Annals of Coloproctology

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Review

Stoma

Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies: Filippo Carannante, Guglielmo Niccolò Piozzi, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Vincenzo Schiavone, Jim S. Khan, Marco Caricato, Gabriella Teresa Capolupo; Ann Coloproctol. 2025;41(6):491-500. Published online December 31, 2025; DOI: https://doi.org/10.3393/ac.2025.00801.0114

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Abstract PDF: Purpose
Stoma reversal is associated with notable postoperative morbidity. Several techniques exist for skin closure after stoma reversal, with linear primary closure (LC) and purse-string closure (PS) being the most common. This systematic review and meta-analysis aim to compare LC and PS skin closure after stoma reversal in terms of surgical site infection (SSI) rates, wound healing, and cosmesis.
Methods
In accordance with the PRISMA statement, a systematic review of skin closure after stoma reversal was conducted using MEDLINE (PubMed), Embase, Web of Science, and Scopus.
Results
Eleven studies, enrolling 1,052 patients (PS, n=534; LC, n=518), published between 2006 and 2024, were included. The overall quality of the studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3–5). Patients underwent ileostomy or ileostomy/colostomy in 6 and 5 studies, respectively. No differences were observed between groups in operative time, length of hospital stay, intestinal obstruction, or incisional hernia. However, SSI and overall infection rates were higher in the LC group, with a statistically significant difference for SSI.
Conclusion
Skin closure following stoma reversal using the PS technique may offer advantages over LC. PS is associated with significantly lower SSI rates compared to LC. Although a large randomized controlled trial with long-term follow-up is still required, current findings suggest that PS could be considered the standard of care for wound closure after ileostomy reversal.

Original Articles

ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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Graphical Abstract Abstract PDF

Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Application of Enhanced Recovery After Surgery in high-risk patients undergoing colon cancer surgery: a retrospective cohort study
Reem Mohammed H. Alshiakh, In Kyeong Kim, Jung Hoon Bae, Yoon Suk Lee, In Kyu Lee
Annals of Surgical Treatment and Research.2026; 110(4): 205. CrossRef
Comparison of Balanced Analgesia and Conventional Analgesia on Postoperative Pain and Recovery
Abdullah Al Mamun, Md Zaheedun Nabi, Mithun Mahbub Khan, Arufa Akhtar Mousumi
TAJ: Journal of Teachers Association.2026; 39(2): 101. CrossRef
Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Quadratus lumborum block for postoperative pain management in patients undergoing ileostomy closure: a prospective, randomized controlled trial
Su Jin Kang, Soo Yeun Park, Jun Seok Park, Jinseok Yeo
Journal of Yeungnam Medical Science.2025; 43: 5. CrossRef
Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

Benign bowel disease

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review: Julianna Seo, Ishith Seth, Dilshad Dooreemeah, Chun Hin Angus Lee; Ann Coloproctol. 2024;40(5):424-430. Published online March 2, 2023; DOI: https://doi.org/10.3393/ac.2022.00976.0139

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Abstract PDF Supplementary Material: Purpose
Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction.
Methods
PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients’ demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient.
Results
Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality.
Conclusion
This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Technical Note

Technical tip

Endoscopic transstomal stent insertion: a novel approach for a stenosed stoma in a challenging patient: Feras Aljarad, Ashutosh Gumber, Anne Marie McLeary, Kawan Shalli; Ann Coloproctol. 2023;39(4):357-361. Published online February 9, 2023; DOI: https://doi.org/10.3393/ac.2022.00962.0137

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Abstract PDF

Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.

Citations

Citations to this article as recorded by

Acupotomy in the management of colostomy stenosis after abdominoperineal resection: a case report
Yun Jiang, Zhenju Liu, Chaoying Cai, Xiaofeng Wang, Yi Yang
Frontiers in Medicine.2026;[Epub] CrossRef
Application of a novel two-piece pouch in postoperative enterostomy in miniature Parma pigs
Yingjie Liu, Caiyan Xue, Jianyuan Wan, Meijiao Lin
Asian Journal of Surgery.2025; 48(3): 1866. CrossRef
The Stomal Stent: A Novel Bridging Therapy for Patients Requiring Delayed Ostomy Revision
Mason Henrich, Bianca Fischer, Jun Tashiro
The American Surgeon™.2025; 91(4): 653. CrossRef

Original Articles

Stoma

Protective loop ileostomy or colostomy? A risk evaluation of all common complications: Yi-Wen Yang, Sheng-Chieh Huang, Hou-Hsuan Cheng, Shih-Ching Chang, Jeng-Kai Jiang, Huann-Sheng Wang, Chun-Chi Lin, Hung-Hsin Lin, Yuan-Tzu Lan; Ann Coloproctol. 2024;40(6):580-587. Published online January 27, 2023; DOI: https://doi.org/10.3393/ac.2022.00710.0101

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Abstract PDF

Purpose
Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice.
Methods
Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared.
Results
There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. For stoma retraction, the multivariate analysis revealed that female (odds ratio [OR], 4.00; 95% confidence interval [CI], 2.13–7.69; P<0.001) and long diversion duration (≥4 months; OR, 2.33; 95% CI, 1.22–4.43; P=0.010) were independent risk factors, but ileostomy was an independent favorable factor (OR, 0.40; 95% CI, 0.22–0.72; P=0.003). The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542).
Conclusion
We suggest avoiding colostomy in patients who are female and potential prolonged diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

Citations

Citations to this article as recorded by

The prognostic nutritional index and a multifactorial nomogram for predicting early stoma-related complications after prophylactic ileostomy: A retrospective cohort study
Xiao Lin, Yafei Zhang, Yuqin Wang, Wenjing Yan, Jing Bian, Xinrong Pei, Yan Zhang, Xia Sun
European Journal of Oncology Nursing.2026; 80: 103086. CrossRef
One-Stitch Versus Traditional Ileostomy After Low Anterior Resection for Rectal Cancer: A Retrospective Cohort Study
Ahmet Sencer Ergin, Ali Karabulut, Alparslan Saylar, Nihat Buğdaycı, Hakan Yiğitbaş
Medicina.2026; 62(3): 423. CrossRef
Impact of ileostomy reversal on gut microbiome and metabolome in rectal cancer: a review of mechanisms and clinical consequences
Haipeng Jin, Wenqiang Zhou, Rongbiao Ying
Langenbeck's Archives of Surgery.2026;[Epub] CrossRef
Choosing a method for forming preventive intestinal stoma in low anterior rectal resection
E. I. Golovina, V. V. Oleksenko, B. D. Seferov, S. I. Efetov
Grekov's Bulletin of Surgery.2026; 185(2): 106. CrossRef
Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications
Dawan Jamal Hawezy, Waleed Baqer, Araz Omar Fatah, Marwa Fadhil Alsaffar
BMC Surgery.2026;[Epub] CrossRef
Prevention and management of anastomotic leakage after colorectal resection: evolving trends among Italian surgeons. A SICCR survey
Renato Costi, Alfredo Annicchiarico, Antonio Amato, Cristina Folliero, Claudio Guerci, Alessandro Facchinetti, Filippo Montali, Adolfo Petrina, Agnese Dezi, Agostino Falcone, Agostino Fernicola, Alba Oliva, Alberto Buonanno, Alberto Porcu, Alberto Servent
Updates in Surgery.2026;[Epub] CrossRef
Gut microbiome and plasma metabolome alterations in ileostomy and after closure of ileostomy
Liang Xu, Xiaolong Li, Lang Chen, Haitao Ma, Ying Wang, Wenwen Liu, Anyan Liao, Liang Tan, Xiao Gao, Weidong Xiao, Hua Yang, Guangyan Ji, Yuan Qiu, Wei-Hua Chen, Qin Liu, Song Liu, Yang Yang
Microbiology Spectrum.2025;[Epub] CrossRef
Effect of one-stitch method of temporary ileostomy on the surgical outcomes and complications after laparoscopic low anterior resection in rectal cancer patients: a propensity score matching analysis
Xin-Peng Shu, Jia-Liang Wang, Zi-Wei Li, Fei Liu, Xu-Rui Liu, Lian-Shuo Li, Yue Tong, Xiao-Yu Liu, Chun-Yi Wang, Yong Cheng, Dong Peng
European Journal of Medical Research.2025;[Epub] CrossRef
The Differences in Postoperative Nursing Between Temporary Ileostomy and Temporary Colostomy: A Retrospective Cohort Study
Mei Wang, Lihong Dai, Xia Fang, Yan Zheng, Yuanhao Shen, Yang Yu
Nursing Open.2025;[Epub] CrossRef
Preventive intestinal stoma: ileostomy, colostomy. Which option is safer? (meta-analysis and systematic review)
Yu. A. Elfimova, R. I. Fayzulin, S. V. Chernyshov, E. G. Rybakov
Koloproktologia.2025; 24(4): 152. CrossRef
Uso de ileostomía derivativa en cáncer de ovario. Revisión de la literatura
Franco Rafael Ruiz-Echeverría, Pedro Hernando Calderón-Quiroz, Juliana Rendón-Hernández
Revista Colombiana de Cirugía.2024; 39(4): 603. CrossRef
Meta-analysis: loop ileostomy versus colostomy to prevent complications of anterior resection for rectal cancer
Shilai Yang, Gang Tang, Yudi Zhang, Zhengqiang Wei, Donglin Du
International Journal of Colorectal Disease.2024;[Epub] CrossRef
The Role of Colon in Isolated Intestinal Transplantation: Description of 4 Cases
Pierpaolo Di Cocco, Giulia Bencini, Alessandro Martinino, Egor Petrochenkov, Stepan Akshelyan, Kentaro Yoshikawa, Mario Spaggiari, Jorge Almario-Alvarez, Ivo Tzvetanov, Enrico Benedetti, Gaetano Gallo
International Journal of Surgical Oncology.2024;[Epub] CrossRef

Benign bowel disease

Development of a home health care service platform for ostomy patient management: Seongwoo Yang, Ji Won Park, Hyuk Hur, Min Jung Kim, Seung-Yong Jeong, Kyounghoon Park, Ik Yong Kim; Ann Coloproctol. 2024;40(1):36-43. Published online November 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00360.0051

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11 Citations

Abstract PDF

Purpose
The use of an ostomy for urination and defecation leads to reduced quality of life. Although many ostomy management strategies are needed, such strategies are often implemented by patients. Thus, there is a need for a home health care service platform that can be used in ostomy patient management.
Methods
We developed an ostomy patient management platform by identifying the needs of patients and medical staff through the Chronic Care Ostomy Self-Management Training Program in the United States and from studies conducted in Korea.
Results
The platform encompassed physical management, psychological management, maintenance of social function, spiritual stability, and home medical care. These components were implemented through monitoring, self-care guidance, and a community platform. For the monitoring function, patients entered their health status in a mobile application (app); the medical staff at the affiliated hospital then monitored the stoma status through a web interface.
Conclusion
Our platform allows medical staff to monitor ostomy patients through a web interface and help such patients to fully manage their ostomy at home using an app. We expect that the continued development of patient-oriented functions in our app will allow ostomy patients to experience quality-of-life improvements.

Citations

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Examining the Impact of Telehealth Stoma Care Interventions on the Ostomates: A Systematic Review and Meta‐Analysis
Soyeon Kim, Ha Na Jeong
Journal of Clinical Nursing.2026; 35(2): 621. CrossRef
Nurses’ willingness and demand for providing Internet+home care services in the elderly with disabilities or dementia and the associated factors in provincial hospitals in China: A cross-sectional study
Jiaxin Lv, Binbin Xu, Haixia Yu, Nian Yao, Jiaji Hu, Zhengkun Shi, Yuhua Fan, Cailan Zhang, Jinghui Zhang
Geriatric Nursing.2026; 68: 103873. CrossRef
Effects of Intestinal Stoma Odor and Pouch Ballooning on Quality of Life and Associated Intervention Strategies
Cui-Ping Xiu, Hai-Yan Jin, Xiao-Qing Xu, Peng Chen
Journal of Multidisciplinary Healthcare.2026; Volume 19: 1. CrossRef
Effects of digital health interventions on self-care and quality of life in patients with an ostomy: A systematic review and meta-analysis
Donglin Wang, Na Zhou, Yingjie Zhang, Jianjuan Dai
Asia-Pacific Journal of Oncology Nursing.2026; 13: 100955. CrossRef
Applications of Telemedicine in Patients with an Ostomy: A Scoping Review
Zhuang Hui-Ren, Zhang Jin, Zheng Pian, Zhang Wei-ying
Advances in Skin & Wound Care.2025; 38(5): 258. CrossRef
Experience of participating in national home-based medical care project for cancer patients with a temporary stoma: a qualitative study
Su Jung Lee, SolBi Jang, YongEun Hong, Hyun Suk Park, Young Ae Kim
Supportive Care in Cancer.2025;[Epub] CrossRef
A randomized controlled trial of a digital lifestyle intervention involving postoperative patients with colorectal cancer
Young Il Kim, In Ja Park, Jun-Soo Ro, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Yura Lee, Yae Won Tak, Seockhoon Chung, Kyung Won Kim, Yousun Ko, Sung-Cheol Yun, Min-Woo Jo, Jong Won Lee
npj Digital Medicine.2025;[Epub] CrossRef
Need-based remote exercise management platform for colorectal cancer patients with intestinal stoma: design and pilot usability evaluation
Cui Yao, Lingyu Ding, Jing Yang, Yueming Sun
Frontiers in Rehabilitation Sciences.2025;[Epub] CrossRef
A mobile application for home-based care of indwelling medical devices: Protocol for development and pilot implementation based on the self-efficacy framework and the analysis, design, development, implementation, evaluation (ADDIE) model
Dakyung Lee, Anna Lee
Health Informatics Journal.2025;[Epub] CrossRef
Mobile Applications for People With Fecal Intestinal Stomas: A Scoping Review With Technological Prospection
Isabelle Pereira da Silva, Rafael Moreira do Nascimento, Felipe Silva Ferreira, Silvia Kalyma Paiva Lucena, Iara Lorena Alves de Morais, Rhayssa de Oliveira e Araújo, Isabelle Katherinne Fernandes Costa
Advances in Skin & Wound Care.2025; 38(9): E107. CrossRef
Lebensqualität von Stomapatienten
Michael S. Kasparek
coloproctology.2023; 45(4): 242. CrossRef

Benign bowel disease

Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases: Sara Gortázar de las Casas, Emanuela Spagnolo, Salomone Di Saverio, Mario Álvarez-Gallego, Ana López Carrasco, María Carbonell López, Sergio Torres Cobos, Constantino Fondevila Campo, Alicia Hernández Gutiérrez, Isabel Pascual Miguelañez; Ann Coloproctol. 2023;39(3):216-222. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00829.0118

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Abstract PDF

Purpose
The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI).
Methods
A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections.
Results
The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4–16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7–18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy.
Conclusion
In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.

