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Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. Currently, there is no consensus regarding the best time for stoma closure (SC). Our aim was to determine the outcomes of early versus late closure. Methods Retrospective analysis of patients who underwent SC following stoma formation for NEC between Jan 2009 and July 2015 was done. Early (EC) versus late closure (LC) was defined as less than 10 weeks versus at or after 10 weeks of stoma formation. Results Of 36 patients, M:F was 23:13. Indications for laparotomy were pneumoperitoneum (30) and gangrene (6). Postoperatively, 9/15 (60.0%) of EC group required ventilator support versus none in LC group ( p  < 0.05). It took longer to establish full feeds following EC (12 days) versus LC (8 days). Median duration of postoperative hospital stay following EC was 31 days (18–35) versus 7 days (4–54) following LC. Three patients were re-operated for intestinal obstruction (two following EC, one following LC). Three patients developed incisional hernia after EC versus none after LC ( p  < 0.05). One patient died after EC due to staphylococcus septicaemia. Conclusion Early closure before 10 weeks of formation for NEC patients is associated with significant morbidity, increased ventilator requirements and chances of developing incisional hernia.

Background Evidence on early closure (EC) of defunctioning stoma (DS) after colorectal surgery shows a favorable effect when patients are carefully selected. Therefore, a clinical pathway adapted to the implementation of an EC strategy was developed in our center. The aim of this study was to carry out a comparative analysis of time until DS closure and DS-related morbidity before and after the implementation of an EC protocol (ECP). Methods This study is a before-and-after comparative analysis. Patients were divided into two cohorts according to the observational period: patients from the period before the ECP implementation (January 2015–December 2019) [Period 1] and those from the period after that (January 2020–December 2022) [Period 2]. All consecutive patients subjected to elective DS closure within both periods were eligible. Early closure was defined as the reversal within 30 days from DS creation. Patients excluded from EC or those not closed within 30 days since primary surgery were analyzed as late closure (LC). Baseline characteristics and DS-related morbidity were recorded. Results A total of 145 patients were analyzed. Median time with DS was shorter in patients after ECP implementation [42 (21–193) days versus 233 (137–382) days, p  < 0.001]. This reduction in time to closure did not impact the DS closure morbidity and resulted in less DS morbidity (68.8% versus 49.2%, p  = 0.017) and fewer stoma nurse visits ( p  = 0.029). Conclusions The ECP was able to significantly reduce intervals to restoration of bowel continuity in patients with DS, which in turn resulted in a direct impact on the reduction of DS morbidity without negatively affecting DS closure morbidity.

The rate of stoma closure after cytoreductive surgery (CRS) ​± ​hypethermic intraperitoneal chemotherapy (HIPEC) is reportedly low. This study aimed to assess predictors of stoma reversal. We retrospectively analyzed all patients who underwent CRS with temporary ostomy at our center between 2009 and 2021, and compared reversed versus non-reversed patients. Out of 625 CRS, 72 (11.5%) patients were included (median age 62 years, 65% female, 75% with HIPEC): 53 (74%) achieved stoma closure. Reversed patients had less high grade tumors, more appendiceal mucinous neoplasms, less ovarian primaries, and more loop ileostomies. The most common reason for non-reversal was disease progression or death (14 cases, 74%). At multivariate analysis, low/intermediate grade tumor differentiation was associated with higher stoma closure rate. In our study, 74% of patients achieved stoma closure after CRS with temporary ostomy. The strongest predictor of stoma closure was a low/intermediate grade tumor. •In this monocentric study on stoma reversal after cytoreductive surgery (CRS) with temporary ostomy including 72 patients, reversal was achieved in 74%.•The most common reason for non-reversal was disease progression or death.•Patients who achieved reversal had less high-grade tumors and higher disease-free survival than non-reversed patients, while, operative time, extent of surgery, concomitant hyperthermic intraperitoneal chemotherapy and postoperative morbidity was similar.•Low/intermediate grade tumor was the only predictor of stoma reversal at multivariate analysis.

Background This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. Methods A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios’ estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. Results Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI ( p  = 0.0001), presence of parastomal hernia ( p  = 0.0023), colostomy ( p  = 0,001), and end stoma ( p  = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease ( p  = 0.0084) and rectum anterior resection ( p  = 0.0011) were found to be protective factors. Conclusions Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

Surgical site infections (SSIs) are one of the most common complications following diverting loop ileostomy (DLI) closures. This study assesses SSIs after DLI closure and the temporal trends in skin closure technique. A retrospective review was conducted using the American College of Surgeons National Surgical Quality Improvement Program database for adult patients who underwent a DLI closure between 2012 and 2021 across a multistate health system. Skin closure technique was categorized as primary, primary ​+ ​drain, or purse-string closure. The primary outcome was SSI at the former DLI site. A SSI was diagnosed in 5.7% of patients; 6.9% for primary closure, 5.7% for primary closure ​+ ​drain, and 2.7% for purse-string closure (p ​= ​0.25). A diagnosis of Crohn's disease, diverticular disease, and increasing operative time were significant risk factors for SSIs. There was a positive trend in the use of purse-string closure over time (p ​< ​0.0001). This study identified a low SSI rate after DLI closure which did not vary significantly based on skin closure technique. Utilization of purse-string closure increased over time. [Display omitted] •There was a low surgical site infection rate after diverting loop ileostomy closure.•Surgical site infections did not vary significantly based on skin closure technique.•Crohn's, diverticulitis, and longer operative times were significant risk factors.•Utilization of the purse-string closure technique has increased over time.

