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Ileostomy or colostomy is a common surgical procedure used for diverting the lower gastrointestinal content away from distal pathology or anastomotic insufficiency. Once the distal problem has been fixed, the plan is to reverse the stoma. However, the reversal of a stoma is associated with complications, including anastomotic leaks, wound infection, and incisional hernias which can reach up to 33-50%.
The ideal site for a stoma on the abdominal wall depends on several factors, including the patient's anatomy, the type of stoma (colostomy or ileostomy), operative findings, and the patient's preferences. Stomas have traditionally been fashioned through the rectus muscle, away from the midline of the abdomen, and below the umbilicus.
Management of a stoma placed at the center of a long midline laparotomy wound is challenging with the risk of faecal contamination of midline incision. However in many scenarios, the surgeon is left without options rather than to exteriorize the bowel loop through the midline. Moreover, advantages of midline stoma may include:
Only, few reports assess the outcomes of midline ostomy as a temporary stoma
This is a prospective cohort study
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Midline stoma group | Experimental | Patients who will undergo temporary stoma (ileostomy/colostomy) through midline incision |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Midline stoma | Procedure | stoma (ileostomy/colostomy) through midline incision |
|
| Measure | Description | Time Frame |
|---|---|---|
| Conversion rate | Need for stoma revision (failure of midline stoma) and creation of conventional trans-rectus stoma. | During surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of peristomal skin complications | Number and percentage of patients with peristomal skin complications around stoma including erythema, erosion, ulceration and tissue overgrowth (hypergranulation) | 1 month after surgery |
| Incidence of Incisional hernia after stoma reversal |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mohamad Raafat, MD | Contact | 0201067877622 | mohamad_raafat10@yahoo.com | |
| Faculty of Medicine-Assiut University | Contact |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Medicine-Assiut University | Recruiting | Asyut | Asyut Governorate | 71515 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24560428 | Background | Nguyen MT, Phatak UR, Li LT, Hicks SC, Moffett JM, Arita NA, Berger RL, Kao LS, Liang MK. Review of stoma site and midline incisional hernias after stoma reversal. J Surg Res. 2014 Aug;190(2):504-9. doi: 10.1016/j.jss.2014.01.046. Epub 2014 Jan 29. | |
| 9205395 | Background | Erwin-Toth P, Barrett P. Stoma site marking: a primer. Ostomy Wound Manage. 1997 May;43(4):18-22, 24-5. |
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| ID | Term |
|---|---|
| D000069290 | Incisional Hernia |
| ID | Term |
|---|---|
| D006547 | Hernia |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011183 | Postoperative Complications |
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Number and percentage of patients developing incisional hernia at the previous stoma site (after stoma reversal) confirmed clinically or radiologically (ultrasound or CT) |
| 1 year after surgery |
| 24222144 | Background | Eto K, Omura N, Haruki K, Uno Y, Ohkuma M, Nakajima S, Anan T, Kosuge M, Fujita T, Ishida K, Yanaga K. Transumbilical defunctioning ileostomy: A new approach for patients at risks of anastomotic leakage after laparoscopic low anterior resection. Anticancer Res. 2013 Nov;33(11):5011-5. |
| 36808053 | Background | Borejsza-Wysocki M, Bobkiewicz A, Ledwosinski W, Szmyt K, Banasiewicz T, Krokowicz L. Stoma close to the abdominal wound: a real technical problem. A description of a novel care strategy. Pol Przegl Chir. 2023 Feb 17;95(4):1-5. doi: 10.5604/01.3001.0016.2731. |
| 33074137 | Background | DeVito R, Shoukry S, Yglesias B, Fullmer R, Zarnoth B, Kerestes T. A case of simultaneous abdominal wall reconstruction and creation of diverting ostomy in a ventral hernia with loss of domain. Int J Surg Case Rep. 2020;76:361-363. doi: 10.1016/j.ijscr.2020.10.012. Epub 2020 Oct 7. |
| D010335 | Pathologic Processes |