Citations

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Surgically Relative Risk Factors for Lower Colorectal Anastomotic Dehiscence and Rectovaginal Fistulas in Complex Deep Endometriosis Cases: A Single-Center Retrospective–Prospective Cohort Study
Krzysztof Nowak, Alicja Dąbrowska, Maja Mrugała, Ewa Milnerowicz-Nabzdyk
Journal of Clinical Medicine.2026; 15(7): 2630. CrossRef
Selective temporary protective loop ileostomy in complex rectal resection for deep infiltrating endometriosis: a prospective matched cohort study on bowel function, quality of life, and postoperative complications
Dawan Jamal Hawezy, Waleed Baqer, Araz Omar Fatah, Marwa Fadhil Alsaffar
BMC Surgery.2026;[Epub] CrossRef
Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve
Emanuela Spagnolo, Ignacio Cristóbal Quevedo, Sara Gortázar de las Casas, Ana López Carrasco, Maria Carbonell López, Isabel Pascual Migueláñez, Alicia Hernández Gutiérrez
Frontiers in Surgery.2022;[Epub] CrossRef
Quality of Life in Women after Deep Endometriosis Surgery: Comparison with Spanish Standardized Values
Alicia Hernández, Elena Muñoz, David Ramiro-Cortijo, Emanuela Spagnolo, Ana Lopez, Angela Sanz, Cristina Redondo, Patricia Salas, Ignacio Cristobal
Journal of Clinical Medicine.2022; 11(20): 6192. CrossRef

Benign proctology,Rare disease & stoma,Surgical technique

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction: Yongjun Park, Dong Uk Choi, Hyung Ook Kim, Yong Bog Kim, Chungki Min, Jung Tack Son, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim; Ann Coloproctol. 2022;38(4):319-326. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00682.0097

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Graphical Abstract Abstract PDF

Purpose
Surgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy.
Methods
Palliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared.
Results
The median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021).
Conclusion
In surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Citations

Citations to this article as recorded by

Transverse blowhole colostomy versus Hartmann’s for urgent management of large bowel obstruction secondary to diverticular stricture
Hannah R. Liefeld, Kristen L. Coleman, Kelsey Lawrence, James W. Ogilvie
International Journal of Colorectal Disease.2026;[Epub] CrossRef
A Last Resort: Dacron Vascular Graft Prosthesis for Management of a Blowhole Colostomy
Brittney A. Ehrlich, Maria C. Unuvar, Justin M. Orenich, Rebecca L. Hoffman
The American Surgeon™.2025; 91(2): 303. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Stoma-Related Complications: A Single-Center Experience and Literature Review
Zalán Benedek, Loránd Kocsis, Orsolya Bauer, Nicolae Suciu, Sorin Sorlea, Călin Crăciun, Rareș Georgescu, Marius Florin Coroș
Journal of Interdisciplinary Medicine.2022; 7(2): 31. CrossRef

Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries: Dan Assaf, David Hazzan, Almog Ben-Yaacov, Shachar Laks, Douglas Zippel, Lior Segev; Ann Coloproctol. 2023;39(2):168-174. Published online August 6, 2021; DOI: https://doi.org/10.3393/ac.2021.00241.0034

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Abstract PDF

Purpose
One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS.
Methods
We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group.
Results
A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001).
Conclusion
Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

Citations

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Clinical factors associated with early high-output stoma and 30-day readmission: a retrospective cohort study
Erman Yekenkurul, Fatih Gürsoy, Mehmet Emin Gönüllü, Mehmet Fuat Çetin
Updates in Surgery.2026;[Epub] CrossRef
Different results with early single-stage and staged repair in infants with ileal atresia: a two-case report on the effect of timing and treatment approach
Layth J.M. Saada, Jamil Saada
International Journal of Surgery Case Reports.2026;[Epub] CrossRef
High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
BMC Gastroenterology.2025;[Epub] CrossRef
Atrial Flutter With Intraventricular Conduction Delay, Hypotension, and Bradycardia in the Setting of High-Output Ileostomy With Renal Failure, Hyperkalemia, and Metabolic Acidosis: A Case Report With Brief Literature Review
Edinen Asuka, Barbara Odac, Andrew Ndakotsu, Anastasia Postoev
Cureus.2025;[Epub] CrossRef
Preoperative High Agatston Score in Aorta Leads to Postoperative High-Output Ileostomy
Yusuke Kono, Manabu Yamamoto, Chiharu Yasui, Ryo Ishiguro, Takuki Yagyu, Kyoichi Kihara, Tomoyuki Matsunaga, Shuichi Takano, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara
Journal of Surgical Research.2025; 314: 139. CrossRef
A review of chyme reinfusion: new tech solutions for age old problems
Chen Liu, Sameer Bhat, Ian Bissett, Gregory O'Grady
Journal of the Royal Society of New Zealand.2024; 54(2): 161. CrossRef
Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study
Qing Zhang, Jianan Sun, Dongxue Wang, Quan Wang, Haiyan Hu
Supportive Care in Cancer.2024;[Epub] CrossRef
Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer
A.I. Maksimkin, Z.A. Bagatelia, V.M. Kulushev, E.N. Gordienko, M.S. Lebedko, S.S. Anikina, E.P. Shin
Pirogov Russian Journal of Surgery.2024; (4): 16. CrossRef
The Frequency of Stoma-Related Readmissions After Emergency and Elective Ileostomy Formation: The Leicester Experience
Ting-Wei Wu, Wen Yuan Chung, Hui En Jewel Ng, Ashley Yap, Konstantinos Baronos, Deepak Paul, Christopher P Neal, David Bowrey
Cureus.2024;[Epub] CrossRef
Predictors of High-output Stoma in Diverting Ileostomy for Rectal Cancer Surgery
Hiroaki Uehara, Hitoshi Kameyama, Toshiyuki Yamazaki, Akira Iwaya, Yuya Enoki
Nippon Daicho Komonbyo Gakkai Zasshi.2023; 76(3): 286. CrossRef
Morpho-functional aspects of various parts of the intestine and risk factors associated with the preventive ileostomy (review)
A. I. Maksimkin, Z. A. Bagatelia, E. N. Gordienko, E. B. Emelyanova, D. M. Sakaeva
Koloproktologia.2023; 22(4): 147. CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef

Case Report

Metachronous carcinoma at the colostomy site after abdominoperineal resection of rectal cancer: a case report: Young Sun Choi, Kil-young Lee, Youn Young Park, Hyung Jin Kim, Jaeim Lee; Ann Coloproctol. 2023;39(2):175-177. Published online July 27, 2021; DOI: https://doi.org/10.3393/ac.2020.00185.0026

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6 Citations

Abstract PDF

Metachronous carcinoma at the colostomy site is very rare after abdominoperineal resection. A 53-year-old male patient underwent an abdominoperineal resection 6 years earlier for rectal cancer developed metachronous carcinoma at the site of stoma. A portion of the colon, including the stoma and the surrounding skin, was resected and a new stoma was created in the transverse colon. Although the occurrence of carcinoma at the stoma site is a rare condition, careful observation for the stoma and colonoscopy for surveillance are necessary.

Citations

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Tumor Recurrence at the Colostomy Site: A Rare Case Report and Literature Review
Abdelhak Ettaoussi, Ilias El Azhari, Nassima Fakhiri, Abdessamad Majd, Kamal Khadija, Mounir Bouali, Abdelilah El Bakouri, Khalid Khaleq, Khalid El Hattabi
European Journal of Medical and Health Research.2025; 3(3): 215. CrossRef
A rare case of metastatic carcinoma at the colostomy site after abdominoperineal resection
Dheeraj Manne, Tirou Aroul, Robinson Smile
International Surgery Journal.2025; 12(10): 1849. CrossRef
Colostomy‐site carcinoma with primitive phenotype in a rectal cancer patient after achieving pathological complete response with neoadjuvant chemoradiotherapy
Takayuki Kodama, Maki Kanzawa, Hiroshi Hasegawa, Shuichi Tsukamoto, Mari Nishio, Manabu Shigeoka, Yu‐ichiro Koma, Tomoo Itoh, Hiroshi Yokozaki
Pathology International.2024; 74(1): 33. CrossRef
Metachronous Carcinoma at Colostomy Site Post Abdominoperineal Resection – A Rare Presentation Case Report
Muhammed Huzaifa, Ankita Singh, Vaibhav Aggarwal, Anita Dhar
Clinical Cancer Investigation Journal.2023; 12(2): 1. CrossRef
Peristomal adenocarcinoma 16 years after colorectal adenocarcinoma resection with curative intent
Kayleigh A M van Dam, Thaís T T Tweed, Bart de Vries, Henricus J Belgers
Journal of Surgical Case Reports.2023;[Epub] CrossRef
A Rare Case of Metachronous Carcinoma at the Colostomy Site Following Abdominoperineal Resection – Case Report
Naoki Todayama, Ai Hua Chang, Tomohiro Tabata
Archive of International Journal of Cancer and Allied Science.2023; 3(2): 1. CrossRef

Original Articles

Benign diesease & IBD,Minimally invasive surgery

Laparoscopic Hartmann reversal: experiences from a developing country: Dung Anh Nguyen, Tuong-Anh Mai-Phan, Truc Thanh Thai, Hai Van Nguyen; Ann Coloproctol. 2022;38(4):297-300. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00577.0082

30,587 View
189 Download
3 Web of Science
2 Citations

Abstract PDF

Purpose
Laparoscopic surgery is considered a promising approach for Hartmann reversal but is also a complicated major surgical procedure. We conducted a retrospective analysis at a city hospital in Vietnam to evaluate the treatment technique and outcomes of laparoscopic Hartmann reversal (LHR).
Methods
A colorectal surgery database in 5 years between 2015 and 2019 (1,175 cases in total) was retrieved to collect 35 consecutive patients undergoing LHR.
Results
The patients had a median age of 61 years old. The median operative time was 185 minutes. All the procedures were first attempted laparoscopically with a conversion rate of 20.0% (7 of 35 cases). There was no intraoperative complication. Postoperative mortality and morbidity were 0 and 11.4% (2 medical, 1 deep surgical site infection, and 1 anastomotic leak required reoperation) respectively. The median time to first bowel activity was 2.8 days and median length of hospital stay was 8 days.
Conclusion
When performed by skilled surgeons, LHR is a feasible and safe operation with acceptable morbidity rate.

Citations

Citations to this article as recorded by

Hartmann’s procedure reversal rate and short-term outcomes: a single centre retrospective cohort study
Christopher C L Liao, Balakrisanan Saravanan, Fatima Ismail, Matthew Farmer, Vamsi R Velchuru
BMC Surgery.2026;[Epub] CrossRef
Surgical Outcomes of Open and Laparoscopic Hartmann Reversal: A Single-Center Comparative Study
Mu-Han Tsai, Ming-Jenn Chen, Khaa-Hoo Ong, Chih-Ying Lu, Chung-Han Ho, Hsuan-Yi Huang, Yu-Feng Tian, I-Ning Yang
Cureus.2024;[Epub] CrossRef

Benign GI diease,Benign diesease & IBD,Rare disease & stoma

Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons: David A. Clark, Bree Stephensen, Aleksandra Edmundson, Daniel Steffens, Michael Solomon; Ann Coloproctol. 2021;37(5):337-345. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.09.14.1

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10 Citations

Abstract PDF

Purpose
Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary diverting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons.
Methods
A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon’s preference for the use of diverting stomas, rectal tubes, and pelvic drains.
Results
There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouches
Conclusion
There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.

Citations

Citations to this article as recorded by

Interrupted Ileostomy Tube vs. traditional diverting ileostomy in low rectal cancer: a propensity score–matched retrospective study
Haiyuan Zhao, Yilin Liu, Yan Jin, Yang Li, Daping Jiang, Guohai Zhao, Jun Zhao
Mini-invasive Surgery.2026;[Epub] CrossRef
Predictors of pouch failure and quality of life following ileal pouch‐anal anastomosis for ulcerative colitis: a retrospective multicenter study
Ahmet Rencuzogullari, Cihangir Akyol, Ismail Hamzaoglu, Tahsin Colak, Tayfun Karahasanoglu, Ugur Sungurtekin, Sezai Leventoglu, Ersin Ozturk, Mustafa Ali Korkut, Selman Sokmen
ANZ Journal of Surgery.2025; 95(3): 457. CrossRef
Drain fluid iodine as a biomarker of anastomotic leak after low anterior resection in patients undergoing Gastrografin rectal tube flushes and omission of a diverting ileostomy: The GUSH study
David A. Clark, Karen Dobeli, Darren Allen, Brett McWhinney, Michael Lonne, Aleksandra Edmundson
Colorectal Disease.2025;[Epub] CrossRef
Feasibility of triple assessment of the anastomosis using an anastomotic checklist
Madeleine Louise Kelly, Amy Cao, Ruben Rajan, David A Clark
ANZ Journal of Surgery.2024; 94(10): 1812. CrossRef
Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy
David A. Clark, Aleksandra Edmundson, Daniel Steffens, Craig Harris, Andrew Stevenson, Michael Solomon
ANZ Journal of Surgery.2022; 92(4): 813. CrossRef
Surgical management and long‐term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy
Tony McGiffin, David A. Clark, Aleks Edmundson, Daniel Steffens, Andrew Stevenson, Michael Solomon
ANZ Journal of Surgery.2022; 92(4): 806. CrossRef
Does an ileostomy cover the surgeon or the anastomosis?
David A. Clark, Andrew Stevenson, John Lumley, Damien Petersen, Craig Harris, Daniel Steffens, Michael Solomon
ANZ Journal of Surgery.2022; 92(1-2): 19. CrossRef
Risk taking propensity: Nurse, surgeon and patient preferences for diverting ileostomy
Ian Mackay, David A. Clark, James Nicholson, Aleks Edmundson, Daniel Steffens, Michael Solomon
Colorectal Disease.2022; 24(9): 1073. CrossRef
Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy
David A. Clark, • Aleksandra Edmundson, Daniel Steffens, Graham Radford-Smith, Michael Solomon
Diseases of the Colon & Rectum.2022; 65(11): 1335. CrossRef
An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice
David A. Clark, Daniel Steffens, Michael Solomon
Colorectal Disease.2021; 23(11): 2795. CrossRef

Malignant disease, Functional outcomes,Colorectal cancer

The Relationship Between High-Output Stomas, Postoperative Ileus, and Readmission After Rectal Cancer Surgery With Diverting Ileostomy: Naa Lee, Soo Young Lee, Chang Hyun Kim, Han Deok Kwak, Jae Kyun Ju, Hyeong Rok Kim; Ann Coloproctol. 2021;37(1):44-50. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.03

6,734 View
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13 Citations

Abstract PDF

Purpose
This study aimed to evaluate the relationship between high-output stomas (HOSs), postoperative ileus (POI), and readmission after rectal cancer surgery with diverting ileostomy.
Methods
We included 302 patients with rectal cancer who underwent restorative resection with diverting ileostomy between January 2011 and December 2015. HOSs were defined as stomas with ≥ 2,000 mL/day output. We analyzed predictive factors for readmission of these patients.
Results
Forty-eight patients (15.9%) had HOSs during the hospital stay, and 41 patients (13.6%) experienced POI. HOSs were strongly associated with POI (45.8% vs. 7.5%, P < 0.001). The all-cause readmission rate was 16.9%, with 19 (6.3%) and 20 (6.6%) experiencing ileus and acute kidney injury, respectively. HOSs (27.1% vs. 15.0%, P = 0.040) and POI (34.1% vs. 14.2%, P = 0.002) were associated with all-cause readmission, and POI was associated with readmission with ileus (17.1% vs. 4.6%, P = 0.007). POI was an independent risk factor for all-cause readmission (adjusted odds ratio [OR], 2.640; 95% confidence interval [CI], 1.162 to 6.001; P = 0.020) and readmission with ileus (adjusted OR = 3.869; 95% CI 1.387 to 10.792; P = 0.010).
Conclusion
POI was associated with readmission, particularly for subsequent ileus, in patients with diverting ileostomy. We should make efforts to reduce POI, such as strong control of HOSs, to prevent readmission.

