A new technical modification of colostomy to prevent parastomal hernias is presented along with our results. We performed stoma site marking in all cases as an important part of the preoperative work－up with an ostomy care nurse. Colostomy was usually performed through the rectus abdominis and the posterior sheath vertically at the same point. The most important point of this new surgical procedure was preservation of the posterior layer of the rectus sheath or fascia transversalis. We dissected through the rectus abdominis to behind the rectus abdominis horizontally. Then we cut open the fascia transversalis widely at the lateral side of the rectus abdominis. A colostomy tunnel was made through the fascia transversalis to the extraperitoneal space. This method is useful to prevent a parastomal hernia because the preserved fascia transversalis covers the defect of the abdominal wall like a mesh repair for an abdominal scar hernia. Our results showed that the occurrence rates of parastomal hernia after the traditional method and after the modified method were 50％ and 0％, respectively．These results suggest that our modified technique may reduce the incidence of parastomal hernias of end colostomies.

The purposes of this study were to clarify the relationship between defecation dysfunction and coping after sphincter-preserving surgery and to consider effective nursing interventions. The subjects comprised 91 outpatients who underwent intersphincteric resection and low anterior resection for rectal cancer.

Many patients with defecation dysfunction after sphincter-preserving surgery for rectal cancer were able to cope by modifying their dietary habits, such as“avoiding spicy foods，”and “avoiding fiber-rich food．”“Anal cleansing，”“ointment application to some portions of the anus，”and“pad diaper use”were considered for care of the anus in addition to“pelvic floor muscle exercises，”“abdominal massage，”and“ medications for intestinal disorders．”Sex, work situations, change of career after the operation, and unemployment were factors that influenced methods patients used to deal with modifications in their dietary habits. When educating patients on how to cope with modifications in their dietary habits in response to defecation dysfunction，it is necessary to grasp their sex and work situation and provide detailed guidance. Patients should also be taught how to use diaper pads to boost their self-esteem. Regarding nursing interventions, it is important to explain to patients the symptoms and course of defecation dysfunction, so they can improve their self-care capabilities, accept the situation, and set goals.