Qualitative exploration of home life experiences and care needs among elderly patients with temporary intestinal stomas

BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.

Effect of Brisk Walking on Self-Care Agency or Care Dependency among Colorectal Cancer Patients with Permanent Stoma

Objective:The purpose of this study was to determine the effectiveness of brisk walking as an intervention for self-care agency and care dependency in patients with permanent colorectal cancer stoma.Method:This study adopted a quasi-experimental research design,specifically a non-equivalent control group pre-test and post-test design.Utilizing the Exercise of Self-Care Agency Scale(ESCA)and Care Dependency Scale(CDS),a survey was administered to 64 patients from a hospital in Shandong Province.The statistical methods used for analyzing data included frequency,mean,standard deviation(SD),independent t-test,P-value calculation,and dependent t-test.Result:After two months of a brisk walking exercise program,participants in the experimental group had a higher level of self-care agency than before the experiment(P<0.05),and their level of care dependency was significantly reduced(P<0.05).Participants in the control group also showed higher levels of self-care agency(P<0.05)and lower levels of care dependency(P<0.05)after two months compared to their levels before the two months.Conclusion:The brisk walking program had a positive impact on patients’self-care agency and reduced their care dependency.

Intestinal Stoma Prolapse and Surgical Treatments of This Condition in Children: A Systematic Review and a Retrospective Study

Background: An intestinal stoma is a surgical opening of the intestine, mostly sutured to the anterior abdominal wall. Stoma prolapse is one of the common complications of stoma. A significant number of stoma prolapse patients require surgical correction. Aim: The first part of this thesis is a literature review of intestinal stoma prolapse and its surgical treatments. The second part is an evaluation of the effect of surgical treatments of this condition on children at OUS-R. Methods: Literature—A literature search was performed. Fifty-seven English-language studies were selected. Methods: Patients evaluation: Design, Setting, and Participants—A retrospective review of pediatric patients (<13 years) surgically treated for intestinal stoma prolapse at OUS-R. Results: Literature—Incidence of intestinal stoma prolapse for children varies from 8.1% to 25.6%. Many proposed surgical repair procedures for stoma prolapse are available and vary from being ineffective to 100% effective. Results: Patients evaluation at OUS-R—From 2001 to 2013, 14 of the 304 children with stoma (4.6%), experienced stoma prolapse. Nine stoma prolapse were surgically corrected: Median age at stoma formation for the 9 patients was 1.7 years. Surgical procedures and success rate: Median 2, range 1 - 9 operations/person;varies from being ineffective to 50% effective. Conclusion: Limited data suggests stoma prolapse repair is a surgical challenge. Thus, preferably when possible, closure of the stoma would be most suitable. Incidence of stoma prolapse in our series of pediatric patients at Oslo University Hospital is lower than most published incidence in the pediatric medical literature.

Role of protective stoma in low anterior resection for rectal cancer:A meta-analysis

AIM: To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer.

Routine defunctioning stoma after chemoradiation and total mesorectal excision:A single-surgeon experience

AIM:To investigate the 10-year results of treating low rectal cancer by a single surgeon in one institution.METHODS:From Oct 1998 to Feb 2009,we prospectively followed a total of 62 patients with cT2-4 low rectal cancer with lower tumor margins measuring at 3 to 6 cm above the anal verge.All patients received neoadjuvant chemoradiation(CRT) for 6 wk.Among them,85% of the patients received 225 mg/m2/d 5-fluorouracil using a portable infusion pump.The whole pelvis received a total dose of 45 Gy of irradiation in 25 fractions over 5 wk.The interval from CRT completion to surgical intervention was planned to be approximately 6-8 wk.Total mesorectal excision(TME) and routine defunctioning stoma construction were performed by one surgeon.The distal resection margin,circumferential resection margin,tumor regression grade(TRG) and other parameters were recorded.We used TRG to evaluate the tumor response after neoadjuvant CRT.We evaluated anal function outcomes using the Memorial Sloan-Kettering Cancer Center anal function scores after closure of the defunctioning stoma.RESULTS:The median distance from the lower margin of rectal cancer to the anal verge was 5 cm:6 cm in 9 patients,5 cm in 32 patients,4 cm in 10 patients,and 3 cm in 11 patients.Before receiving neoadjuvant CRT,45 patients(72.6%) had a cT3-4 tumor,and 21(33.9%) patients had a cN1-2 lymph node status.After CRT,30 patients(48.4%) had a greater than 50% clinical reduction in tumor size.The final pathology reports revealed that 33 patients(53.2%) had a ypT3-4 tumor and 12(19.4%) patients had ypN1-2 lymph node involvement.All patients completed the entire course of neoadjuvant CRT.Most patients developed only Grade 1-2 toxicities during CRT.Thirteen patients(21%) achieved a pathologic complete response.Few post-operative complications occurred.Nearly 90% of the defunctioning stomas were closed within 6 mo.The local recurrence rate was 3.2%.Pathologic lymph node involvement was the only prognostic factor predicting disease recurrence(36.5% vs 76.5%,P = 0.006).Nearly 90% of patients recovered sphincter function within 2 year after closure of the defunctioning stoma.CONCLUSION:Neoadjuvant CRT followed by TME,combined with routine defunctioning stoma construction and high-volume surgeon experience,can provide excellent surgical quality and good local disease control.

