CCIS) as primary outcome at 12 months postoperatively. Manometric data of five time-points were also analyzed. Results: Twenty-one patients in the BFT group and 23 patients in the control group received anorectal physiologic testing. The incidence of CCIS of more than 9 points, which is the primary end point in this study, was not statistically different between BFT group and control group (p = 1.000). The liquid stool incontinence in the BFT group showed a better tendency (p = 0.06) at 12 months post-SPS. Time-dependent serial changes in maximal sensory threshold (Max RST) was significantly different between the BFT and control groups (p = 0.048). Also, the change of mean resting pressure (MRP) tended to be more stable in the BFT group (p = 0.074). Conclusions: The BFT in the period of temporary stoma may be related to liquid stool incontinence at 12 months post-SPS and lead to stable MRP and better Max RST. Therefore, BFT during temporary stoma might be helpful for preventing and minimizing defecation dysfunction in high risk patients after SPS, NCT01661829).

Early same admission closure of temporary bowel stomas: pros and cones

Background: Early closure of a temporary stoma is usually associated with low morbidity and mortality. However, some cases of stoma reversal may develop complications which may need surgical correction with subsequent major complications. We aim to evaluate early bowel stoma closure; de-functioning diversion stoma closure within the same admission (8-15 days) and study morbidity, health related quality of life (QOL) and length of stay at hospital (LOH). Methods: This study was done at general surgery department, Sohag faculty of medicine; in the period between March 2020 and March2021, 28 patients were closed early (at the same admission). Which are chosen randomly. The 28 patients who underwent early temporary stoma reversal following bowel surgery and abdominal exploration between March 2020 and March 2021 were included. The rate of complications (medical and surgical) following early stoma closure were assessed. Health-related QoL and LoH were assessed.Results: Total 28 patients were taken up for early stoma closure, reversal of stoma occurred between 8-15 days following its creation. Postoperative complications occurred in 53% of our patients, skin excoriation the commonest (28%). No difficulty was encountered during stoma closure surgery. Post-operative complications occurred in 53% of patients. 5 patients develop Ileus which were managed conservatively and one patient (3.5%) develop intra-abdominal abscess and treated with aspiration under sonographic guided. In our study no mortality occurred.Conclusions: Early stoma closure is feasible in selected patients, with reduced hospital stay, adhesions, bowel obstruction and medical complications and leads to better QOL, but a higher wound complication rate.

Bowel dysfunction after surgery

The functions of the lower parts of the bowel, namely the colon and rectum, are predominantly the absorption of fluids and elimination of faeces and flatus. Bowel surgery may be carried out in the treatment of colorectal cancer, inflammatory bowel disease or diverticular disease, and may involve the formation of a permanent or temporary stoma. The type of colorectal surgery carried out depends on the condition and where the problem occurs. Surgery can alter not only the bowel's anatomy but also its functioning. Bowel dysfunction can manifest as constipation, faecal incontinence or diarrhoea. Nurses are well placed to assist patients to resolve many of these problems as well as stoma issues.

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery

Purpose: Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.Methods: From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.Results: The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).Conclusion: In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

Factors affecting temporary stoma outcomes at a major Saudi University Hospital

Background: Temporary stoma formation for fecal diversion is commonly performed in surgery. The rate of stoma-related complications is high, and the risk increases in patients with prolonged time to closure. Thus, identifying factors that influence the time to stoma closure and the rate of its complications would aid in implementing preventive measures. We aimed to determine predictors affecting the time to stoma closure and to identify risk factors for developing complications following stoma reversal.Methods: A retrospective review including all adult patients who underwent stoma closure from 2012-2018 at our institution was conducted. Multivariate regression analysis was used to determine risk factors affecting time to stoma closure and developing complications after reversal surgery.Results: A total of 63 patients were included. Of those, 50.8% were diagnosed with malignancy. The median time to stoma closure was 222.5 days (interquartile range i.e. IQR 12-2228).Having an American society of anesthesiologists (ASA) class IV was the only significant predictor of prolonged time to closure. For cancer patients, developing complications following stoma formation surgery, and receiving adjuvant therapy significantly increased the time to stoma reversal. In contrast, cancer patients who underwent multi-organ resection had shorter time to closure. The rate of complications following stoma reversal was 30.2%. Having a colostomy and requiring readmission after stoma formation surgery increased the risk of developing complications related to stoma reversal.Conclusions: Multiple factors can impact the time to stoma closure and increase the risk of developing complication related to stoma closure. Awareness about these factors and development of preventive strategies is recommended.

Bishop Koop conversion of temporary stoma can be an option to establish gut continuity early when primary anastomosis is not safe

BackgroundIntestinal perforation and sometimes obstruction in neonates demand diverting stomas which are associated with fluid, electrolytes and nutrient loss. Early establishment of gut continuity is the key to the best outcome, though primary anastomosis is not always safe. The aim of this study was to evaluate the effectiveness of Bishop Koop stoma in establishing early continuity of gut and confirming the function of distal gut.MethodsData of patients who underwent Bishop Koop conversion of diverting stoma from July 2016 to June 2018 were reviewed retrospectively. Demographic and outcome data were recorded and analyzed using Statistical Package for the Social Science (SPSS) V.22 software. Ethical permission was taken from hospital ethical committee.Results29 patients were included (16 male and 13 female). Mean age of conversion was 5.8±2.5 months and mean weight was 4.9±1.6. Normal bowel movement was established in 26 patients. One patient died of sepsis on sixth postoperative day and one had anastomotic leakage. There was no significant difference with respect to outcome between perforation and obstruction group. Bishop Koop stomas were closed after 6 weeks of formation.ConclusionsBishop Koop conversion of temporary stoma was turned out as a good choice for these patients.

Loop Transverse Colostomy - A Modified Technique

Background: Transverse colostomy is commonly performed to create temporary stoma in rectal cancer patients after neoadjuvant chemoradiotherapy. Conventional methods are either difficult to implement or to care for. To resolve these problems, we herein describe a modified transverse colostomy method. Material and Methods: Two sutures of peritoneum were made as “bridges” to support the stoma. Absorbable sutures were utilized to reinforce the stoma. Once the stoma was created, the stoma bag was immediately placed on the skin. 120 patients who received conventional or modified transverse colostomy between 2008 and 2014 were selected. Then, the two groups of patients were compared for stoma-related complications. Results: The operation time of stoma construction was 34±10 minutes for the conventional method and 28±7 minutes for the modified method (P= 0.009). There were no significant differences between the two groups with respect to postoperative bleeding, bowel obstruction or stoma retraction. Patients with conventional transverse colostomy were remarkably more likely to experience parastoma hernia (P= 0.048) and stoma prolapse (P= 0.038). Conclusion: In comparison with conventional methods, the modified transverse colostomy is a safe and effective diverting technique. It can be readily performed by all kinds of surgeons, especially those in underdeveloped areas. The technique represents a preferred method for constructing temporary stoma in rectal cancer patients treated with neoadjuvant chemoradiotherapy.