Citations

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Risk factors and prediction model for early high-output stoma after colorectal cancer surgery: A retrospective study
Haiyan Chen, Qunmin Wang, Yehong Chen, Lu Li, Feixia Wang, Chaoxu Liu
Asia-Pacific Journal of Oncology Nursing.2026; 13: 100922. CrossRef
Reducing Ileostomy Postoperative Complications Due to Dehydration
Amanda Eltz, Jennifer Trueheart, Tara Beuscher, Christopher Mantyh, Tracey L. Yap
Journal of Wound, Ostomy & Continence Nursing.2026; 53(3): 219. CrossRef
Clinical factors associated with early high-output stoma and 30-day readmission: a retrospective cohort study
Erman Yekenkurul, Fatih Gürsoy, Mehmet Emin Gönüllü, Mehmet Fuat Çetin
Updates in Surgery.2026;[Epub] CrossRef
High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
BMC Gastroenterology.2025;[Epub] CrossRef
Summary of Best Evidence for the Dietary Management in Patients with High-Output Ileostomy
Ying Wang, Hua Peng, Cui Cui, Qi Zou, Mudi Yang
Journal of Multidisciplinary Healthcare.2025; Volume 18: 877. CrossRef
Elevating surgical standards: The role of intraperitoneal isoperistaltic side-to-side anastomosis in colon cancer surgery
Sung Uk Bae
World Journal of Gastrointestinal Oncology.2025;[Epub] CrossRef
Maximizing Readmission Reduction in Colon Cancer Patients
Mario Schootman, Chenghui Li, Jun Ying, Sonia T. Orcutt, Jonathan Laryea
Journal of Surgical Research.2024; 295: 587. CrossRef
Analysis of decision-making factors for defunctioning ileostomy after rectal cancer surgery and their impact on perioperative recovery: a retrospective study of 1082 patients
Xiaojiang Yi, Huaguo Yang, Hongming Li, Xiaochuang Feng, Weilin Liao, Jiaxin Lin, Zhifeng Chen, Dechang Diao, Manzhao Ouyang
Surgical Endoscopy.2024; 38(11): 6782. CrossRef
Effect of intracorporeal anastomosis on postoperative ileus after laparoscopic right colectomy
Sangwoo Kim, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek, Young-Gil Son
Annals of Surgical Treatment and Research.2023; 104(3): 156. CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Overall readmissions and readmissions related to dehydration after creation of an ileostomy: a systematic review and meta-analysis
I. Vogel, M. Shinkwin, S. L. van der Storm, J. Torkington, J. A.Cornish, P. J. Tanis, R. Hompes, W. A. Bemelman
Techniques in Coloproctology.2022; 26(5): 333. CrossRef
Postoperative paralytic ileus following debulking surgery in ovarian cancer patients
Eva K. Egger, Freya Merker, Damian J. Ralser, Milka Marinova, Tim O. Vilz, Hanno Matthaei, Tobias Hilbert, Alexander Mustea
Frontiers in Surgery.2022;[Epub] CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef

Case Report

Benign GI diease,Benign diesease & IBD,Complication

Clostridium difficile Infection After Ileostomy Reversal: Ho Seung Kim, Jae Hyun Kang, Han-gil Kim, Young Hun Kim, Hyeonwoo Bae, Nam Kyu Kim; Ann Coloproctol. 2021;37(Suppl 1):S4-S6. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.24

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Abstract PDF

Clostridium difficile infection (CDI) after ileostomy reversal is rare, with few reports available in the available literature describing this condition. The diagnosis of CDI after ileostomy reversal is challenging because symptoms such as diarrhea observed in these patients can occur frequently after surgery. However, CDI can be fatal, so early diagnosis and prompt treatment are important. We discuss 2 patients with positive C. difficile toxin assay results on stool cultures performed after ileostomy reversal. Clinical progression differed between these patients: one patient who presented with severe CDI and shock was successfully treated following a prolonged intensive care unit stay for the management of vital signs and underwent hemodialysis, while another patient showed symptoms of mild colitis but we could not confirm whether diarrhea was associated with CDI or with the usual postoperative state. To our knowledge, these represent 2 of just a few cases reported in the literature describing CDI after ileostomy reversal.

Citations

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Influence of additional prophylactic oral antibiotics during mechanical bowel preparation on surgical site infection in patients receiving colorectal surgery
Hayoung Lee, Jong Lyul Lee, Ji Sung Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok‐Byung Lim
World Journal of Surgery.2024; 48(6): 1534. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Original Articles

Malignant disease, Functional outcomes

Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings: Seng-Muk Kang, Jung Rae Cho, Heung-Kwon Oh, Eun-Ju Lee, Min Hyun Kim, Duck-Woo Kim, Sung-Bum Kang; Ann Coloproctol. 2020;36(1):17-21. Published online February 29, 2020; DOI: https://doi.org/10.3393/ac.2019.04.25

6,339 View
84 Download
1 Web of Science
2 Citations

Abstract PDF

Purpose
Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy.
Methods
Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed.
Results
Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality.
Conclusion
Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.

Citations

Citations to this article as recorded by

Single port–assisted diverting ileostomy formation for anastomotic leakage after low anterior resection
Kyong-Min Kang, Heung-Kwon Oh, Hong-min Ahn, Hye-Rim Shin, Min-Hyeong Jo, Mi-Jeong Choi, Duck-Woo Kim, Sung-Bum Kang
Journal of Minimally Invasive Surgery.2025; 28(1): 47. CrossRef
Comparison between liquid skin adhesive and wound closure strip for skin closure after subcuticular suturing in single-port laparoscopic appendectomy: a single-center retrospective study in Korea
Kyeong Eui Kim, Yu Ra Jeon, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Journal of Minimally Invasive Surgery.2024; 27(1): 14. CrossRef

Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery: Yoo Jin Choi, Jung-Myun Kwak, Neul Ha, Tae Hoon Lee, Se Jin Baek, Jin Kim, Seon Hahn Kim; Ann Coloproctol. 2019;35(4):187-193. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.10.18.1

9,412 View
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14 Citations

Abstract PDF

Purpose
No guidelines exist detailing when to implement a temporary ileostomy closure in the setting of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer. The aim of this study was to evaluate the clinical and oncological outcomes of ileostomy closure during adjuvant chemotherapy in patients with curative resection of rectal cancer.
Methods
This retrospective study investigated 220 patients with rectal cancer undergoing sphincter-saving surgery with protective loop ileostomy from January 2007 to August 2016. Patients were divided into 2 groups: group 1 (n = 161) who underwent stoma closure during adjuvant chemotherapy and group 2 (n = 59) who underwent stoma closure after adjuvant chemotherapy.
Results
No significant differences were observed in operative time, blood loss, postoperative hospital stay, or postoperative complications in ileostomy closure between the 2 groups. No difference in overall survival (P = 0.959) or disease-free survival (P = 0.114) was observed between the 2 groups.
Conclusion
Ileostomy closure during adjuvant chemotherapy was clinically safe, and interruption of chemotherapy due to ileostomy closure did not change oncologic outcomes.

Citations

Citations to this article as recorded by

Impact of combined treatment for rectal cancer on long-term outcomes
O. K. Bondarenko, Yu. A. Gevorkyan, N. V. Soldatkina, M. A. Gusareva, N. G. Kosheleva, A. A. Maslov, Yu. A. Fomenko, D. S. Petrov, E. N. Kolesnikov, A. N. Shevchenko, A. V. Shaposhnikov, D. A. Savchenko, V. Yu. Gevorkyan, D. V. Kolesnikov, O. I. Kit
South Russian Journal of Cancer.2026; 7(2): 34. CrossRef
Early closure of protective ileostomy—a benefit for the patient?
Zuzana Adamová, Michaela Filová, Veronika Pechalová, Martin Chrostek, Radim Slováček
European Surgery.2025; 57(4): 172. CrossRef
Clinical Outcomes of Ileostomy Closure during versus after Adjuvant Chemotherapy in Patients with Rectal Cancer
Fan He, Fuyu Yang, Chenglin Tang, Defei Chen, Dongqin Zhao, Junjie Xiong, Yu Zou, Guoquan Huang, Kun Qian, Masanao Nakamura
Canadian Journal of Gastroenterology and Hepatology.2024; 2024: 1. CrossRef
Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence—a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial)
Sven Müller, Dirk Weyhe, Florian Herrle, Philipp Horvath, Robert Bachmann, Viktor von Ehrlich-Treuenstätt, Patrick Heger, Nadir Nasir, Christina Klose, Alexander Ritz, Anja Sander, Erich Grohmann, Colette Dörr-Harim, André L. Mihaljevic
Trials.2023;[Epub] CrossRef
Impact of chemotherapy on surgical outcomes in ileostomy reversal: a propensity score matching study from a single centre
H.-H. Cheng, Y.-C. Shao, C.-Y. Lin, T.-W. Chiang, M.-C. Chen, T.-Y. Chiu, Y.-L. Huang, C.-C. Chen, C.-P. Chen, F.-F. Chiang
Techniques in Coloproctology.2023; 27(12): 1227. CrossRef
Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients
Kun-Yu Tsai, Jeng-Fu You, Shu-Huan Huang, Tzong-yun Tsai, Pao-Shiu Hsieh, Cheng-Chou Lai, Wen-Sy Tsai, Hsin-Yuan Hung
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis
Li Wang, Xinling Chen, Chen Liao, Qian Wu, Hongliang Luo, Fengming Yi, Yiping Wei, Wenxiong Zhang
Surgery Today.2021; 51(4): 463. CrossRef
Low albumin level and longer interval to closure increase the early complications after ileostomy closure
HyungJoo Baik, Ki Beom Bae
Asian Journal of Surgery.2021; 44(1): 352. CrossRef
Does the timing of protective ileostomy closure post-low anterior resection have an impact on the outcome? A retrospective study
Fozan Sauri, Ahmad Sakr, Ho Seung Kim, Mohammed Alessa, Radwan Torky, Eman Zakarneh, Seung Yoon Yang, Nam Kyu Kim
Asian Journal of Surgery.2021; 44(1): 374. CrossRef
Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis
I. Vogel, N. Reeves, P. J. Tanis, W. A. Bemelman, J. Torkington, R. Hompes, J. A. Cornish
Techniques in Coloproctology.2021; 25(7): 751. CrossRef
Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center
Zhen Sun, Yufeng Zhao, Lu Liu, Jichao Qin, Zhongguang Luo
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef
Delayed ileostomy closure increases the odds of Clostridium difficile infection
Simon J. G. Richards, Dilshan K. Udayasiri, Ian T. Jones, Ian A. Hastie, Raaj Chandra, Jacob J. McCormick, Timothy J. Chittleborough, David J. Read, Ian P. Hayes
Colorectal Disease.2021; 23(12): 3213. CrossRef
The effect of ileostomy closure timing on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer
Hemn Hussain Kaka Ali, Qalandar Hussein Abdulkarim, Karzan Seerwan, Barham M. M .Salih, Omar H Ghalib Hawramy, Dara Ahmed Mohammed, Syamand Orhaman Ahmed
Kurdistan Journal of Applied Research.2021; : 126. CrossRef
Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients
Marcin Zeman, Marek Czarnecki, Andrzej Chmielarz, Adam Idasiak, Maciej Grajek, Agnieszka Czarniecka
World Journal of Surgical Oncology.2020;[Epub] CrossRef

Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?: Chris Tae-Young Chung, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim; Ann Coloproctol. 2019;35(1):30-35. Published online January 25, 2019; DOI: https://doi.org/10.3393/ac.2018.08.13

9,035 View
163 Download
5 Web of Science
5 Citations

Abstract PDF

Purpose
The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus.
Methods
The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus.
Results
Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture.
Conclusion
Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Citations

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Nirvana B. Saraswat, Scott A. Brill, William E. Wise
The American Surgeon™.2023; 89(2): 322. CrossRef
The management of asymptomatic radiological anastomotic leakage following anterior resection
Mohamed Rabie, Laura Parry, Iannish Sadien, Sandeep Kapur, Adam Stearns, Irshad Shaikh
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Peter Kienle, Jörn Richard Magdeburg
Der Chirurg.2021; 92(7): 605. CrossRef
Response to Dioscoridi et al.
G. I. Popivanov, V. M. Mutafchiyski, R. Cirocchi, S. D. Chipeva, V. V. Vasilev, K. T. Kjossev, M. S. Tabakov
Colorectal Disease.2020; 22(7): 841. CrossRef
Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?
Chang Hyun Kim
Annals of Coloproctology.2019; 35(1): 1. CrossRef

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal: Won Park, Won Cheol Park, Keun Young Kim, Seok Youn Lee; Ann Coloproctol. 2018;34(6):306-311. Published online December 20, 2018; DOI: https://doi.org/10.3393/ac.2018.09.07

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Abstract PDF

Purpose
Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center.
Methods
We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG).
Results
The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%).
Conclusion
If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