Although the purse-string suture (PSS) method is widely adopted to reduce surgical-site infection (SSI; the commonest complication following bowel-stoma closure), this technique is associated with delayed epithelialization. Recently, delayed primary closure (DPC) combined with negative-pressure wound therapy (NPWT) has been proposed as a promising alternative. This study aimed to evaluate the clinical efficacy of DPC with NPWT compared to the PSS method in stoma-closure surgery. We conducted a retrospective observational study involving 31 patients who underwent stoma closure between January 2021 and March 2023. Patients were categorized into two groups: PSS with or without NPWT (PSS±NPWT; n=15) and DPC with NPWT (DPC+NPWT; n=16). The primary outcome was wound-healing duration; the secondary outcomes were patient satisfaction and in-hospital costs. The wound-healing duration was significantly shorter in the DPC+NPWT group compared to the PSS±NPWT group (median: 20 45 days, <0.001). Multivariate analysis identified wound-closure method as an independent predictor of wound healing at 30 days. Patient-reported outcomes indicated improved wound-care experience and a trend toward better cosmetic satisfaction in the DPC+NPWT group. Although not statistically significant, the total in-hospital costs were lower in the DPC+NPWT group despite higher device-related expenditures. DPC with NPWT significantly shortened the wound-healing duration and showed potential benefits regarding patient satisfaction and healthcare costs compared to the PSS method. These findings suggest DPC with NPWT as a viable alternative for bowel-stoma closure and wound management.

PurposeEven though minor, stoma-related complications significantly impact quality of life, they are often excluded from clinical analyses that compare short-term postoperative outcomes of loop ileostomy and loop colostomy. This study compares stoma-related complications between loop ileostomy and loop colostomy after rectal resection, including minor complications, and discusses the characteristics of diverting stoma types.MethodsA retrospective review was conducted in patients who underwent diverting stoma construction after rectal resection. Data on patient background and postoperative short-term outcomes, including stoma-related complications and morbidity after stoma closure, were collected and compared between loop ileostomy and loop colostomy groups. Morbidities of all severity grades were targeted for analysis.ResultsA total of 47 patients (27 loop ileostomy, 20 loop colostomy) underwent diverting stoma construction following rectal resection. Overall stoma-related complications, incidence of skin irritation, high-output stoma, and outlet obstruction were significantly higher in the loop ileostomy group but high-output stoma and outlet obstruction were absent in the loop colostomy group. Regarding morbidity after stoma closure, operation times and surgical site infections were significantly higher in the loop colostomy group while anastomotic leakage after diverting stoma closure occurred (2 cases; 15%) in the loop colostomy group but not the loop ileostomy group.ConclusionBecause stoma-related complications were significantly higher in the loop ileostomy group, and even these minor complications may impair QOL, early loop ileostomy closure is recommended. For loop colostomy, stoma-related morbidities are lower but post-closure leakage is a calculated risk.

Background In this study, we aimed to identify the risk factors in patients with rectal anastomotic re-leakage and develop a prediction model to predict the probability of rectal anastomotic re-leakage after stoma closure. Methods This study was a single-center retrospective analysis of patients with rectal cancer who underwent surgery between January 2010 and December 2020. Among 3225 patients who underwent Total or Partial Mesorectal Excision (TME/PME) surgery for rectal cancer, 129 who experienced anastomotic leakage following stoma closure were enrolled. Risk factors for rectal anastomotic re-leakage were analyzed, and a prediction model was established for rectal anastomotic re-leakage. Results Anastomotic re-leakage after stoma closure developed in 13.2% (17/129) of patients. Multivariable analysis revealed that neoadjuvant chemoradiotherapy (odds ratio, 4.07; 95% confidence interval, 1.17–14.21; p =  0.03), blood loss > 50 ml (odds ratio, 4.52; 95% confidence interval, 1.31–15.63; p  = 0.02), and intersphincteric resection (intersphincteric resection vs. low anterior resection: odds ratio, 6.85; 95% confidence interval, 2.01–23.36; p  = 0.002) were independent risk factors for anastomotic re-leakage. A nomogram was constructed to predict the probability of anastomotic re-leakage, with an area under the receiver operating characteristic curve of 0.828 in the cohort. Predictive results correlated with the actual results according to the calibration curve. Conclusions Neoadjuvant chemoradiotherapy, blood loss > 50 ml, and intersphincteric resection are independent risk factors for anastomotic re-leakage following stoma closure. The nomogram can help surgeons identify patients at a higher risk of rectal anastomotic re-leakage.

IntroductionThere are many methods to prevent hernia following stoma closure; however, there is a lack of evidence of the efficacy of prophylactic sublay synthetic mesh placement. This study aimed to investigate the safety of sublay mesh placement during stoma closure.MethodsPatients with rectal cancer who underwent stoma closure with prophylactic sublay mesh placement following low anterior resection at N.N. Blokhin Cancer Research Center between June and July 2023 were included in this pilot study. The inclusion criteria were age 18-75, TNM stage I-III, and written informed consent. The exclusion criteria included patients with synchronous and metachronous cancers, human immunodeficiency virus, an Eastern Cooperative Oncology Group score of >2, and those undergoing chemotherapy. The sublay mesh placement technique was used, with the endpoints being surgical site infection rate at 30 days, operative time, mesh placement time, and postoperative morbidity (Clavien-Dindo classification).ResultsTen patients were included in the study. Among them, one patient (10%) had a postoperative surgical site infection, which did not require mesh removal. There was no other morbidity. The median operative time was 105.5 min, whereas the median mesh placement time was 25.5 min.ConclusionA low surgical site infection rate makes it possible to consider preventive sublay mesh placement during stoma closure. We initiated a prospective randomized clinical trial after this pilot study (ClinicalTrials.gov, NCT05939687).