Colostomy irrigation is a procedure that allows patients to achieve a certain degree of bowel control, and a period free of stoma effluent. It has the potential to improve quality of life, body image and confidence, and reduce patient anxiety. It may also help reduce odour and flatus, prevent/address peristomal skin irritation and alleviate constipation. Because it can reduce or eliminate the need for a colostomy bag, it may also cut expenditure on stoma appliances. However, colostomy irrigation is not offered to patients as standard. A protocol was drawn up to ensure colostomy irrigation was routinely offered to suitable patients and to provide them with a structured follow-up to ensure they were well supported throughout the first year of carrying out the procedure. Quality of life and the efficacy of colostomy irrigation can be monitored using questionnaires on these two issues. Two case studies demonstrate how patients\' quality of life can improve when using colostomy irrigation as part of their stoma care routine.

Postoperative stoma education is an essential aspect of care for all types of stoma formation because having a stoma impacts on every aspect of a person\'s life. This critical review of the literature explores stoma patients\' needs and wants; postoperative education care guidelines; the role of ward link nurses; and care pathways. The findings from this review demonstrate that there is no national standard postoperative stoma care pathway, yet such pathways are a cost-effective means to improve patient outcomes and care. The review also identified that structured care pathways are not a new concept, but there is a lack of formal research to determine best practice in postoperative stoma education. In the UK, there is wide variation in practice and outcomes, which means that effectiveness cannot be accurately measured. The author has developed and implemented a multidisciplinary postoperative education pathway in line with a national need to further refine postoperative stoma care services to meet stoma patients\' needs.

Inflammatory Bowel Disease often causes abdominal pain, faecal urgency and a range of other symptoms, and is a common chronic disease among young people. Stoma surgery seeks to alleviate these symptoms, though complications often arise from surgery and many stoma patients experience various stigmas. Young people with chronic conditions are increasingly gathering online to share their experiences of illness. Given the rise in popularity of TikTok and its appeal to young people, this study explored how young ostomates with Inflammatory Bowel Disease and a stoma portray themselves on TikTok. Using thematic analysis, three themes were identified in which ostomates portrayed themselves as educators, warriors and reformers, providing education, support and guidance to the wider stoma community. These findings show that TikTok offers an innovative platform for ostomates\' self-presentations and a novel space health professionals should harness to better support ostomates.

BACKGROUND: Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI.
METHODS: In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes.
RESULTS: There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001).
CONCLUSIONS: An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

Lips form a structure that are difficult to reconstruct after a traumatic avulsion injury or cancer ablative surgery secondary to loss of volumetric muscle mass. Traditional tissue engineering approaches of in vitro fabrication of mature tissue constructs can supply an alternative to the current surgical standard of care for functional lip reconstruction. We demonstrate a hybrid approach that combines the advantages of in situ muscle flap prefabrication with in vitro fabrication of an autogenous mucocutaneous construct as the laminate for prelamination to form a designer microvascular muscle free flap for lip reconstruction.

OBJECTIVE: The purpose of this study was to investigate how stoma patients perceive their experiences living with a stoma.
METHODS: The research is a descriptive study conducted with 42 patients who lived with a stoma for at least 3 months. Data were collected by a face-to-face interview method with a semi-structured form. The metaphors obtained from the analysis are presented under 3 main headings.
RESULTS: The participant\'s gender was 59.5% male, 78.6% were between the ages of 18 and 64, and 78.6% were married. We discussed patients\' statements about living with a stoma under the themes of \'positive\', \'negative\', and \'both positive and negative\'. A statistically significant relationship was found between age groups, stoma type (colostomy/ileostomy), and stoma type (permanent/temporary) (p < 0.05).
CONCLUSIONS: The findings reveal that negative metaphors occur most frequently in patients between the ages of 18 and 64 who have undergone temporary stoma surgery. Knowing patients\' perceptions of their stoma can be a guide in planning support services for individuals to cope with their negative emotions.

A male patient in his 40s was diagnosed with rectal cancer and underwent abdominoperineal resection (APR) with permanent end colostomy as surgical treatment. He wanted to return to work as soon as possible after discharge. A physical therapist (PT) was involved in the preoperative consultation, and both the PT and occupational therapist started bed rest and activities of daily living (ADL) practice the day after surgery. On the third postoperative day, lightweight trunk exercises were initiated with a gradual increase in load. Stoma management was supervised by a nurse and progress was monitored. The patient\'s progress in ADLs, postoperative complications, and return to work were evaluated two weeks after discharge. Consequently, the patient was able to continue rehabilitation without early complications related to postoperative stoma. He could lift 20 kg and return to carpentry two weeks after discharge. The stoma quality of life improved from 61 points at two weeks after surgery to 74 points at two weeks after discharge. Early rehabilitation for social reintegration after ostomy creation can be safely performed under PT supervision, and a comprehensive interprofessional collaboration can contribute to smooth social reintegration.