Citations

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Hartmann's Reversal and Abdominal Wall Reconstruction: Too Risky to Combine?
María A. Casas, Agustín C. Valinoti, Francisco Schlottmann, María M. Ledesma, Maximiliano E. Bun, Emmanuel E. Sadava, Nicolás A. Rotholtz
ANZ Journal of Surgery.2026;[Epub] CrossRef
Complete prevention of anastomotic leakage using total enteric flow diversion
Tao Hu, Jing Wang, Nan-Hui Yu
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Surgical Outcomes of Open and Laparoscopic Hartmann Reversal: A Single-Center Comparative Study
Mu-Han Tsai, Ming-Jenn Chen, Khaa-Hoo Ong, Chih-Ying Lu, Chung-Han Ho, Hsuan-Yi Huang, Yu-Feng Tian, I-Ning Yang
Cureus.2024;[Epub] CrossRef
Laparoscopic versus open Hartmann reversal: a propensity score matching analysis
Li Tan, Xiao-Yu Liu, Bin Zhang, Lian-Lian Wang, Zheng-Qiang Wei, Dong Peng
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Comparison of outcomes between laparoscopic and open Hartmann's reversal: A single‐center retrospective study in Japan
Aya Sato, Ken Imaizumi, Hiroyuki Kasajima, Keisuke Obuchi, Kentaro Sato, Daisuke Yamana, Yosuke Tsuruga, Minoru Umehara, Michihiro Kurushima, Kazuaki Nakanishi
Asian Journal of Endoscopic Surgery.2022; 15(1): 137. CrossRef
A Case of Laparoscopic Hartmann's Procedure Followed by Laparoscopic Reversal for Perforated Diverticulitis
Ryo Maemoto, Shingo Tsujinaka, Ryotaro Sakio, Nao Kakizawa, Rei Takahashi, Yuuri Hatsuzawa, Yasuaki Kimura, Erika Machida, Sawako Tamaki, Hideki Ishikawa, Yasuyuki Miyakura, Toshiki Rikiyama
Nippon Daicho Komonbyo Gakkai Zasshi.2022; 75(1): 36. CrossRef
Is laparoscopy a reliable alternative to laparotomy in Hartmann's reversal? An updated meta-analysis
D. Chavrier, A. Alves, B. Menahem
Techniques in Coloproctology.2022; 26(4): 239. CrossRef
Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients
Anwar Medellin Abueta, Nairo Javier Senejoa, Mauricio Pedraza Ciro, Lina Fory, Carlos Perez Rivera, Carlos Edmundo Martinez Jaramillo, Lina Maria Mateus Barbosa, Heinz Orlando Ibañez Varela, Javier A. Carrera, Rafael Garcia Duperly, Luis A Sanchez, Ivan D
Health Science Reports.2022;[Epub] CrossRef
Laparoscopic Hartmann reversal: experiences from a developing country
Dung Anh Nguyen, Tuong-Anh Mai-Phan, Truc Thanh Thai, Hai Van Nguyen
Annals of Coloproctology.2022; 38(4): 297. CrossRef
Open versus laparoscopic Hartmann’s procedure: a systematic review and meta-analysis
Yingjia Zhang, Chunxi Liu, Kameswara Rishi Yeshayahu Nistala, Choon Seng Chong
International Journal of Colorectal Disease.2022; 37(12): 2421. CrossRef
Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study
Paolo Panaccio, Tommaso Grottola, Rossana Percario, Federico Selvaggi, Severino Cericola, Alfonso Lapergola, Maira Farrukh, Giuseppe Di Martino, Marco Ricciardiello, Pierluigi Di Sebastiano, Fabio Francesco Di Mola, Todd Pesavento
Surgery Research and Practice.2021; 2021: 1. CrossRef
Effects of Laparoscopic Hartmann Reversal on Short-term Operative Outcomes Among Vietnamese Patients
Viet Van Ung, Bang Cong Huynh, Vinh Chi Le, Dang Ngoc Tran, Trung Nguyen Vo, Tan Van Pham, Bac Hoang Nguyen
Journal of Coloproctology.2021; 41(02): 117. CrossRef
A comparative study between open versus laparoscopic Hartmann reversal
Hye Jung Cho, Woo Ram Kim, Jong Woo Kim
Medicine.2021; 100(47): e27976. CrossRef
Colorectal reconstructions following Hartmann’s procedure: challenges and solutions
A. N. Igolkin, V. V. Polovinkin
Innovative medicine of Kuban.2020; (4): 51. CrossRef
Emergency Hartmann’s Procedure and its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis
Diletta Cassini, Michelangelo Miccini, Farshad Manoochehri, Matteo Gregori, Gianandrea Baldazzi
Surgical Innovation.2019; 26(6): 770. CrossRef

Postoperative Outcomes of Stoma Takedown: Results of Long-term Follow-up: Bomina Paik, Chang Woo Kim, Sun Jin Park, Kil Yeon Lee, Suk-Hwan Lee; Ann Coloproctol. 2018;34(5):266-270. Published online October 10, 2018; DOI: https://doi.org/10.3393/ac.2017.12.13

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10 Citations

Abstract PDF

Purpose
Stoma takedown is a frequently performed procedure with considerable postoperative morbidities. Various skin closure techniques have been introduced to reduce surgical site infections. The aim of this study was to assess postoperative outcomes after stoma takedown during a long-term follow-up period.
Methods
Between October 2006 and December 2015, 84 consecutive patients underwent a colostomy or ileostomy takedown at our institution. Baseline characteristics and perioperative outcomes were analyzed through retrospective reviews of medical records.
Results
The proportion of male patients was 60.7%, and the mean age of the patients was 59.0 years. The overall complication rate was 28.6%, with the most common complication being prolonged ileus, followed by incisional hernia, anastomotic leakage, surgical site infection, anastomotic stenosis, and entero-cutaneous fistula. The mean follow-up period was 64.3 months. The univariate analysis revealed no risk factors related to overall complications or prolonged ileus.
Conclusion
The postoperative clinical course and long-term outcomes following stoma takedown were acceptable. Stoma takedown is a procedure that can be performed safely.

Citations

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Multidisciplinary management of a patient with vesicosigmoid fistula and multisystem diseases undergoing stoma reversal: a case report
Jian Yang, Li Zhang, Ke Zeng
BMC Surgery.2026;[Epub] CrossRef
Risk factors for infectious enteritis after temporary stoma closure following colorectal cancer surgery: a retrospective cohort study
Reina Onaka, Hironori Fukuoka, Susumu Daibo, Hiroki Ohya, Kazuya Nakagawa, Mayumi Ozawa, Yusuke Saigusa, Hirotoshi Akiyama, Itaru Endo
Annals of Medicine & Surgery.2026; 88(6): 3069. CrossRef
Complicated diverticulitis: Diagnostic precision and surgical solutions in a patient with chronic kidney disease
Sharon L. Hsieh, Nathaniel Grabill, Mena Louis, Bradley Kuhn
Radiology Case Reports.2025; 20(1): 346. CrossRef
Comparing Surgical Site Infection Rate Between Primary Closure and Rhomboid Flap After Stoma Reversal
Che-Ming Chu, Chih-Cheng Chen, Yu-Yao Chang, Kai-Jyun Syu, Shih-Lung Lin
Annals of Plastic Surgery.2024; 92(1S): S33. CrossRef
TIMING OF THE STOMA REVERSAL, WHAT IS THE SAFE PERIOD?: A RETROSPECTIVE OBSERVATIONAL STUDY
GIRIDHAR ASHWATH, ESHWAR KATHIRESAN MANASIJAN, ANTHONY P ROZARIO
Asian Journal of Pharmaceutical and Clinical Research.2024; : 181. CrossRef
Diverting ileostomy in benign colorectal surgery: the real clinical cost analysis
F. Ascari, G. Barugola, G. Ruffo
Updates in Surgery.2024; 76(5): 1761. CrossRef
Laparoscopic versus open Hartmann reversal: a propensity score matching analysis
Li Tan, Xiao-Yu Liu, Bin Zhang, Lian-Lian Wang, Zheng-Qiang Wei, Dong Peng
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage: a national population-based cohort study
Eihab Munshi, Marie-Louise Lydrup, Pamela Buchwald
BMC Surgery.2023;[Epub] CrossRef
Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure
Muhammad Awais Khan, Khurram Niaz, Shahzeb Asghar, Maaz A Yusufi, Mohtamam Nazir, Syed Muhammad Ali, Aryan Ahmed, Akeel Ahamed Salahudeen, Talha Kareem
Cureus.2023;[Epub] CrossRef
Factors Predicting the Reversal of Hartmann’s Procedure
Ömer Yalkın, Fatih Altıntoprak, Mustafa Yener Uzunoğlu, Yasin Alper Yıldız, Muhammet Burak Kamburoğlu, Necattin Fırat, Fehmi Çelebi, Mihajlo Jakovljevic
BioMed Research International.2022;[Epub] CrossRef

Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery: Seung-Seop Yeom, Chan Wook Kim, Sung Woo Jung, Se Heon Oh, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2018;34(2):72-77. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.29

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3 Citations

Abstract PDF

Purpose
Colostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique.
Methods
We retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation.
Results
One hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001).
Conclusion
The trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.

Citations

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Non-operative management of gallstone sigmoid ileus in a patient with a prostatic cancer
Ahmed M AlMuhsin, Abdulaziz Bazuhair, Omar AlKhlaiwy, Rami O Abu Hajar, Thabit Alotaibi
Journal of Surgical Case Reports.2023;[Epub] CrossRef
Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction
Yongjun Park, Dong Uk Choi, Hyung Ook Kim, Yong Bog Kim, Chungki Min, Jung Tack Son, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim
Annals of Coloproctology.2022; 38(4): 319. CrossRef
Minimally invasive colostomy with endoscopy as a novel technique for creation of a trephine stoma
Teppei Kamada, Hironori Ohdaira, Junji Takahashi, Wataru Kai, Keigo Nakashima, Yuichi Nakaseko, Norihiko Suzuki, Masashi Yoshida, Yutaka Suzuki
Scientific Reports.2021;[Epub] CrossRef

Small Bowel Obstruction After Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis: Hitoshi Kameyama, Yoshifumi Hashimoto, Yoshifumi Shimada, Saki Yamada, Ryoma Yagi, Yosuke Tajima, Takuma Okamura, Masato Nakano, Kohei Miura, Masayuki Nagahashi, Jun Sakata, Takashi Kobayashi, Shin-ichi Kosugi, Toshifumi Wakai; Ann Coloproctol. 2018;34(2):94-100. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.06.14

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12 Citations

Abstract PDF

Purpose
Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC.
Methods
The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters.
Results
The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14–72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009–8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO.
Conclusion
The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.

Citations

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Right-Sided Ileostomy on Stoma Outlet Obstruction in Ulcerative Colitis: A Randomized Controlled Trial
Ryuichi Kuwahara, Motoi Uchino, Yusuke Tomoo, Kazunori Nomura, Kentaro Nagano, Kurando Kusunoki, Yuki Horio, Hiroki Ikeuchi
Diseases of the Colon & Rectum.2026; 69(4): 598. CrossRef
Management of J-pouch Complications
Beatrix H. Choi, David Cohen, Caleah Kitchens, David M. Schwartzberg
Surgical Clinics of North America.2025; 105(2): 357. CrossRef
Influence of the rotation of the diverting loop ileostomy in rectal cancer surgery on small-bowel obstruction: A multicenter prospective study conducted by the Clinical Study Group of Osaka University, Colorectal Group
Masaaki Miyo, Mamoru Uemura, Yuki Ozato, Junichi Nishimura, Ken Nakata, Yozo Suzuki, Yoshinori Kagawa, Taishi Hata, Koji Munakata, Mitsuyoshi Tei, Genta Sawada, Shinichi Yoshioka, Yusuke Takahashi, Koji Oba, Tsuyoshi Hata, Takayuki Ogino, Norikatsu Miyosh
Surgery.2025; 178: 108874. CrossRef
Risk factors for stoma outlet obstruction: systematic review and meta-analysis
Ali Toffaha, Ahmed Badr, Mahmood Al-Dhaheri, Ammar Aleter, Ejaz Latif, Mohamed Kurer, Ayman Ahmed, Noof Al Naimi, Issam Abu-Issa, Tausief Fatima, Amjad Parvaiz, Mohamed Abu Nada
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Risk Factors for Stoma Outlet Obstruction after Proctocolectomy for Ulcerative Colitis
Keisuke Ihara, Takatoshi Nakamura, Masashi Takayanagi, Junki Fujita, Yasunori Maeda, Yusuke Nishi, Norisuke Shibuya, Hiroyuki Hachiya, Mitsuru Ishizuka, Keiichi Tominaga, Kazuyuki Kojima, Atsushi Irisawa
Journal of the Anus, Rectum and Colon.2024; 8(1): 18. CrossRef
Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review
Julianna Seo, Ishith Seth, Dilshad Dooreemeah, Chun Hin Angus Lee
Annals of Coloproctology.2024; 40(5): 424. CrossRef
Association Between Advanced T Stage and Thick Rectus Abdominis Muscle and Outlet Obstruction and High-Output Stoma After Ileostomy in Patients With Rectal Cancer
Yasuhiro Komatsu, Kunitoshi Shigeyasu, Sho Takeda, Yoshiko Mori, Kazutaka Takahashi, Nanako Hata, Kokichi Miyamoto, Hibiki Umeda, Yoshihiko Kakiuchi, Satoru Kikuchi, Shuya Yano, Shinji Kuroda, Yoshitaka Kondo, Hiroyuki Kishimoto, Fuminori Teraishi, Masahi
International Surgery.2022; 106(3): 102. CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef
Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy
Ryo Maemoto, Shingo Tsujinaka, Yasuyuki Miyakura, Rintaro Fukuda, Nao Kakizawa, Tsutomu Takenami, Erika Machida, Nozomi Kikuchi, Rina Kanemitsu, Sawako Tamaki, Hideki Ishikawa, Toshiki Rikiyama
Asian Journal of Surgery.2021; 44(8): 1037. CrossRef
RISK FACTORS FOR THE DEVELOPMENT OF COMPLICATIONS OF ILEAL POUCH IN PATIENTS WITH ULCERATIVE COLITIS
S. I. Achkasov, O. I. Sushkov, A. E. Kulikov, Sh. A. Binnatli, M. A. Nagudov, A. V. Vardanyan
Koloproktologia.2020; 19(1): 51. CrossRef
A Common Complication After an Ileal Pouch-Anal Anastomosis With a Loop Ileostomy in Patients With Ulcerative Colitis: Small Bowel Obstruction
Chang-Nam Kim
Annals of Coloproctology.2018; 34(2): 57. CrossRef
Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch–anal anastomosis: a retrospective cohort study
Satoshi Okada, Keisuke Hata, Shigenobu Emoto, Koji Murono, Manabu Kaneko, Kazuhito Sasaki, Kensuke Otani, Takeshi Nishikawa, Toshiaki Tanaka, Kazushige Kawai, Hiroaki Nozawa
Surgery Today.2018; 48(12): 1060. CrossRef

Case Report

Side-to-Side Ileosigmoidostomy Shunting Surgery for the Treatment of Elderly Patients With Chronic Constipation: Yuda Handaya, Agung Maryanto, Marijata; Ann Coloproctol. 2017;33(6):249-252. Published online December 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.6.249

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Abstract PDF: Constipation is a digestive disorder that often occurs in the elderly; its main cause is bowel motility disorder. Treatments for patients with chronic constipation include pharmacotherapy, diet changes, and surgery if other therapies do not offer satisfactory results. We describe 4 patients, 2 men (70 and 65 years old) and 2 women (75 and 66 years old), who were diagnosed with chronic constipation (slow transit constipation) and treated with conventional therapy, but did not improve. For that reason, side-to-side ileosigmoidostomy shunting surgery was performed. After the surgery, the average time until normal defecation was 16 days, and the defecation frequency was 3 to 4 times a day with no need for a laxative. No patient had a recurrence of constipation. Based on these results, side-to-side ileosigmoidostomy shunting surgery is expected to restore digestive function and can be considered as an alternative therapy for elderly patients with chronic constipation.