Healing of Stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both P<0.05) and stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both P<0.01) were significantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

Factors associated with stoma quality of life among stoma patients

Background:Quality of life(QOL)concerns in patients with stomas is a globally important health issue.Currently,a lack of understanding into which factors influence QOL postcolostomy hinders the ability of health care professionals to provide appropriate instruction and care needed to improve a patient’s QOL.Objectives:To determine the level of stoma-specific QOL and to determine which factors associate with stoma-specific QOL among patients with a stoma.Methods:A convenience sample of 76 patients with stomas was recruited from patients who presented to the ward for checkup in a tertiary hospital in Beijing.Quality of life,selfcare,and hope were assessed in patients by the Stoma-QOL,stoma self-care agency scale,and Herth Hope Index,respectively.Statistical analyses were performed using Pearson correlation,t-test,and multiple linear regression analysis.Results:Our stoma-QOL survey demonstrated that stoma patients experienced difficulties functioning in work and social situations,had issues with sexuality and body image,and difficulties with stoma function.Patients expressed concerns related to the stoma itself such as finding privacy to empty the pouch,problems with leakage,and difficulties participating in social activities.Multiple linear regression analysis indicated that self-care agency and hope were the main influencing factors and explained 23.4%of the variance of stoma function and 17.8%of the variance of work/social function.Conclusion:QOL in patients with a stoma was not ideal.Our findings demonstrate that following stoma implantation,improvements in self-care and inspiring hope in patients played an important role in bettering their stoma-QOL.The strength of our study is that we adopted a stoma-specific questionnaire instead of a general scale such as EORTC C30.

Risk factors for postoperative stoma outlet obstruction in ulcerativecolitis

BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard procedure is restorativeproctocolectomy (RPC) with ileal pouch-anal anastomosis, commonly performedas two- or three-stage RPC with diverting ileostomy. Postoperative stoma outletobstruction (SOO) is frequent, but the causes are not well known.AIM To identify the risk factors for SOO after stoma surgery in patients with UC.METHODS We retrospectively reviewed the files of 148 consecutive UC patients whounderwent surgery with stoma construction. SOO was defined as small bowelobstruction symptoms and intestinal dilatation just below the penetrating part ofthe stoma on computed tomography. Patients were divided into two groups:Those who developed SOO within 30 d after surgery and those who did not.Patient characteristics, intraoperative parameters, the stoma site, and rectusabdominis muscle thickness were collected. Moreover, we identified the patientswho repeatedly developed SOO. Univariate and multivariate analyses wereperformed to identify risk factors for SOO and recurring SOO.RESULTS Eighty-nine patients who underwent two-stage RPC were included betweenJanuary 2008 and March 2020. Postoperatively, SOO occurred in 25 (16.9%)patients after a median time of 9 d (range 2-26). Compared to patients withoutSOO, patients with SOO had a significantly higher rate of malignant tumors ordysplasia (36.0% vs 17.1%, P = 0.032), lower total glucocorticoid dose one monthbefore surgery (0 mg vs 0 mg, P = 0.026), higher preoperative total protein level(6.8 g/dL vs 6.3 g/dL, P = 0.048), higher rate of loop ileostomy (88.0% vs 55.3%, P= 0.002), and higher maximum stoma drainage volume (2300 mL vs 1690 mL, P =0.004). Loop ileostomy (OR = 6.361;95%CI 1.322–30.611;P = 0.021) and maximumstoma drainage volume (OR = 1.000;95%CI 1.000–1.001;P = 0.015) wereconfirmed as independent risk factors for SOO. Eighteen patients with SOO weretreated conservatively without recurrence (sSOO group). Seven (28.0%) patientsrepeatedly developed SOO (rSOO group) during the observation period. Asignificant difference was observed in the rectus abdominis muscle thicknessbetween the two groups (sSOO 9.3 mm, rSOO 12.7 mm, P = 0.006). Musclethickness was confirmed as an independent risk factor for recurring SOO (OR =2.676;95%CI 1.176-4.300;P = 0.008).CONCLUSION In this study, high maximum stoma drainage volume and loop ileostomy areindependent risk factors for SOO. Additionally, among patients with a thickrectus abdominis muscle, the risk of SOO recurrence is high.