BACKGROUND: Over 42 000 Australians live with a stoma, and this number increases annually. Pregnancy in stoma patients is a rare but complex condition and there is limited published literature regarding surgical and obstetric complications in pregnant stoma patients. The aim of this paper was to review stoma outcomes, perinatal morbidity and mortality, and early postpartum period in pregnant stoma patients.
METHODS: Data was retrospectively obtained on women of childbearing age, with a stoma, who had been pregnant and birthed in the last nine years at the Royal Brisbane and Women\'s Hospital between January 2014 to December 2022. Data recorded included patient demographics, type of stoma, indication for stoma, need for additional abdominal surgeries, method of conception, pregnancy complications, length of stay, neonatal outcomes and post pregnancy stomal complications.
RESULTS: In total, there were 16 births from 13 mothers with stomas. Of 10 births to IBD patients, 40% experienced a serious stomal complication. Caesarean section (CS) rate was 90% for IBD and 83% for non-IBD. In-vitro fertilisation rates were 40% in IBD patients and 0% in non-IBD patients. The average gestational age at delivery was 36 weeks in IBD and 35 weeks non-IBD patients. Neonates delivered to IBD mothers had a birth weight under 2500g in 40% of cases and in non IBD mothers at 33.3% (p = 0.62). Of the sixteen births there was five complications (31.25%) associated with the stoma either during pregnancy or during the sixty-day postpartum period.
CONCLUSIONS: Pregnancy in stoma patients is a rare occurrence and appears to be associated with high rates of CS, preterm delivery, low birth weight and stomal complication.

(1) Background: In recent years, there has been a change in practice for diverting stomas in rectal cancer surgery, shifting from routine diverting stomas to a more selective approach. Studies suggest that the benefits of temporary ileostomies do not live up to their risks, such as high-output stomas, stoma dysfunction, and reoperation. (2) Methods: All rectal cancer patients treated with a robotic resection in a single tertiary colorectal centre in the UK from 2013 to 2021 were analysed. In 2015, our unit made a shift to a more selective approach to temporary diverting ileostomies. The cohort was divided into a routine diversion group treated before 2015 and a selective diversion group treated after 2015. Both groups were analysed and compared for short-term outcomes and morbidities. (3) Results: In group A, 63/70 patients (90%) had a diverting stoma compared to 98/135 patients (72.6%) in group B (p = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, p = 0.312) or other complications (p = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, p = 0.312) or reoperation (3.8% vs. 2.6%, p = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% (p = 1.000) of patients were stoma-free. One major reason for the delay in stoma reversal was the COVID-19 pandemic, which only occurred in group B (0% vs. 22%, p = 0.054). (4) Conclusions: A more selective approach to diverting stomas for robotic rectal cancer patients does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours.

BACKGROUND: Intestinal stomas are one of the most common parts of pediatric surgical care, and complications arising from it have significant impact on overall patient outcomes. However, data on major complications in low-middle-income countries remain limited. This pilot retrospective cohort study aimed to investigate the prevalence, types, and management of major stoma complications in pediatric patients at a tertiary government hospital in the Philippines.
METHODS: Medical records of pediatric patients with major stoma complications classified as Clavien-Dindo III-V from June 2018 to June 2023 were reviewed. Patient-related factors (age, sex, diagnosis) and surgery-related factors (stoma type and location, surgeon expertise) were analyzed. Descriptive statistics characterized demographic profiles, while Chi-square and t tests analyzed categorical and continuous variables, respectively. Multivariable logistic regression evaluated independent associations with major stoma complications.
RESULTS: Out of 1041 pediatric patients with stomas, 102 cases had major complications, representing a prevalence rate of 9.8%. Mortality directly attributed to stoma complications accounted for 1.3% of the total cases, or 14 deaths in 5 years. Neonates comprised a significant portion, primarily diagnosed with congenital conditions like anorectal malformation and Hirschsprung\'s disease. Ileostomies exhibited a higher incidence of major complications compared to other stoma types. Stomal prolapse and adhesive bowel obstruction are the most common reported stoma complications requiring surgical intervention while stoma revision is the most frequent corrective procedure. The median time from stoma creation to presentation of major complication was 14 months, with nearly half of the complications occurring within the first year. Only the presence of ileostomy had significant association with the development of major complications among the risk factors analyzed.
CONCLUSIONS: This study provides useful insights into stoma complications in pediatric patients in a low-middle income country. Despite the lack of significant associations between the patient-related and surgeon-related factors, and major stoma complications, further investigation into other contributing factors is warranted. Improvements in data collection methods and prospective studies with larger sample sizes are recommended to enhance understanding and optimize care of major stoma complications. Addressing the challenges identified in this study could lead to a comprehensive and tailored approach to pediatric stoma care and their complications.