Original Articles

Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial: Mina Alvandipour, Babak Gharedaghi, Hamed Khodabakhsh, Mohammad Yasin Karami; Ann Coloproctol. 2016;32(4):144-149. Published online August 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.4.144

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25 Web of Science
27 Citations

Abstract PDF

Purpose

Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound.

Methods

This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire.

Results

Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043).

Conclusion

After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.

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Senbin Lin, Misha Mao, Rui Chen, Linnan Guo, Mengya Zhou, Jianhui Chen
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A systematic review and Bayesian network meta‐analysis of randomized controlled trials on multiple skin closure techniques following stoma closure
Daichi Kitaguchi, Antonello Forgione, Chiara Innocenzi, Yuchuan Yang, Federico Espínola, Mariano Giménez, Tatsuya Oda, Jacques Marescaux
Colorectal Disease.2026;[Epub] CrossRef
Primary Linear Closure With Negative Pressure Wound Therapy Versus Purse-String Approximation After Ileostomy Reversal: A Randomized Noninferiority Trial
Devesh S. Ballal, Daniel J. Borsuk, Mark Gabriel C. Gonzalez, Marhama Zafar, Slawomir J. Marecik, John J. Park, Gerald Gantt, Kunal Kochar
Diseases of the Colon & Rectum.2026; 69(7): 1921. CrossRef
Mechanically powered negative pressure dressing reduces surgical site infection after stoma reversal
Brian Williams, Aubrey Swinford, Jordan Martucci, Johnny Wang, Jordan R. Wlodarczyk, Abhinav Gupta, Kyle G. Cologne, Sarah E. Koller, Christine Hsieh, Marjun P. Duldulao, Joongho Shin
Surgery Open Science.2025; 23: 69. CrossRef
Usefulness of a negative pressure wound therapy system for stoma closure
Chisato Shirakawa, Yuzuru Sakamoto, Shinya Ueki, Hiroki Shomura, Keizo Kazui, Akinobu Taketomi
Journal of Wound Care.2025; 34(2): 106. CrossRef
Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis
F. Menegon Tasselli, F. Pata, G. Fuschillo, G. Signoriello, A. Bondurri, G. Sciaudone, F. Selvaggi, G. Pellino
Techniques in Coloproctology.2025;[Epub] CrossRef
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Henry Krasner, Abigail W Cheng, Lance Horner, Ovunc Bardakcioglu
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Filippo Carannante, Guglielmo Niccolò Piozzi, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Vincenzo Schiavone, Jim S. Khan, Marco Caricato, Gabriella Teresa Capolupo
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Assad Ameer, Muhammad Bilal Mirza, Nabila Talat
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Shahab Hajibandeh, Shahin Hajibandeh, Andrew Maw
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Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial
Filippo Carannante, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Gianluca Masciana, Sara Lauricella, Marco Caricato, Gabriella Teresa Capolupo
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
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Jinlong Luo, Dan Liu, Junmei Wu, Huaiwu Jiang, Jin Chen, Hua Yang, Lie Yang
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Yu-Rong Jiao, Xin-Bin Zhou, Yao Ye, Qian Xiao, Xiang-Xing Kong, Ke-Feng Ding, Jun Li
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N. A. Maistrenko, A. A. Sazonov, P. N. Romashchenko, M. V. Zotov
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Sumesh Kaistha, Rajesh Panwar, Sujoy Pal, Nihar Ranjan Dash, Peush Sahni, Tushar Kanti Chattopadhyay
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Shahnam Askarpour, Mehran Peyvasteh, Farbod Farhadi, Hazhir Javaherizadeh
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Francesco M Carrano, Annalisa Maroli, Michele Carvello, Caterina Foppa, Matteo Sacchi, Jacopo Crippa, Giuseppe Clerico, Francesca De Lucia, Elisabetta Coppola, Nadav Ben David, Antonino Spinelli
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Biofeedback Therapy Before Ileostomy Closure in Patients Undergoing Sphincter-Saving Surgery for Rectal Cancer: A Pilot Study: Jeong-Ki Kim, Byeong Geon Jeon, Yoon Suk Song, Mi Sun Seo, Yoon-Hye Kwon, JI Won Park, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2015;31(4):138-143. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.138

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Abstract PDF

Purpose

This study prospectively investigated the effects of biofeedback therapy on objective anorectal function and subjective bowel function in patients after sphincter-saving surgery for rectal cancer.

Methods

Sixteen patients who underwent an ileostomy were randomized into two groups, one receiving conservative management with the Kegel maneuver and the other receiving active biofeedback before ileostomy closure. Among them, 12 patients (mean age, 57.5 years; range, 38 to 69 years; 6 patients in each group) completed the study. Conservative management included lifestyle modifications, Kegel exercises, and medication. Patients were evaluated at baseline and at 1, 3, 6, and 12 months after ileostomy closure by using anal manometry, modified Wexner Incontinence Scores (WISs), and fecal incontinence quality of life (FI-QoL) scores.

Results

Before the ileostomy closure, the groups did not differ in baseline clinical characteristics or resting manometric parameters. After 12 months of follow-up, the biofeedback group demonstrated a statistically significant improvement in the mean maximum squeezing pressure (from 146.3 to 178.9, P = 0.002). However, no beneficial effect on the WIS was noted for biofeedback compared to conservative management alone. Overall, the FI-QoL scores were increased significantly in both groups after ileostomy closure (P = 0.006), but did not differ significantly between the two groups.

Conclusion

Although the biofeedback therapy group demonstrated a statistically significant improvement in the maximum squeezing pressure, significant improvements in the WISs and the FI-QoL scores over time were noted in both groups. The study was terminated early because no therapeutic benefit of biofeedback had been demonstrated.

Citations

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Effectiveness of pelvic floor rehabilitation in the prevention and treatment of postoperative bowel symptoms in patients with rectal cancer: a systematic review and meta-analysis of randomized controlled trials
Lu Zhou, Can Wang, June Zhang
Journal of Cancer Survivorship.2026;[Epub] CrossRef
Effectiveness of pelvic floor muscle training in the recovery of patients after low anterior resection: A systematic review and meta-analysis
Min Jeong Kim, Seonmi Yeom, Young Man Kim
European Journal of Oncology Nursing.2025; 77: 102918. CrossRef
BENEFÍCIOS DA FISIOTERAPIA EM PACIENTES COLOSTOMIZADOS E ILEOSTOMIZADOS: UMA REVISÃO NARRATIVA
Ana Carolina Aboukalam da Cruz, Anderson Viana Pantoja, Leonardo Gomes de Souza, Maicon Maximiliano de Almeida, Marcus Vinicius Henriques Brito, George Alberto da Silva Dias
REVISTA FOCO.2025; 18(7): e9137. CrossRef
The effectiveness of physiotherapy interventions on fecal incontinence and quality of life following colorectal surgery: a systematic review and meta-analysis of randomized controlled trials
Ming Yan Pun, Pak Ho Leung, Tsz Ching Chan, Chunn Pang, Kin Hei Chan, Priya Kannan
Supportive Care in Cancer.2024;[Epub] CrossRef
Application of pelvic floor rehabilitation in patients with colorectal cancer: a scoping review
Lu Zhou, Changkun Zhong, Yuanyuan Su, Zhengyang Zhang, Ling Wang
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Effectiveness of Pelvic Floor Muscle Training for Patients Following Low Anterior Resection
Young Man Kim, Eui Geum Oh
Journal of Wound, Ostomy & Continence Nursing.2023; 50(2): 142. CrossRef
ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal
N. Blanco, I. Oliva, P. Tejedor, E. Pastor, A. Alvarellos, C. Pastor, J. Baixauli, J. Arredondo
Techniques in Coloproctology.2023; 27(12): 1251. CrossRef
Low anterior resection syndrome
Seung‐Bum Ryoo
Annals of Gastroenterological Surgery.2023; 7(5): 719. CrossRef
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Yuki Nakashima, Kenichi Fudeyasu, Yuki Kataoka, Shunsuke Taito, Takashi Ariie, Yukio Mikami
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Sigmar Stelzner, Juliane Kupsch, Sören Torge Mees
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Multivariate Analysis of Risk Factors Associated With the Nonreversal Ileostomy Following Sphincter-Preserving Surgery for Rectal Cancer: Young Ah Kim, Gil Jae Lee, Sung Won Park, Won-Suk Lee, Jeong-Heum Baek; Ann Coloproctol. 2015;31(3):98-102. Published online June 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.3.98

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Abstract PDF

Purpose

A loop ileostomy is used to protect an anastomosis after anal sphincter-preserving surgery, especially in patients with low rectal cancer, but little information is available concerning risk factors associated with a nonreversal ileostomy. The purpose of this study was to identify risk factors of ileostomy nonreversibility after a sphincter-saving resection for rectal cancer.

Methods

Six hundred seventy-nine (679) patients with rectal cancer who underwent sphincter-preserving surgery between January 2004 and December 2011 were evaluated retrospectively. Of the 679, 135 (19.9%) underwent a defunctioning loop ileostomy of temporary intent, and these patients were divided into two groups, that is, a reversal group (RG, 112 patients) and a nonreversal group (NRG, 23 patients) according to the reversibility of the ileostomy.

Results

In 23 of the 135 rectal cancer patients (17.0%) that underwent a diverting ileostomy, stoma reversal was not possible for the following reasons; stage IV rectal cancer (11, 47.8%), poor tone of the anal sphincter (4, 17.4%), local recurrence (2, 8.7%), anastomotic leakage (1, 4.3%), radiation proctitis (1, 4.3%), and patient refusal (4, 17.4%). The independent risk factors of the nonreversal group were anastomotic leakage or fistula, stage IV cancer, local recurrence, and comorbidity.

Conclusion

Postoperative complications such as anastomotic leakage or fistula, advanced primary disease (stage IV), local recurrence and comorbidity were identified as risk factors of a nonreversal ileostomy. These factors should be considered when drafting prudential guidelines for ileostomy closure.

Citations

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Unintended prolonged and permanent stoma following restorative rectal cancer surgery with defunctioning loop ileostomy: A systematic review and meta‐analysis
Paolo E. Meneghesso, Edward Murphy, Éanna J. Ryan, Ruth Walsh, Luca Risi, Annalisa Maroli, Caterina Foppa, Antonino Spinelli, Ronan A. Cahill
Colorectal Disease.2026;[Epub] CrossRef
Early vs. Late Stoma Reversal After Open Low Anterior Resection Post-Neoadjuvant Chemoradiotherapy
Fahad Bin Abdul Majeed, Madhu Muralee, Chandramohan
Indian Journal of Surgical Oncology.2025; 16(1): 94. CrossRef
Preoperative risk factors and cumulative incidence of temporary ileostomy non-closure after sphincter-preserving surgery for rectal cancer: a meta-analysis
Fan He, Chenglin Tang, Fuyu Yang, Defei Chen, Junjie Xiong, Yu Zou, Dongqin Zhao, Kun Qian
World Journal of Surgical Oncology.2024;[Epub] CrossRef
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Olorungbami K Anifalaje, Charles Ojo, Oluwaseyi T Balogun, Fikayo A Ayodele, Abeeb Azeez, Shirley Gabriels
Cureus.2024;[Epub] CrossRef
Determination of Factors Related to the Reversal and Perioperative Outcomes of Defunctioning Ileostomies in Patients Undergoing Rectal Cancer Surgery: A Regression Analysis Model
Ioannis Baloyiannis, Konstantinos Perivoliotis, Ioannis Mamaloudis, Effrosyni Bompou, Chamaidi Sarakatsianou, George Tzovaras
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Jingjing Ye, Xiaoyan Xu, Shengnian Lu, Xiaojun Xu, Hanmei Liu, Mingxian Luo, Jiamei Zhou, Lianhong Wang, Yongmei Zhang, Nabeel Al-Yateem
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Risk factors and incidence of non-closure stoma in patients with anterior resection of rectal cancer with temporary stoma: A systematic review and meta-analysis
Lu Zhou, Zuming Qin, Ling Wang
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Temporary Stomas after Rectal Cancer Resection; Predilection of Being Permanent and Predictors of Complications?
Islam H. Metwally, Mohamed Abdelkhalek, Mohammad Zuhdy, Saleh S. Elbalka
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Ian Fukudome, Hiromichi Maeda, Ken Okamoto, Hajime Kuroiwa, Sachi Yamaguchi, Kazune Fujisawa, Mai Shiga, Ken Dabanaka, Michiya Kobayashi, Tsutomu Namikawa, Kazuhiro Hanazaki
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Risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer: univariate and multivariate analysis
M.V. Alekseev, Yu.A. Shelygin, E.G. Rybakov
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Morbidity and costs of diverting ileostomy in transanal total mesorectal excision with primary anastomosis for rectal cancer
J. C. Hol, F. Bakker, N. T. van Heek, G. M. de Jong, F. M. Kruyt, C. Sietses
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Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
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Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function
S. Kim, M. H. Kim, J. H. Oh, S.‐Y. Jeong, K. J. Park, H.‐K. Oh, D.‐W. Kim, S.‐B. Kang
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Ri Na Yoo, Gun Kim, Bong-Hyeon Kye, Hyeon-Min Cho, HyungJin Kim
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Mohammed Iyoob Mohammed Ilyas, David A. Haggstrom, Melinda A. Maggard-Gibbons, Christopher S. Wendel, Susan Rawl, Christian Max Schmidt, Clifford Y. Ko, Robert S. Krouse
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Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis
Xin Zhou, Bingyan Wang, Fei Li, Jilian Wang, Wei Fu
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Shinya Abe, Kazushige Kawai, Hiroaki Nozawa, Keisuke Hata, Tomomichi Kiyomatsu, Toshiaki Tanaka, Takeshi Nishikawa, Kensuke Otani, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Shigenobu Emoto, Toshiaki Watanabe
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Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer
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Predictors of Fecal Incontinence and Related Quality of Life After a Total Mesorectal Excision With Primary Anastomosis for Patients With Rectal Cancer: Marieke S. Walma, Verena N. N. Kornmann, Djamila Boerma, Marnix A. J. de Roos, Henderik L. van Westreenen; Ann Coloproctol. 2015;31(1):23-28. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.23

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Abstract PDF

Purpose

After total mesorectal excision (TME) with primary anastomosis for patients with rectal cancer, the quality of life (QoL) may be decreased due to fecal incontinence. This study aimed to identify predictors of fecal incontinence and related QoL.

Methods

Patients who underwent TME with primary anastomosis for rectal cancer between December 2008 and June 2012 completed the fecal incontinence quality of life scale (FIQoL) and Wexner incontinence score. Factors associated with these scores were identified using a linear regression analysis.