Nomogram to predict permanent stoma in rectal cancer patients after sphincter-saving surgery

BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.

Standardized technique for single-incision laparoscopicassisted stoma creation

To describe the procedure, efficacy, and utility of singleincision laparoscopic-assisted stoma creation(SILStoma) for transverse colostomy. Using single-incision laparoscopic surgery, we developed a standardized technique for SILStoma. Twelve consecutive patients underwent SILStoma for transverse colostomy at Osaka Medical Center for Cancer and Cardiovascular Diseases from April 2013 to March 2016. A single, intended stoma site was created with a 2.5-3.5 cm skin incision for primary access to the intra-abdominal space, and it functioned as the main port through which multi-trocars were placed. Clinical and operative factors and postoperative outcomes were evaluated. Patient demographics, including age, gender, body mass index, and surgical indications for intestinal diversion were evaluated. SILStoma was performed in nine cases without the requirement of additional ports. In the remaining three cases, 1-2 additional 5-mm ports were required for mobilization of the transverse colon and safe dissection of abdominal adhesions. No cases required conversion to open surgery. In all cases, SILStoma was completed at the initial stoma site marked preoperatively. No intraoperative or postoperative complications greater than Grade Ⅱ(the Clavien-Dindo classification) were reported in the complication survey. Surgical site infection at stoma sites was observed in four cases; however, surgical interventions were not required and all infectionswere cured completely. In all cases, the resumption of bowel movements was observed between postoperative days 1 and 2. SILStoma for transverse loop colostomy represents a feasible surgical procedure that allows the creation of a stoma at the preoperatively marked site without any additional large skin incisions.

Recurrent tense pneumoperitoneum due to air influx via abdominal wall stoma of a PEG tube

A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding.Radiography revealed free air in the abdomen and gastrograffin(G) study showed no extravasation into the peritoneum.The G tube was successfully repositioned with mechanical release of air.Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum.Mechanical release of air with sealing of the abdominal wound was performed.Later,the patient was restarted on tube feeding with no complications.This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.

Risk factors for anastomotic leakage after low anterior resection without diversional stomas

Objective The most important complication after low anterior resection(LAR) for mid-low rectal cancer is symptomatic anastomotic leakage(AL). More than one-third of patients with rectal cancer who underwent LAR will have functional stomas during primary operation. The aim of this retrospective study was to evaluate the risk factors associated with clinical AL following LAR without diversional stomas.Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The associations between AL and 14 patient-related and surgical variables were examined by both univariate chi-square test and multivariate logistic regression analysis.Results The AL rate was 7.27%(42 of 578). Univariate and multivariate analyses showed that male sex(P = 0.018), mid-low rectal cancer(located 10 cm or less above the anal verge)(P = 0.041), presence of diabetes(odds ratio = 2.117), longer duration of operation(odds ratio = 1.890), and intraoperative contamination(odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and independently predictive of clinical AL. Nearly 83.3%(35 of 42) of leakage could be cured by persistent pelvic irrigation-suction-drainage without surgical intervention. Only 7 patients(16.7%) with severe complications, such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and male sex were independent risk factors for developing clinical AL after LAR without diversional stomas, as well as longer duration of operation, presence of diabetes, and contamination of the operative field. Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective, and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage.

