Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients:A single center experience

BACKGROUND Mucocutaneous separation(MCS)is a common postoperative complication in enterostomy patients,potentially leading to significant morbidity.Early identification of risk factors is crucial for preventing this condition.However,predictive models for MCS remain underdeveloped.AIM To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy.METHODS A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study.Patients were divided into two groups,the MCS group(n=110),and the non-MCS(n=382)based on the occurrence of MCS within the first 3 weeks after surgery.Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed.Receiver operating characteristic curve analysis was used to assess the model’s performance.RESULTS The postoperative MCS incidence rate was 22.4%.Suture dislodgement(P<0.0001),serum albumin level(P<0.0001),body mass index(BMI)(P=0.0006),hemoglobin level(P=0.0409),intestinal rapture(P=0.0043),incision infection(P<0.0001),neoadjuvant therapy(P=0.0432),stoma site(P=0.0028)and elevated intra-abdominal pressure(P=0.0395)were potential predictive factors of MCS.Suture dislodgement[P<0.0001,OR:28.007595%CI:(11.0901-82.1751)],serum albumin level(P=0.0008,OR:0.3504,95%CI:[0.1902-0.6485]),BMI[P=0.0045,OR:2.1361,95%CI:(1.2660-3.6235)],hemoglobin level[P=0.0269,OR:0.5164,95%CI:(0.2881-0.9324)],intestinal rapture[P=0.0351,OR:3.0694,95%CI:(1.0482-8.5558)],incision infection[P=0.0179,OR:0.2885,95%CI:(0.0950-0.7624)]and neoadjuvant therapy[P=0.0112,OR:1.9769,95%CI:(1.1718-3.3690)]were independent predictive factors and included in the model.The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis.CONCLUSION The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.

Assessment of the Effect of “3H” Nursing Mode on Negative Emotions and Insomnia in Patients with Enterostomy

Objective: To explore the clinical significance of “3H” nursing mode in improving negative emotions and insomnia in patients with enterostomy through a prospective cohort study. Methods: Adult patients who underwent enterostomy surgery in our gastroenterology department with negative emotions and insomnia between August 2021 and August 2022 were selected as research objects and randomly divided into “3H” nursing mode group and conventional nursing management group. For the conventional nursing group, routine standard nursing mode was adopted after enterostomy, while extra systematic “3H” nursing service on the basis of conventional nursing management was applied for its counterpart. SAS and SDS scores, Pittsburgh sleep quality index, Barthel index and nursing satisfaction were compared between the two groups. Results: SAS and SDS scores, Pittsburgh sleep quality index, Barthel index and nursing satisfaction of “3H” nursing mode group were evidently better than those of conventional nursing management group, and the difference was significant (P Conclusion: The “3H” nursing mode can effectively improve negative emotions of patients with enterostomy, such as anxiety and depression, improve their sleep quality and self-care ability in daily life, and play an important role in building a harmonious relationship between doctors and patients, nurses and patients, which is worthy of clinical application.

Transumbilical enterostomy for Hirschsprung’s disease with a two-stage laparoscopy-assisted pull-through procedure

BACKGROUND A one-stage laparoscopic operation has recently been considered a favorable option for the management of patients with Hirschsprung's disease(HD)due to its superior cosmetic results.One-stage transanal endorectal pull-through for the treatment of rectosigmoid HD has been widely used in newborns without complications.However,enterostomy is required in some HD cases for enterocolitis and dilated colon.Our transumbilical enterostomy(TUE)and twostage laparoscopy-assisted anorectoplasty were effective and achieved a similar cosmetic effect to one-stage laparoscopy on the abdominal wall in patients with anorectal malformation,but the effect in patients with HD is unclear.AIM To evaluate the safety,efficacy and cosmetic results of TUE in two-stage laparoscopy-assisted pull-through for HD.METHODS From June 2013 to June 2018,53 patients(40 boys,13 girls;mean age at enterostomy:5.5±2.2 mo)who underwent enterostomy and two-stage laparoscopy-assisted pull-through for HD with stoma closure were reviewed at our institution.Two enterostomy approaches were used:TUE in 24 patients,and conventional abdominal enterostomy(CAE)in 29 patients.Eleven patients with rectosigmoid HD had severe preoperative enterocolitis or a dilated colon.26 patients had long-segment HD,and 16 patients had total colonic aganglionosis(TCA).The patients with left-sided HD underwent the two-stage laparoscopic Soave procedure,and the patients with right-sided HD and TCA underwent the laparoscopic Duhamel procedure.Demographics,enterostomy operative time,complications and cosmetic results were respectively evaluated.RESULTS There were no differences between the groups with respect to gender,age at enterostomy,weight and clinical type(P>0.05).No conversion to open technique was required.Two patients experienced episodes of stomal mucosal prolapse in the TUE group and 1 patient in the CAE group(8.33%vs 3.45%,P>0.05).No parastomal hernia was observed in either of the two groups.Wound infection at the stoma was seen in 1 case in the TUE group,and 2 cases in the CAE group(4.17%vs 6.90%,P>0.05).No obstruction was noted in any of the patients in the TUE group,whereas obstruction was found in 1 patient in the CAE group.Enterocolitis was observed in 3 and 5 patients in the TUE and CAE group,respectively(12.50%vs 17.24%,P>0.05).There was no significant difference between the TUE group and CAE group in terms of the incidence of soiling and constipation(P>0.05).The cosmetic result using the scar score in the TUE group was better than that in the CAE group(6.83±0.96 vs 13.32±1.57,P<0.05).CONCLUSION TUE is a safe and feasible method for the treatment of HD,and the staged enterostomy and two-stage laparoscopy-assisted pull-through achieved a similar cosmetic effect to the one-stage laparoscopic procedure.

Development and validation of a self-management behavior questionnaire for Chinese enterostomy patients

Objectives:This study aimed to develop a self-management behavior questionnaire for Chinese enter-ostomy patients and examine its reliability and validity.Methods:Guided by the theory of self-management,an initial questionnaire was generated through literature review,group meetings,and two rounds of an expert consultation.Finally,the reliability and validity of the questionnaire were validated through a questionnaire survey of 200 enterostomy patients were selected from the Affiliated Hospital of Medical University from June 2016 to March 2017.Results:The content validity index was 0.80e1.00.The exploratory factor analysis yielded a five-factor(dietary behavior,psychosocial behavior,symptom management behavior,medical compliance behavior,information management behavior),consisting of 40 items.The cumulative variance contri-bution rate was 65.42%.The Cronbach’s a coefficient for the total questionnaire was 0.972,and for the five factors ranged from 0.797 to 0.939,indicating a good internal consistency.The test-retest reliability was 0.867(P<0.01).The self-management behavior questionnaire score was negatively related to the Ostomy Skin Tool score(r=-0.800,P<0.01).Conclusions:The self-management behavior questionnaire developed in this study showed good reli-ability and validity and can be used to assess the self-management behavior of Chinese enterostomy patients.

Enterostomy can decrease the mortality of patients with Fournier gangrene

AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene.

Endoscopy-based early enterostomy closure for superior mesenteric arterial occlusion

AIM:To evaluate the efficacy of endoscopic examination of blood flow and edema in the remnant bowel.METHODS:We retrospectively studied 15 patients who underwent massive bowel resection with enterostomy for superior mesenteric arterial occlusion (SMAO); the patients were divided into a delayed closure group (D group) and an early closure group (E group).RESULTS:The mean duration from initial operation to enterostomy closure was significantly shorter in the E group (18.3 ± 2.1 d) than in the D group (34.3 ± 5.9 d) (P < 0.0001). The duration of hospitalization after surgery was significantly shorter in the E group (33 ± 2.2 d) than in the D group (51 ± 8.9 d) (P < 0.0002).CONCLUSION:Endoscopic examination of blood flow and edema in the remnant bowel is useful to assess the feasibility of early closure of enterostomy in SMAO cases.

Technical Points Regarding New Enterostomy Formation for Incarcerated Stomal Prolapse in Loop Enterostomy

Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.

The research status of self-care agency assessment and intervention of enterostomy patients

Objective:To discuss the research status of self-care agency assessment and intervention of enterostomy patients at home and abroad,and to provide reference for medical staff to understand the defects and needs of self-care agency of enterostomy patients and implement effective intervention.Methods:By searching the literature comprehensively,the latest research progress of self-care agency assessment and intervention of enterostomy patients at home and abroad was summarized.Results:The self-care agency assessment tools for patients with enterostomy included Stoma Self-Care Scale(SSCS),Specific Self-Care for Ostomized Patients Questionnaire(CAESPO)and Self-Care Competence of the Person with an Intestinal Stoma:Nursing School of Porto(CAO-EI:ESEP).Interventions included extended care,educational intervention and multidisciplinary team nursing.Conclusion:The concept of renewal should be used to evaluate the self-care agency of enterostomy patients from various aspects.In the future,we should actively carry out standardized research on the content and time of extended nursing and educational intervention,promote the extensive and standardized implementation of multidisciplinary team nursing,and promote the comprehensive improvement of self-care agency of enterostomy patients.

Reporting Quality Assessment of systematic reviews on Quality of Life in Patients with Enterostomy in China

Aims:The study aimed to comprehensively search the systematic reviews and meta-analyses on quality of life in colorectal cancer patients with enterostomy in China and strictly evaluate the reporting quality,to promote the clinical transformation and implementation of evidence-based evidence on quality of life in colorectal cancer patients with enterostomy.Method:Cnki,Wanfang and VIP databases were comprehensively searched from the database construction to September 15,2021,to find the meta-analyses on quality of life in colorectal cancer patients with enterostomy in China.We used the PRISMA statement to evaluate their reporting quality rigorously.Results:9 articles were included in this study.Their PRISMA scores ranged from 18 to 24,with an average score of 20.44.The reporting rate of PRISMA in 9 articles was 70.37%to 88.89%.The 27 PRISMA items had a 0-100%reporting rate.Conclusion:The reporting quality of meta-analyses on quality of life in colorectal cancer patients with enterostomy in China is ideal.However,there are still 8 PRISMA items with a reporting rate of less than 70%,which need to be further improved in future research.

Application progress of Acceptance and Commitment Therapy in patients with permanent enterostomy

The psychosocial disorder of patients with enterostomy is still a huge challenge for the health systems.Acceptance and Commitment Therapy(ACT)has shown good results in permanent enterostomy in recent years.This paper explores the current status regarding ACT for patients with enterostomy in recent years through a literature review approach.The findings can provide scientific evidence for researchers,clinical practitioners and policy makers in this field.The study concludes that as a new psychological intervention method,ACT can significantly reduce the negative emotions and complications of patients with enterostomy,and improve their psychological flexibility,stoma acceptance,psychosocial adaptability,self-care ability and quality of life.

Complications of newborn enterostomies

AIM To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.METHODS A 10-year retrospective cohort study(2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study(corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis(NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson's χ2 test or Fisher's exact test for categorical variables and the Wilcoxon-Mann-Whitney U-Test for continuous variables. RESULTS In total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC(Group 1) were significantly older at enterostomy for-mation than the neonates of Group 2 [median(range), 11(2-75) d vs 4(1-101) d, P = 0.004)]. Significantly more ileostomies were created in Group 1 [47(92.2%) vs 16(64.0%), P = 0.007], whereas colostomies were performed significantly more often in Group 2 [2(3.9%) vs 8(32.0%), P = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median(range), 5(3-13) vs 3(1-9), P < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2(P = 0.073). Most patients suffered from two complications(23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2(P = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients(30.6% in Group 1 and 16.7% in Group 2, P = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48(65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification(CDC) < Ⅲ], while 25(34.2%) required surgery to address the complications(CDC ≥Ⅲ). Early reversal of the enterostomy was performed significantly more often(P = 0.003) and the time to full enteral nutrition after closure was significantly longer [median(range), 7(3-87) d vs 12(5-93) d, P = 0.006] in infants with a CDC grading ≥Ⅲ than in infants with a CDC grading < Ⅲ. CONCLUSION Complications occur in almost all infants with enterostomies. The majority of these complications are minor and do not require surgical treatment. There is a clear trend that neonates with NEC have a higher risk for developing complications than those without NEC.

Intestinal T-cell lymphomas:A retrospective analysis of 68 cases in China

AIM: To investigate the clinical features, diagnosis, treatment and prognosis of intestinal T-cell lymphomas (ITCL) by retrospective analysis.

Modified laparoscopic Sugarbaker repair of parastomal hernia with a three-point anchoring technique

AIMTo retrospectively evaluate the safety and feasibility of a new modified laparoscopic Sugarbaker repair in patients with parastomal hernias.METHODSA retrospective study was performed to analyze eight patients who underwent parastomal hernia repair between June 2016 and January 2018. All of these patients received modified laparoscopic Sugarbakerhernia repair treatment. This modifed technique included an innovative three-point anchoring and complete su-turing technique to fix the mesh. All procedures were performed by a skilled hernia surgeon. Demographic data and perioperative outcomes were collected to eva-luate the safety and effcacy of this modifed technique.RESULTSOf these eight patients, two had concomitant incisional hernias. All the hernias were repaired by the modifed laparoscopic Sugarbaker technique with no conversion to laparotomy. Three patients had in-situ reconstruc-tion of intestinal stoma. The median mesh size was 300 cm2, and the mean operative time was 205.6 min. The mean postoperative hospitalization time was 10.4 d, with a median pain score of 1 （visual analog scale method） at postoperative day 1. Two patientsdeveloped postoperative complications. One patient had a pocket of effusion surrounding the biologic mesh, and one patient experienced an infection around the reconstructed stoma. Both patients recovered after conservative management. There was no recurrence during the follow-up period （6-22 mo, average 13 mo）.CONCLUSIONThe modifed laparoscopic Sugarbaker repair could fx the mesh reliably with mild postoperative pain and a low recurrence rate. The technique is safe and feasible for parastomal hernias.

Literature Review of the Frequency of Reoperations after One Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) has gained worldwide acceptance. However surgical success is often reported separately, while the necessity for true reoperation is difficult to establish. Aim: To evaluate the incidence of reoperations following TERPT procedure. The findings will be important in counseling and planning childcare for HD patients as well as providing a benchmark for single centers clinical results. Methods: A literature review of reported TERPT operations on children with HD between 1998 through 2011 was performed. Only planned TERPT operation reports were included. Information was collected with particular emphasis on reoperations and their reasons. Results: Out of 26 published articles 23 were included, reporting on 836 children, female/male ratio: 1/3.3, undergoing the TERPT procedure as the only operative intervention with described postoperative courses. The children comprised neonates, 3 years of age (12%). The average follow up was 18.5 (6 - 38) months. The resected bowel length mean was 20.5 cm. Forty-one reoperations were reported (4.9%), including 24 laparotomies, 8 laparoscopies, 6 colostomies and ileostomies in 3 children. Only 2 re-do TERPT were reported (0.2%). Seven patients were considered TERPT failures (0.8%) with 5 requiring diverting colostomies and additional transabdominal pull-through operations. Two myectomies were performed (0.2%). One child with aganglionosis underwent a Duhamel pull through. Two (0.2%) had serious damage to the urinary tract also one child with a vas deferens lesion was reoperated. Two bowel obstructions required adhesiolysis. Eight anastomotic dehiscences (0.9%) required surgery after reparation. One prolapse of the pulled through colon was reported. Six patients (0.7%) suffered anastomotic leaks. Anastomotic strictures rate was 2.8%, all repaired with anal dilatation. Conclusion: The review supports the low incidence of reported reoperations for the TERPT procedure.

Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices

Gastrostomy tube placement is a procedure that achieves enteral access for nutrition,decompression,and medication administration.Preprocedural evaluation and selection of patients is necessary to provide optimal benefit and reduce the risk of adverse events(AEs).Appropriate indications,contraindications,ethical considerations,and comorbidities of patients referred for gastrostomy placement should be weighed and balanced.Additionally,endoscopist should consider either a transoral or transabdominal approach is appropriate,and radiologic or surgical gastrostomy tube placement is needed.However,medical history,physical examination,and imaging prior to the procedure should be considered to tailor the appropriate approach and reduce the risk of AEs.