Results

A total of 80 patients were included. Multivariate analysis identified a diverting ileostomy (n = 58) as an independent predictor of an unfavorable outcome on the FIQoL subscale coping/behavior (P = 0.041). Ileostomy closure within and after 3 months resulted in median Wexner scores of 5.0 (interquartile range [IQR], 2.5-8.0) and 10.5 (IQR, 6.0-13.8), respectively (P < 0.001). The median FIQoL score was 15.0 (IQR, 13.1-16.0) for stoma closure within 3 months versus 12.0 (IQR, 10.5-13.9) for closure after 3 months (P = 0.001).

Conclusion

A diverting ileostomy is a predictor for an impaired FIQoL after a TME for rectal cancer. Stoma reversal within 3 months showed better outcomes than reversal after 3 months. Patients with a diverting ileostomy should be informed about the impaired QoL, even after stoma closure.

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Feasibility and Safety of a Fold-Over Diverting Ileostomy Reversal After Rectal Cancer Surgery: Case-Matched Comparison to the Resection Technique: Jinock Cheong, Jeonghyun Kang, Im-Kyung Kim, Nam Kyu Kim, Seung-Kook Sohn, Kang Young Lee; Ann Coloproctol. 2014;30(3):118-121. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.118

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Abstract PDF

Purpose

Compared to the stapling technique, the fold-over technique (FO) has the benefit of avoiding the sacrifice of the bowel segment. The aim of this study was to compare short-term outcomes between the FO and a conventional resection.

Methods

Between June 2008 and March 2012, a total of 242 patients who underwent a diverting ileostomy reversal after rectal cancer surgery were selected. Among them, 29 patients underwent the FO. Using propensity scores to adjust for body mass index, previous abdominal surgery history, rectal cancer surgery type (open vs. minimally invasive), and reason for ileostomy (protective aim vs. leakage management), we created a well-balanced cohort by matching each patient who underwent the FO, as the study group, with two patients who underwent a stapled or a hand-sewn technique with bowel resection (RE), as the control group (FO : RE = 1 : 2). Morbidity and perioperative recovery were compared between the two groups.

Results

Twenty-four and forty-eight patients were allocated to the FO and the RE groups, respectively. The mean operation time was 91 ± 26 minutes in the FO group and 97 ± 34 minutes in the RE group (P = 0.494). The overall morbidity rates were not different between the two groups (12.5% in FO vs. 14.6% in RE, P = 1.000). The rate of postoperative ileus was similar between the two groups (8.3% in FO vs. 12.5% in RE, P = 0.710). Although time to resumption of soft diet was shorter in the FO group than in the RE group, the lengths of hospital stay were not different.

Conclusion

The FO and the conventional resection have similar short-term clinical outcomes for diverting ileostomy reversal.

Citations

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Comparison of hand-sewn anterior repair, resection and hand-sewn anastomosis, resection and stapled anastomosis techniques for the reversal of diverting loop ileostomy after low anterior rectal resection: a randomized clinical trial
Seyed Mostafa Meshkati Yazd, Reza Shahriarirad, Mohammad Reza Keramati, Mehdi Fallahi, Soheila-sadat Nourmohammadi, Alireza Kazemeini, Mohammad Sadegh Fazeli, Amir Keshvari
Techniques in Coloproctology.2024;[Epub] CrossRef
Does the timing of protective ileostomy closure post-low anterior resection have an impact on the outcome? A retrospective study
Fozan Sauri, Ahmad Sakr, Ho Seung Kim, Mohammed Alessa, Radwan Torky, Eman Zakarneh, Seung Yoon Yang, Nam Kyu Kim
Asian Journal of Surgery.2021; 44(1): 374. CrossRef
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Seung Up Yang, Eun Jung Park, Seung Hyuk Baik, Kang Young Lee, Jeonghyun Kang
Journal of Clinical Medicine.2019; 8(9): 1450. CrossRef
Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period
Bojan Krebs, Arpad Ivanecz, Stojan Potrc, Matjaz Horvat
Radiology and Oncology.2019; 53(3): 331. CrossRef
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Im-kyung Kim, Jeonghyun Kang, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim, Seung-Kook Sohn
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Endless Arguments Over Diversion Stomas
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The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer: Seok In Seo, Chang Sik Yu, Gwon Sik Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2013;29(2):66-71. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.66

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Abstract PDF

Purpose

A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer.

Methods

Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups.

Results

Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246).

Conclusion

The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.

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Feasibility of Neurovascular Antropylorus Perineal Transposition With Pudendal Nerve Anastomosis Following Anorectal Excision: A Cadaveric Study for Neoanal Reconstruction: Abhijit Chandra, Ashok Kumar, M Noushif, Nitish Gupta, Vijay Kumar, Navneet Kumar Chauhan, Vishal Gupta; Ann Coloproctol. 2013;29(1):7-11. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.7

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4 Citations

Abstract PDF

Purpose

Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers.

Methods

The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis.

Results

The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied.

Conclusion

An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.

Citations

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Current surgical strategies to treat fecal incontinence
Steven D Wexner, Joshua Bleier
Expert Review of Gastroenterology & Hepatology.2015; 9(12): 1577. CrossRef
Dynamic Article
Abhijit Chandra, Brijesh Mishra, Saket Kumar, Vishal Gupta, M. Noushif, U. C. Ghoshal, Asha Misra, P. K. Srivastava
Diseases of the Colon & Rectum.2015; 58(5): 508. CrossRef
Neuromodulation of perineally transposed antropylorus with pudendal nerve anastomosis following total anorectal reconstruction in humans
Abhijit Chandra, Hardeep S. Malhotra, Noushif M, Vishal Gupta, Sunil K. Singh, Neeraj Kumar, Rakesh S. Lalla, Ayush Chandra, Ravindra K. Garg
Neurogastroenterology & Motility.2014; 26(9): 1342. CrossRef
Neurovascular antropylorus perineal transposition using inferior rectal nerve anastomosis for total anorectal reconstruction: preliminary report in humans
A. Chandra, A. Kumar, M. Noushif, V. Gupta, V. Kumar, P. K. Srivastav, H. S. Malhotra, M. Kumar, U. C. Ghoshal
Techniques in Coloproctology.2014; 18(6): 535. CrossRef

Incidence and Risk Factors of Parastomal Hernia: Yeun Ju Sohn, Sun Mi Moon, Ui Sup Shin, Sun Hee Jee; J Korean Soc Coloproctol. 2012;28(5):241-246. Published online October 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.5.241

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69 Citations

Abstract PDF

Purpose

Among the various stoma complications, the parastomal hernia (PSH) is the most common. Prevention of PSH is very important to improve the quality of life and to prevent further serious complications. The aim of this study was to analyze the incidence and the risk factors of PSH.

Methods

From January 2002 and October 2008, we retrospectively reviewed 165 patients who underwent an end colostomy. As a routine oncologic follow-up, abdomino-pelvic computed tomography was used to examine the occurrence of the PSH. The associations of age, sex, body mass index (BMI), history of steroid use and comorbidities to the development of the PSH were analyzed. The median duration of the follow-up was 36 months (0 to 99 months).

Results

During follow-up, 50 patients developed a PSH and the 5-year cumulative incidence rate of a PSH, obtained by using the Kaplan-Meier method, was 37.8%. In the multivariate COX analysis, female gender (hazard ratio [HR], 3.29; 95% confidence interval [CI], 1.77 to 6.11; P < 0.0001), age over 60 years (HR, 2.37; 95% CI, 1.26 to 4.46; P = 0.01), BMI more than 25 kg/m² (HR, 1.8; 95% CI, 1.02 to 3.16; P = 0.04), and hypertension (HR, 2.08; 95% CI, 1.14 to 3.81; P = 0.02) were all independent risk factors for the development of a PSH.

Conclusion

The 5-year incidence rate of a PSH was 37.8%. The significant risk factors of a PSH were as follows: female gender, age over 60 years, BMI more than 25 kg/m², and hypertension. Using a prophylactic mesh during colostomy formation might be advisable when the patients have these factors.

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The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown: Min Sang Kim, Ho Kun Kim, Dong Yi Kim, Jae Kyun Ju; J Korean Soc Coloproctol. 2012;28(3):145-151. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.145

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Abstract PDF

Purpose

Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition.

Methods

A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010.

Results

Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications.

Conclusion

A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.

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Review

Management of Colorectal Trauma: Won Jun Choi; J Korean Soc Coloproctol. 2011;27(4):166-172. Published online August 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.4.166

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Abstract PDF

Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed.

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Original Articles

Conventional Linear versus Purse-string Skin Closure after Loop Ileostomy Reversal: Comparison of Wound Infection Rates and Operative Outcomes: Jung Ryeol Lee, Young Wan Kim, Jong Je Sung, Ok-Pyung Song, Hyung Chul Kim, Cheol-Wan Lim, Gyu-Seok Cho, Jun Chul Jung, Eung-Jin Shin; J Korean Soc Coloproctol. 2011;27(2):58-63. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.58

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Abstract PDF

Purpose

Wound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional linear skin closure. This study is designed to compare wound infection rates and operative outcomes between linear and purse-string skin closure after a loop ileostomy reversal.

Methods

Between December 2002 and October 2010, a total of 48 consecutive patients undergoing a loop ileostomy reversal were enrolled. Outcomes were compared between linear skin closure (group L, n = 30) and purse string closure (group P, n = 18). The operative technique for linear skin closure consisted of an elliptical incision around the stoma, with mobilization, and anastomosis of the ileum. The rectus fascia was repaired with interrupted sutures. Skin closure was performed with vertical mattress interrupted sutures. Purse-string skin closure consisted of a circumstomal incision around the ileostomy using the same procedures as used for the ileum. Fascial closure was identical to linear closure, but the circumstomal skin incision was approximated using a purse-string subcuticular suture (2-0 Polysorb).

Results

Between group L and P, there were no differences of age, gender, body mass index, and American Society of Anesthesiologists (ASA) scores. Original indication for ileostomy was 23 cases of malignancy (76.7%) in group L, and 13 cases of malignancy (77.2%) in group P. The median time duration from ileostomy to reversal was 4.0 months (range, 0.6 to 55.7 months) in group L and 4.1 months (range, 2.2 to 43.9 months) in group P. The median operative time was 103 minutes (range, 45 to 260 minutes) in group L and 100 minutes (range, 30 to 185 minutes) in group P. The median hospital stay was 11 days (range, 5 to 4 days) in group L and 7 days (range, 4 to 14 days) in group P (P < 0.001). Wound infection was found in 5 cases (16.7%) in group L and in one case (5.6%) in group L (P = 0.26).

Conclusion

Based on this study, purse-string skin closure after a loop ileostomy reversal showed comparable outcomes, in terms of wound infection rates, to those of linear skin closure. Thus, purse-string skin closure could be a good alternative to the conventional linear closure.

Citations

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Higher BMI increases risk of stoma-site incisional hernia and other complications following diverting loop ileostomy and reversal: a systematic review and meta-analysis
Kaiser O’Sahil Sadiq, Swetha Lakshminarayanan, Patricia Ruiz Cota, Eugenia Marquez Castillo
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World Journal of Gastrointestinal Surgery.2024; 16(1): 186. CrossRef
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Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
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Sumesh Kaistha, Rajesh Panwar, Sujoy Pal, Nihar Ranjan Dash, Peush Sahni, Tushar Kanti Chattopadhyay
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Chanathip Sayuen, Ratiyaporn Phannua, Sinobol Chusilp, Patchareeporn Tanming, Suchat Areemit, Katawaetee Decharun, Paisarn Vejchapipat, Kanokrat Thaiwatcharamas
Pediatric Surgery International.2022; 38(1): 149. CrossRef
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Vivek Kumar Roy, Pradeep Jaiswal, Mukesh Kumar, Sukalyan Saha Roy, Saumya Sinha, Anjili Kumari, Krishna Gopal
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Shahnam Askarpour, Mehran Peyvasteh, Farbod Farhadi, Hazhir Javaherizadeh
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2022;[Epub] CrossRef
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Chuang-Kun Li, Wei-Wen Liang, Huai-Ming Wang, Wen-Tai Guo, Xiu-Sen Qin, Jie Zhao, Wen-Bin Zhou, Yang Li, Hui Wang, Rong-Kang Huang
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Nilotpal Behuria, Jayant Kumar Banerjee, Sita Ram Ghosh, Shrirang Vasant Kulkarni, Ramanathan Saranga Bharathi
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M. Gachabayov, H. Lee, A. Chudner, A. Dyatlov, N. Zhang, R. Bergamaschi
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The Effectiveness of Contralateral Drainage in Reducing Superficial Incisional Surgical Site Infection in Loop Ileostomy Closure: Prospective, Randomized Controlled Trial
Anna Serracant, Xavier Serra‐Aracil, Laura Mora‐López, Anna Pallisera‐Lloveras, Sheila Serra‐Pla, Alba Zárate‐Pinedo, Salvador Navarro‐Soto
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Does Wound Irrigation with Clorhexidine Gluconate Reduce the Surgical Site Infection Rate in Closure of Temporary Loop Ileostomy? A Prospective Clinical Study
Mustafa Goztok, Mustafa Cem Terzi, Tufan Egeli, Naciye Cigdem Arslan, Aras Emre Canda
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Shahab Hajibandeh, Shahin Hajibandeh, Andrew Kennedy-Dalby, Sheik Rehman, Reza Arsalani Zadeh
International Journal of Colorectal Disease.2018; 33(10): 1319. CrossRef
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Masahiro Hada, Masanori Kotake, Daiki Kakiuchi, Kengo Hayashi, Sho Yamada, Koichiro Sawada, Masahiro Oshima, Yosuke Kato, Chikashi Hiranuma, Yuko Yamada, Chiharu Hiraki, Takuo Hara
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Mina Alvandipour, Babak Gharedaghi, Hamed Khodabakhsh, Mohammad Yasin Karami
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Temporary Diverting Ileostomy via the Umbilicus: a Small Case Series
C. D. Mushaya, Raaj Chandra, Wendy Sansom, James Keck
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Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach?
Monica T. Young, Grace S. Hwang, Gopal Menon, Timothy F. Feldmann, Mehraneh D. Jafari, Fariba Jafari, Eden Perez, Alessio Pigazzi
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Clinical Trial on the Incidence of Wound Infection and Patient Satisfaction After Stoma Closure: Comparison of Two Skin Closure Techniques
Sang Il Yoon, Sun Mi Bae, Hwan Namgung, Dong Guk Park
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Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal
YUMA WADA, NORIKATSU MIYOSHI, MASAYUKI OHUE, SHINGO NOURA, SHIKI FUJINO, KEIJIROU SUGIMURA, HIROFUMI AKITA, MASAAKI MOTOORI, KUNIHITO GOTOH, HIDENORI TAKAHASHI, SHOGO KOBAYASHI, TAKESHI OHMORI, YOSHIYUKI FUJIWARA, MASAHIKO YANO
Molecular and Clinical Oncology.2015; 3(3): 619. CrossRef
A beneficial effect of purse-string skin closure after ileostomy takedown: A retrospective cohort study
Yong Joon Suh, Ji Won Park, Yong Sok Kim, Sung Chan Park, Jae Hwan Oh
International Journal of Surgery.2014; 12(6): 615. CrossRef
Abdominal Wall Closure After a Stomal Reversal Procedure
Manuel López-Cano, José Antonio Pereira, Borja Villanueva, Francesc Vallribera, Eloy Espin, Manuel Armengol Carrasco, María Antonia Arbós Vía, Xavier Feliu, Salvador Morales-Conde
Cirugía Española (English Edition).2014; 92(6): 387. CrossRef
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Manuel López-Cano, José Antonio Pereira, Borja Villanueva, Francesc Vallribera, Eloy Espin, Manuel Armengol Carrasco, María Antonia Arbós Vía, Xavier Feliu, Salvador Morales-Conde
Cirugía Española.2014; 92(6): 387. CrossRef
The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates—a single high-volume centre experience
Nils Habbe, Sabine Hannes, Juliane Liese, Guido Woeste, Wolf Otto Bechstein, Christoph Strey
International Journal of Colorectal Disease.2014; 29(6): 709. CrossRef
Pursestring Closure of the Stoma Site Leads to Fewer Wound Infections
Janet T. Lee, Thao T. Marquez, Daniel Clerc, Olivier Gie, Nicolas Demartines, Robert D. Madoff, David A. Rothenberger, Dimitrios Christoforidis
Diseases of the Colon & Rectum.2014; 57(11): 1282. CrossRef
Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients
Eligijus Poskus, Edvinas Kildusis, Edgaras Smolskas, Marijus Ambrazevicius, Kestutis Strupas
Visceral Medicine.2014; 30(4): 276. CrossRef
Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture
N. Dusch, D. Goranova, F. Herrle, M. Niedergethmann, P. Kienle
Colorectal Disease.2013; 15(8): 1033. CrossRef
Influence of skin closure technique on surgical site infection after loop ileostomy reversal: Retrospective cohort study
C.D. Klink, M. Wünschmann, M. Binnebösel, H.P. Alizai, A. Lambertz, G. Boehm, U.P. Neumann, C.J. Krones
International Journal of Surgery.2013; 11(10): 1123. CrossRef
Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis
D. P. McCartan, J. P. Burke, S. R. Walsh, J. C. Coffey
Techniques in Coloproctology.2013; 17(4): 345. CrossRef
Primary linear closure with closed suction wound drain after ileostomy takedown
Mi Kyoung Hong, Min-Su Park, Sun Jin Park, Kil Yeon Lee
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Usefulness of an Open Cecostomy in the Treatment of a Distal Colon Obstruction.: Kuk, Jung Cheol , Jung, Eun Joo , Ryu, Chun Geun , Moon, Sun Mi , Hwang, Dae Yong; J Korean Soc Coloproctol. 2010;26(2):111-115.; DOI: https://doi.org/10.3393/jksc.2010.26.2.111

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Abstract PDF

PURPOSE
Stoma formation has usually been used for bowel decompression or fecal diversion. For these, a cecostomy is rarely performed because of disadvantages such as incomplete fecal diversion or fatal complications. The aim of this study was to evaluate the usefulness of an open cecostomy in treating patients with colonic obstruction.
METHODS
Between May 2005 and August 2008, 20 patients underwent an open cecostomy because of colonic obstruction. All information on the patients was reviewed retrospectively for underlying disease, obstruction site, diameter of the cecum and transverse colon, and complications.
RESULTS
Of the 20 patients, 14 had colorectal cancer, 3 had stomach cancer, 1 had cervical cancer, 1 had a carcinoid tumor, and 1 had an osteosarcoma. The cause of the obstruction was the primary tumor in 7 patients, peritoneal carcinomatosis in 7 patients, local recurrence in 5, and tissue edema after cyberknife treatment in 1 patient. All patients, except for 1 patient with a hopeless discharge due to rapid disease progression, were discharged on the tenth day postoperatively. No fatal complication developed. In 2 patients, the cecostomy closed spontaneously at 5.5 mo postoperatively after the distal obstruction had been resolved.
CONCLUSION
An open cecostomy may be a useful and simple method for the decompression of a colonic obstruction, even though the diversion may not be complete.

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Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction
Yongjun Park, Dong Uk Choi, Hyung Ook Kim, Yong Bog Kim, Chungki Min, Jung Tack Son, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim
Annals of Coloproctology.2022; 38(4): 319. CrossRef

Review

Controversies in Pouch Surgery for Ulcerative Colitis.: Yu, Chang Sik; J Korean Soc Coloproctol. 2009;25(3):207-211.; DOI: https://doi.org/10.3393/jksc.2009.25.3.207

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Abstract PDF: Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn's disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn's disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

Original Article

Complication and Relevant Factors after an Ileostomy for Fecal Diversion in a Patient with Rectal Cancer.: Kim, Jeong Yeon , Kim, Jin Soo , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2009;25(2):81-87.; DOI: https://doi.org/10.3393/jksc.2009.25.2.81

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Abstract PDF

PURPOSE
The proportion of sphincter-saving operations for lower rectal cancer is increasing with improved surgical techniques and additional concurrent preoperative chemo-radiation therapy. A defunctioning ileostomy or colostomy is performed after a sphincter-saving operation in the belief that diverting the fecal stream will prevent anastomotic leakage. This study was undertaken to assess all morbidity and combined problems associated with a temporary loop ileostomy. METHODS: A total of 167 patients who had undergone an ileostomy after a proctectomy between July 1997 and May 2007 were enrolled in this study. All patients were analyzed retrospectively, and the enrolled patients were registered in the Colorectal Cancer Database and were followed prospectively. Three patients did not receive an ileostomy take-down operation because of tumor recurrence.
RESULTS
Complications of ileostomy formation developed in 20 (11.9%) cases. There were no significant relevant factors influencing the complications of ileostomy formation. Complications related with ileostomy take-down developed in 33 (17.9%) cases. Longer operation time, perioperative transfusion, and postoperative radiotherapy were statistically significant factors related to the complications of ileostomy take-down (P=0.047, P=0.019, P=0.042). After ileostomy take-down, six patients were identified with complications, such as a rectovaginal fistula or an anastomotic stenosis, related with rectal cancer surgery. CONCLUSIONS: The useful ileostomy sometimes carries certain morbidity; therefore, an ileostomy should be performed selectively, and the decision should be made with care. Also, a careful evaluation of the distal part of an ileostomy is necessary before and after an ileostomy take-down.

Citations

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Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta‐analysis
Joseph P. Borucki, Sarah Schlaeger, Jasmine Crane, James M. Hernon, Adam T. Stearns
Colorectal Disease.2021; 23(7): 1721. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef
Conventional Linear versus Purse-string Skin Closure after Loop Ileostomy Reversal: Comparison of Wound Infection Rates and Operative Outcomes
Jung Ryeol Lee, Young Wan Kim, Jong Je Sung, Ok-Pyung Song, Hyung Chul Kim, Cheol-Wan Lim, Gyu-Seok Cho, Jun Chul Jung, Eung-Jin Shin
Journal of the Korean Society of Coloproctology.2011; 27(2): 58. CrossRef

Case Report

Primary Repair of a Huge Incisional Hernia by Using an External Oblique Myofascial Releasing Technique without Mesh: A Case Report.: Park, Ki Jae , Woo, Jin Hee , Lee, Hak Youn , Lee, Se Yong , Shin, Jong Sok , Roh, Young Hoon , Kim, Sung Heun , Choi, Hong Jo; J Korean Soc Coloproctol. 2008;24(5):386-389.; DOI: https://doi.org/10.3393/jksc.2008.24.5.386

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Abstract PDF: Incisional hernias are one of the most common complications after abdominal surgery and are an important cause of postoperative morbidity. Various methods are available for repairing incisional hernias, such as primary suture repair, an open mesh technique, and a laparoscopic mesh technique. The surgical management of a large incisional hernia by using a prosthetic mesh in a contaminated operative field (i.e., opened bowel from previous stoma or bowel resection) remains a difficult challenge because the non-absorbable mesh used is accompanied by a potential risk of infection and its related morbidity. We present a case of a large abdominal-wall defect, which was corrected by utilizing an external oblique myofascial releasing technique without the use of mesh, in a patient with an incisional hernia coexistent with Hartmann's colostomy.

Original Articles

Analysis of Results after Percutaneous Catheter Drainage for Anastomotic Leakage.: Hwang, Sang Il , Kim, Hungdai , Han, Won Kon; J Korean Soc Coloproctol. 2008;24(4):260-264.; DOI: https://doi.org/10.3393/jksc.2008.24.4.260

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Abstract PDF: PURPOSE
Anastomotic leakage is a serious and life- threatening complication after colorectal surgery. The management of clinical anastomotic leakage remains largely operative. The aim of this study was to analyze the clinical characteristics and the natural history of percutaneous catheter drainage (PCD) for anastomotic leakage after colorectal surgery.
METHODS
Twenty patients who were managed by PCD after anastomotic leakage between January 2002 and December 2006 were studied. Charts were reviewed for information on clinical characteristics and biolologic finding prePCD and postPCD.
RESULTS
Anastomotic leakage was managed by using only PCD in 16 of 20 patients (80%), and twenty percent of patients (4/20) were managed by using a loop ileostomy after PCD. Nine patients (45%) had peritoneal drains left in place at diagnosis. Before PCD, the mean of the peak white blood cell (WBC) was 12,800/mm3, and the mean period of fever (>38degrees C) was 3.4 (2~5) days. After PCD, the mean time until the body temperature dropped below 37oC was 3.1 (1~5) days, the mean time until the WBC count dropped below 10,000/mm3 was 3.2 (0~6) days, the mean duration of ileus and diarrhea was 3.3 (0~6) days, the mean total amount of drainage during 6 days was 880 cc, and the mean length of stay after PCD was 14.9 days.
CONCLUSIONS
PCD is a safe and effective method for treating anastomtic leakage in patients without sepsis or diffuse peritonitis and with CT scans that reveal no diffuse fluid collection.

The Complications of Stoma Take-down.: Kim, Dae Dong , Kim, Eun Jung , Lee, Hae Ok , Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(2):83-90.; DOI: https://doi.org/10.3393/jksc.2008.24.2.83

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Abstract PDF

PURPOSE
The study aimed to investigate the complications accompanying stoma take-down and to elucidate the significant factors associated with complications. METHODS: We recruited 341 patients who underwent stoma take-down in our hospital between January 2000 and December 2005. Data on various complications during this procedure, i.e., wound infection, prolonged ileus, and anastomotic leakage, were collected with respect to patient- and operation-associated parameters. RESULTS: Complications of stoma take-down developed in 72 (21.1%) patients: 53 (20.3%) patients in a loop ileosotmy, 10 (21.3%) patients in a loop colostomy, and 9 (27.3%) patients in a Hartmann colostomy, The overall complication rate was significantly associated with the urgency of the primary operation (elective vs. emergent, 17.8% vs. 29%, P=0.017), and with the operation time (< or =80 min vs. > 80 min, 16.5% vs. 29.3%, P=0.005). Among the complications, ileus developed in 46 (13.5%) patients, wound infection in 17 (5.0%) patients, and anastomotic leakage in 5 (1.5%) patients. Wound infection was related to the type of stoma between a loop ileostomy and a Hartmann colostomy (3.5% vs. 12.1%; P=0.014), but no other factors were associated with other complications. CONCLUSIONS: There were significant differences in overall complications in relation to urgency of the primary operation and the operation time, but there was no statistical difference in complications between a loop ileostomy and a loop colostomy take- down groups. The significance of these factors appears to be reduced with accurate surgical technique and patient care.

Citations

Citations to this article as recorded by

Comparing Surgical Site Infection Rate Between Primary Closure and Rhomboid Flap After Stoma Reversal
Che-Ming Chu, Chih-Cheng Chen, Yu-Yao Chang, Kai-Jyun Syu, Shih-Lung Lin
Annals of Plastic Surgery.2024; 92(1S): S33. CrossRef
Influences of Symptom Experience and Depression on Quality of Life in Colorectal Cancer Patients with Stoma Reversal
Jung Ha Kim, Hyunjung Kim
Journal of Korean Biological Nursing Science.2015; 17(4): 306. CrossRef
The Influence of Nutritional Assessment on the Outcome of Ostomy Takedown
Min Sang Kim, Ho Kun Kim, Dong Yi Kim, Jae Kyun Ju
Journal of the Korean Society of Coloproctology.2012; 28(3): 145. CrossRef

Application of BMS(TM) Avoids a Defunctioning Colostomy in the Treatment of Fournier's Gangrene.: Shon, Dae Ho , Jung, Sang Hun , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2008;24(2):137-143.; DOI: https://doi.org/10.3393/jksc.2008.24.2.137

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Abstract PDF: PURPOSE
Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.

Loop Colostomy with Not Everted Fashion for Rectal Cancer.: Kim, Kyung Ha , Kim, Hyun Tae , Ha, Tae Geun , Shin, Jin Yong , Kim, Woon Won , Hong, Kwan Hee; J Korean Soc Coloproctol. 2007;23(1):28-33.; DOI: https://doi.org/10.3393/jksc.2007.23.1.28

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Abstract PDF: PURPOSE
An anastomotic leak after resection of rectal cancer is a omnious complication. The diverting stoma is performed to avoid this serious complication. However, a diverting stoma and a stoma reversal are associated with significant morbidity and a small mortality. As stoma-related complications are associated with a delay of adjuvant therapy for advanced rectal cancer, minimal stoma-related morbidity is mandatory for rectal cancer patients. A safe and simple dissection of the stoma is known to be associated with less morbidity at stoma closure. Since in a loop colostomy of a not everted fashion, it is easy to construct and dissect the peristomal site at colostomy reversal, this study evaluated the usefulness of a protective loop colostomy of a not everted fashion in rectal cancer.
METHODS
We reviewed the clinical records of 71 cases of loop colostomy closure for rectal cancer between January 1996 and December 2004. The clinical data, including indications for the stoma, the clinicopathologic features of the patients and their general conditions, the data for patients receiving adjuvant therapy, stoma-related morbidity, stoma-closure-related morbidity, and perioperative data were examined.
RESULTS
Indications for stoma creation are the discretion of the surgeon (n=22), poor bowel preparation (n=21), unstable anastomosis (n=16), bowel obstruction (n=6), and anastomotic leakage (n=6). The stoma-related morbidity rate for a non-eversion colostomy was 5.6%. Morbidity events were peristomal erythema (n=2), prolapse (n=1), and parastomal hernia (n=1) requiring surgery. The stoma-closure-related morbidity rates was 9.9%. In the 45 patients undergoing adjuvant therapy, colostomy closure was performed during adjuvant therapy in 39 patients. Major complications, such as anastomotic leakage or abscess following reversal of the non-eversion colostomy, occurred in 1 of the 71 patients (1.4%). The average operating time and the blood loss for clostomy closure were 89.5 minutes and 202.3 ml, respectively. A simple closure of the loop colostomy was performed in 51 patients (71.8%).
CONCLUSIONS
Based on our results, a non-eversion colostomy may be considered due to the ease of construction and reversal if a temporary diverting stoma for rectal cancer is indicated.

The Significance of Diverting Ileostomy during Restorative Proctocolectomy.: Hong, Dong Hyun , Yu, Chang Sik , NamGung, Hwan , Cho, Young Kyu , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(6):386-389.

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Abstract PDF: PURPOSE
Restorative proctocolectomy (RP) is a standard surgery in patients with ulcerative colitis and familial adenomatous polyposis. Usually, diverting ileostomy is performed to protect an ileoanal anastomosis with RP. However, there are many controversies whether diverting ileostomy might urgently be needed. This study was performed to compare postoperative complications after RP with or without diverting ileostomy.
METHODS
Between July 1994 and June 2001, 77 (M : F= 45 : 32) patients underwent RP. The indication criteria for diverting ileostomy included tension at the anastomosis, positive leakage test, compromised blood flow in the ileal pouch, long-term and high-dose steroid use, and severe rectal inflammation in ulcerative colitis patients.
RESULTS
Histopathologic diagnoses revealed 45 ulcerative colitis, 23 familial adenomatous polyposis, 5 rectal cancer, and 4 hereditary nonpolyposis colorectal cancer. Diverting ileostomies were performed in 40 patients (51.9%) and closed approximately 4 months later. Fourty eight complications were present in 32 patients. There was no perioperative death. There was no difference in perioperative outcome, morbidity or functional status between patients with and without ileostomy. However, in ulcerative colitis patients, anastomosis leakage was more frequent in patients without ileostomy.
CONCLUSIONS
Restorative proctocolectomy can be safely performed without diverting ileostomy in most cases of RP. However, diverting ileostomy may reduce anastomosis leakage in patients with ulcerative colitis.

Is Barium Enema Prior to Ileostomy Closure Necessary?.: Lee, Min Ro , Lee, Min Joo , Kim, Jong Hun , Hwang, Yong; J Korean Soc Coloproctol. 2006;22(5):298-300.

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Abstract PDF: PURPOSE
A barium enema is frequently performed to check for healing prior to ileostomy closure, but there have been reports that ileostomy closure without a contrast study is safe in selected patients. The aim of this study was to assess the necessity of a routine barium enema prior to ileostomy closure.
METHODS
Between January 1994 and June 2005, 51 patients with a temporary loop ileostomy who had a barium enema prior to ileostomy closure at Chonbuk National University Hospital were retrospectively reviewed. These patients were divided into 2 groups, the protective ileostomy group and the ileostomy-after-leakage group. To examine the necessity of a routine barium enema prior to ileostomy closure, we assessed whether the barium enema results changed management and whether there were pelvic sepsis and obstructive symptoms following ileostomy closure.
RESULTS
In the protective ileostomy group (n=39), the barium enema was performed after a mean of 59 days (range: 27~151 days). There were no abnormal findings at the barium enema, no schedule changes, no pelvic sepsis, and no obstructive symptoms following ileostomy closure. In the ileostomy-after-leakage group (n=12), the barium enema was performed after a mean of 54 days (range: 30~82 days). In 2 patients, with barium enemas at 33 days and 36 days, an anastomotic leakage was found, and ileostomy closure was delayed.
CONCLUSIONS
In patients with a protective ileostomy, a barium enema prior to ileostomy closure is unnecessary, but in patients with an ileostomy after leakage, barium enema should be considered.

Clinical Results of Coloanal Anastomosis in Radiation-induced Rectovaginal Fistula.: Lee, Il Kyun , Hah, Hyun Su , Sohn, Seung Kook , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2002;18(5):300-304.

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Abstract PDF: PURPOSE
Generally speaking, permanent colostomy has been frequently used as a treatment for radiation-induced rectovaginal fistula. In order to administer an operation accurately, at least two-staged operations have been performed. If anastomosis were to be performed between normal, healthy tissues after removal of irradiation-damaged tissues definite operation could be performed in one stage. We reviewed clinical records to evaluate postoperative recurrence and anal functions in patients who underwent coloanal anastomosis without diverting colostomy as one step due to radiation-induced rectovaginal fistula.
METHOD
From Sep. 1994 to Jun. 2000 we did a retrospective study with clinical data of 8 patients who underwent operations due to radiation-induced rectovaginal fistula in Yongdong Severance Hospital.
RESULTS
The mean age was 49 years (range 31-61). All patients concurrently received irradiation and induction chemotherapy due to primary, gynecologic malignancies. The total dosage of exposure to radiation was 8,400 cGy in 6 of 8 cases and 8,940 cGy in the remaining 2 cases. TAH with BSO had been undergone before concurrent chemoradiation in 2 cases. The median duration from diagnosis to operation was 29 months (range 16-131) in cases without previous colostomy (n=7) and 7 months in cases with colostom y (n=1). Before the operation, previous surgery had been undergone in 2 cases due to rectovaginal fistula. No recurrences were noted for gynecologic malignancies. The mean distance of fistula opening from anal verge was 3.9 cm (range 2.0-7.0). For 7 out of 8 cases, patients underwent LAR with handsewn coloanal anstomosis and the remaining patient underwent anterior resection. No diverting colostomy was performed for all cases. During the median follow-up period of 25 months (range 7-71), two patients developed anal stenosis. One patient experienced postoperative recurrence for the follow-up period. In terms of sphincter function (n=6) (f/u period>12 months), there were 1 urgency, 1 gas incontinence and 1 night staining.
CONCLUSIONS
Although this study is a small scale research in terms of the number of subjects involved, one-staged, handsewn coloanal anastomosis after LAR without colostomy may be proved to be helpful for the patients with radiation-induced rectovaginal fistula. If case selection performed properly, unnecessary operation can be avoided and psychologic resistance can be reduced by this procedure.

Factors Affective Sexual Function after Abdominoperineal Resection for Patients with Rectal Cancer.: Yoo, Jang Hak , Kim, Hee Cheol , Cho, Young Kyu , Namgung, Hwan , Kim, Mi Sook , Lee, Hae Ok , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(4):234-239.

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Abstract PDF: BACKGROUND
Abdominoperineal resection (APR) combined with autonomic nerve preservation (ANP) is proven to reduce sexual dysfunction. However, Sexual dysfunction after APR combined ANP occurs as many as 59% of case. PURPOSE: The aims of this study were to assess prog nostic value of various postoperative factors affective sexual function after APR combined with ANP and to suggest a clinical relevant factors for the improvement of sexual function.
METHODS
This was a cross sectional descriptive study. Data were collected using individual-based interviews from 63 patients who underwent APR during the period of Feb. 2001 and April. 2001. The tool for this study was developed by the researcher through modification of the QLQ-CR38 (European Organization for Research and Treatment of Cancer, 1999).
RESULTS
The severity of sexual function showed significant differences according to occupation, intervals after operation, colostomy irrigation. Intervals of longer than 18 month after operation was associated with better sexual function. In multiple regression analysis, colostomy related problems, colostomy irrigation, colostomy complications, intervals after operation, recurrence affected sexual function significantly.
CONCLUSIONS
Colostomy related problems, colostomy irrigation, colostomy complications, intervals after operation and recurrence appear to be associated with sexual function after APR.

Comparative Analysis between Natural Evacuation and Irrigation Technique in Patients with Colostomy.: Lee, Kang Hong , Lee, Hae Ok , Kim, Mi Suk , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 1998;14(3):453-458.

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Abstract PDF: Sixty-three patients with permanent sigmoid colostomy were surveyed to evaluate their satisfaction and complications with the "irrigation technique" and the "atural evacuation" of the colostomy management (irrigation technique; 32 patients, natural evacuation; 31 patients). All patients had colostomy for at least 12 months without disease recurrence. Each patient was interviewed in addition to standard questionnaire. The irrigation was not associated with any major complication including colonic perforation. The irrigation was used younger age group than the natural evacuation (53+/-10 vs. 62+/-12, P=0.01). The frequency of bowel movement was lower in the irrigation than in the natural evacuation (5.1+/-2.5/wk vs. 10.8+/-9.0/wk, P=0.04). Five patients (16%) of the irrigation experienced spontaneous bowel action but only one patient suffered from it. The time spent for managing irrigation was 59+/-13 minutes. Twenty-three patients (74%) of the natural evacuation suffered from one or moreproblems such as expensive apparatus, leakage, skin irritation or odor. Sixteen patients (52%) of the natural evacuation and 2 patients (6%) of the irrigation were restricted in social activity (P=0.0001). Thirteen patients (42%) of the natural evacuation and 1 patient (3%) of the irrigation were dissatisfied with colostomy management (P=0.002). Thus, the irrigation technique seems to be more effective and satisfactory method for managing colostomy without compromising patient's social activity when it is performed in appropriately selected patients.

Clinical Trial

Application of a New Colostomy Device in Incontinent Dog Model.: Lim, Myeung Kook , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 1998;14(3):439-446.

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Abstract PDF: BACKGROUND
Recently developed electrically stimulated gracilis neosphicter or artificial sphincter is quite a promising trial in fecal incontinence However, surgical technique is not simple, the devices are expensive and only specialists can perform the procedures successfully. The aim of this study is to evaluate the efficacy of a newly developed simple silicon device in incontinent dog model.
METHODS
A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured extemal balloon surrounding the internal balloon, a connecting tube disposed under the both infernal and external balloons and supply tube containing a pair of air passages and an enema fluid passage. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 22~26 kg of body weight were prepared. Anal incontinence was made by bilateral severing of the internal and external sphincters and puborectalis muscle under the general anesthesia. Marlex mesh ring was applied to the anal canal as Thiersch wire for the prevention of NCD expulsion in straining. After then, NCD with 2.5 cm of luminal diameter was inserted to the rectum proximal to the Malex mesh ring. Daily irrigation and evacuation was done with 800~1000 cc of tepid water in each dogs. Daily food contained 30 gm of Psyllium dextrose.
RESULTS
Initially 6 dogs were observed for 7 days. Daily irrigation made evacuation of fecal matter well in each dogs. There was no prolapse of device through the anal orifice. Anoscopic examination after 7 days showed no rectal and anal mucosal injury. Two dogs were kept for 40 days as same manner. Sometimes spontaneous bowel movement without water irrigation was noted when the stool were loose. Weelky anoscopic examination revealed no evidence of mucosal injuries for 40 days also. There was no septic or other complication.
CONCLUSION
NCD evacuated fecal matter well enough to empty the rectum in all incontinence dog model. Adequate sized NCD could be used for clinical trials in selected incontinence patients.

Original Articles

Passive Bowel Movement with a New Colostomy Device: An Acute Experiment in Dog.: Lee, Gy Yeong , Kim, Jae Hwang , Lim, Myeung Kook , Chim, Myn Chul; J Korean Soc Coloproctol. 1998;14(3):431-438.

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Abstract PDF: In some clinical situations such as cerebrovascular accident, pelvic bone fracture or any bed ridden states patients do not have self control of their bowel movement. Nursing care around the perianal area is not an easy job. There is no devices which substitude the work because of the chracteristics of the anatomy of the anorectum and the fecal matter made of solid and gel state component. AIM: to evaluate the possibility of passive evacuation of the fecal matter from the rectum with a newly developed silicon device. MATERIAL AND METHODS: A New Colostomy Device (NCD; US Patent No. 5,569,216) for fixing in the stoma or rectum of human body, includes an internal balloon, a ring figured external balloon surrounding the internal balloon, a connecting tube disposed under the both internal and external balloons and supply tube containing a pair of air passages and an enema fluid passages. It is designed to be inserted into the rectum and is held in place by an inflatable external balloon and drains irrigated fecal matter through a thin collapsible connecting tube which exist in the anal canal. Six mongrel dog with 20~25 kg of body weight was used for the acute experiment. Three types (1.5, 2.0, 2.5 cm in luminal diameter of the solid portion) of NCD were applied in 3 consecutive every other days. For softening of the stool, normally harder than that of human, Psyllium dextrose 30 gm was added to the daily food. Average 750 cc of tepid water was administered through the device for bowel irrigation. Anesthesia was not used in each procedures. The amount evacuated fecal matter and remained solid stool in rectum were checked. To evaluate the rectal mucosal injury anoscopic examinations were performed.
RESULTS
Stool evacuation was closely correlated with the intemal diameter of the device and stool component. The device with 2.5 cm in luminal diameter passed fecal matter well enough in 5 of 6 dogs however, smaller devices did not. Accidental prolapse of NCD were noted in 4 of 6 cases with 2.5 cm sized and all of 1.5 and 2.0 sized devices eventually until last push.
CONCLUSION
The NCD with 2.5 cm of internal diameter could be used in selected clinical situations.

A Subtotally Divided End-loop Colostomy for Unresectable Rectal Cancer.: Park, Yonghoe , Yang, Kwangho , Cho, Yonghoon , Kwak, Hisuk , Sin, Jinyong , Oh, Nahmgun; J Korean Soc Coloproctol. 2006;22(1):29-33.

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Abstract PDF: PURPOSE
Divided end-loop colostomy is recommended in some cases of unresectable rectal cancer or anal incontinence, because a conventional loop colostomy is difficult to managing due to bulky stoma volume for a long period. In such case of the divided end-loop colostomy, severe inflammation may occur at the stoma site by poor conditions of the patient so that cause to be retracted or detached, and distal loop may be disrupted. To avoid these problems, we designed subtotally divided end-loop colostomy and studied its clinical effectiveness retrospectively.
METHODS
About a 3 cm diameter, round skin incision as presumed colostomy size was made at the left lower abdomen, and entered the abdominal cavity by splitting the rectus muscle fibers. The caudal side of colon can be identified by confirming the fusioned taenia at the rectosigmoid colon level. After pulling out the colonic loop, the distal colon far from the lesion was subtotally divided by a GIA staple or manual suture, which cut obliquely 80% or 90% from the antimesenteric side of the distal loop while maintaining the 10% or 20% mesenteric side of the colonic loop. Then an end-loop colostomy is matured with a small fistularization of the distal loop as the undivided mesenteric side of colon.
RESULTS
In 8 cases, subtotally divided colonic loop using a GIA staple. But in 9 cases, divided manually because of makedly thickened, edematous colonic wall resulting from prolonged obstruction. There were several mild complications, i.e. transient dermatitis in 5 cases, transient bulky stoma due to edema in 4 cases, mild retraction of stoma in 2 cases, and mild prolapse of stoma in 1 case. There were no major functional abnormalities during the follow-up period.
CONCLUSIONS
Although we need to get further clinical experiences, the subtotally divided end-loop colostomy seems to be a useful alternative surgical procedure for unresectable rectal cancer.

Stomal Complications in Infants and Children.: Jun, Si Youl , Choi, Hyun Sheol , Lee, Seok , Jeong, Keuk Won , Chung, Woo Shik; J Korean Soc Coloproctol. 1998;14(2):299-304.

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Abstract PDF: We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.

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