Outcomes and Quality of Life of Patients with a Digestive Stoma in Sub-Saharan Africa: Case of the Yaounde Central Hospital, Cameroon

Introduction: The installation of a digestive stoma involves changes affecting all aspects of the patients’ lives. The objective of this study was to determine the impact of a digestive stoma on the quality of life of patients operated on at the Yaounde Central Hospital (YCH). Patients and Methodology: We conducted a prospective descriptive study over a period of 12 months from June 2018 to May 2019 in all patients with a digestive stoma for at least 3 months operated on at the YCH. The follow-up was done within 12 months. Quality of life was assessed using the stoma QOL (quality of life) and self-image using the BIS (Body Image Scale). Results: We collected a total of 34 patients, of whom 22 were male, giving an M/F sex ratio of 1.8. The average age of the patients was 42.8 years. The indications were tumoral in 44.11% of cases (n = 15) and non-tumoral in 55.88% of cases (n = 19). The colon was the most frequently ablated organ (n = 26) with 76.5% of colostomies. The complication rate was 67.6%. Stomal oedema was the most common early complication with 38.2% of cases. All patients used colostomy bags. The average time to return to sexual activity was 8 months for men and 9 months for women. 85.3% of the patients had an average impairment of quality of life according to the Stoma Quality of Life Scale. According to the Body Image Scale, 73.5% of the patients had a moderate dissatisfaction with their self-image. Conclusion: The realization of a digestive stoma imposes a long-term follow-up especially on the psychological level in order to allow the empowerment of the patients who all have a modification of their quality of life and their self-image.

Meta-analysis of the effect of continuing nursing on the psychological status of rectal cancer patients undergoing stoma

Objective:To systematically evaluate the effect of continuous nursing on the psychological status of rectal cancer patients undergoing stoma.Methods:Five databases including China HowNet,Chongqing Weipu Chinese Science and Technology Database,Wanfang Database,Embase and PubMed were searched.Randomized controlled trials were collected on the effect of continuing nursing on the psychological status of rectal cancer patients undergoing stoma.The searching time was from the establishment of the database to March 30,2019.RevMan 5.3 software was used to analyze the bias risk of the study after two researchers independently screened the researchers,extracted the data and evaluated the bias risk of the study.Results:A total of 15 studies were included.Meta-analysis showed that the continuing nursing group improved anxiety[MD=-10.89,95%CI(-13.52,-8.26),P<0.00001],depression[MD=-4.78,95%CI(-5.77,-3.80,P<0.00001],fear[MD=-6.06,95%CI(-7.70,-4.43),P<0.00001],hostile[MD=-7.00,95%CI(-13.62,-0.38),P=0.04<0.05],somatization[MD=-7.63,95%CI(-13.49,-1.77),P=0.01<0.05].The self-care ability[MD=38.24,95%CI(35.38,41.11),P<0.00001]was superior to the routine nursing group.Conclusion:Continuous nursing has more advantages than routine nursing,and it can improve the negative psychological state of rectal cancer patients undergoing stoma.Due to the limitations of the quantity and quality of the included studies,the above conclusions need to be verified by more high-quality studies.

Smart responsive staple for dynamic promotion of anastomotic stoma healing

The precise combination of conflicting biological properties through sophisticated structural and functional design to meet all the requirements of anastomotic healing is of great demand but remains challenging.Here,we develop a smart responsive anastomotic staple(Ti–OH-MC)by integrating porous titanium anastomotic staple with multifunctional polytannic acid/tannic acid coating.This design achieves dynamic sequential regulation of antibacterial,anti-inflammatory,and cell proliferation properties.During the inflammatory phase of the anastomotic stoma,our Ti–OH-MC can release tannic acid to provide antibacterial and anti-inflammatory properties,together with immune microenvironment regulation function.At the same time,as the healing progresses,the multifunctional coating gradually falls off to expose the porous structure of the titanium anastomotic staple,which promotes cell adhesion and proliferation during the later proliferative and remodeling phases.As a result,our Ti–OH-MC exceeds the properties of clinically used titanium anastomotic staple,and can effectively promote the healing.The staple’s preparation strategy is simple and biocompatible,promising for industrialisation and clinical application.This work provides an effective anastomotic staple for anastomotic stoma healing and serve as a reference for the functional design and preparation of other types of titanium-based tissue repair materials.

Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

Background::Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery.However,the complications of stoma and stoma reversal surgery should not be underestimated.Furthermore,in some patients,stoma reversal failed.Here,we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed.Methods::In total,154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed.Patients were divided into two groups according to whether their stoma got reversed or not.The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed.Results::The mean follow-up time was 47.54(range 4.0-164.0)months.During follow-up,19.5%of the patients suffered stoma-related long-term complications.Only 79(51.3%)patients had their stomas reversed.The morbidity of complications after reversal surgery was 45.6%,and these mainly consisted of incision-related complications.Multivariate analyses showed that pre-treatment comorbidity(HR=3.17,95%CI 1.27-7.96,P=0.014),postoperative TNM stage(HR=2.55,95%CI 1.05-6.18,P=0.038),neoadjuvant therapy(HR=2.75,95%CI 1.07-7.05,P=0.036),anastomosis-related complications(HR=4.52,95%CI 1.81-11.29,P=0.001),and disease recurrence(HR=24.83,95%CI 2.90-213.06,P=0.003)were significant independent risk factors for a defunctioning stoma to be permanent.Conclusions::Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage,but the stoma itself and its reversal procedure are associated with high morbidity of complications,and many defunctioning stomas eventually become permanent.Therefore,surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients.In addition,doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

Parastomal hernia repair

Despite significant advances in abdominal wall reconstruction,parastomal hernias remain a complex problem,with a high risk of recurrence following repair.While a number of surgical hernia repair techniques have been proposed,there is no consensus on optimal management.Several clinical variables must be considered when developing a comprehensive repair plan that minimizes the likelihood of hernia recurrence and surgical site occurrences.In this review,we describe the incidence of parastomal hernias and discuss pertinent risk factors,medical history findings,physical examination findings,supplementary diagnostic modalities,parastomal hernia classification systems,surgical indications,and repair techniques.Special consideration is given to the discussion of mesh reinforcement,including available biomaterials,anatomic plane selection,and the extent of mesh reinforcement.Although open repairs are the primary focus of this article,minimally invasive laparoscopic and robotic approaches are also briefly described.It is our hope that the provided surgical outcome data will help guide surgical management and optimize outcomes for affected patients.

Stomatal conductivity, canopy temperature and evapotranspiration of maize (Zea mays L.) to water stress in Northeast China

The Northeast China Plain(NECP)is one of the main maize(Zea mays L.)production regions in China but is now subject to drought because of climate change and a rain-fed cultivation system.A two-year experiment was conducted in a typical maize cultivation region in the NECP to investigate the responses of plant physiological factors and evapotranspiration(ET)to water stresses at different growth stages.Results show that the responses of plant physiological factors to water stress can be divided into three levels based on soil water content(SWC)in the main root zone:when SWC was greater than 0.22 cm^(3)/cm^(3)(equivalent to 62%field capacity(FC)),stomatal conductivity(gs)and ET reached their highest values,and the canopy temperature(Tc)was close to the air temperature;when SWC was within 0.15-0.22 cm^(3)/cm^(3)(43%-62%FC),the gs and ET decreased,and Tc increased as SWC decreased;and when SWC was lower than 0.15 cm^(3)/cm^(3)(<43%FC),gs and ET reached their lowest values and Tc was greater than 1.2 times the air temperature.The ratio of canopy temperature to air temperature(RT),is closely related to stomatal conductivity and soil water content,and especially linearly related to crop water stress index(CWSI),and can be used as an alternative to CWSI for evaluating maize water stress because of easily data achieving and simple calculation processes.In a conclusion,RT of 1.2 can be used as an index to identify a severe water stress status,and maintaining SWC greater than 60%FC at the heading and grain-filling stages is important for supporting maize normal ET and growth in the study region.

Diagnosis and management of parastomal pyoderma gangrenosum

Parastomal pyoderma gangrenosum(PPG)is an unusual neutrophilic dermatosis characterized by painful,necrotic ulcerations occurring in the area surrounding an abdominal stoma.It typically affects young to middle-aged adults,with a slight female predominance.The underlying etiology for PPG remains enigmatic but aberrant immune response to injury may play a pivotal role.The reported risk factors for the development of PPG include the presence of extra-intestinal manifestations,autoimmune disorders and obesity,along with local factors,such as the presence of parastomal hernia or pressure ulcer.PPG can develop at any time after the stoma construction.The histopathological features of PPG are not pathognomonic and its diagnosis is mainly based on clinical features.The management of PPG often requires a multidisciplinary approach,with a combination of local wound care and systemic medications.

Spontaneous closure of stoma

Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems,but it rarely undergoes spontaneous closure,without surgical intervention.Two male patients presented to our emergency surgical department with acute abdominal pain.One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation.The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy;the patient underwent second loop ileostomy,this time for complicated intestinal obstruction.To our surprise,both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks,respectively,without any consequences.Spontaneous stoma closure is a rare and interesting event.The exact etiology for spontaneous closure remains unknown,but it may be hypothesized to result from slow retraction of the stoma,added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula.