Purpose:To analyze surgical site infections （SSIs） and other complications after stoma closure.
Methods:The subjects were patients who underwent loop stoma closure between 2010 and 2019 in our institution. SSIs and other postoperative complications were analyzed, particularly their relationships to skin closure methods.
Results:The subjects were 54 patients （median age:68 years, 31 males）. Their stomas had been created at the transverse colon in 33, the ileum in 19, and the sigmoid colon in 2.Regarding the anastomotic procedure, an instrumental functional end-to-end anastomosis and a hand-sewn anastomosis were performed in 33 and 21 cases, respectively. As for skin closure methods, purse-string approximation, semi-closure, and Benz mark methods were used in 48, 4, and 2 cases, respectively. SSIs occurred in 9.3％ , accounting for 42％ of all complications. The SSI incidence was lower in purse-string approximation （8.3％） than in semi-closure（ 25％）, although the difference was not significant. Postoperative hospital stay was significantly longer in patients with SSIs than in those without complications （median 18 vs 10 days, p＝0.0003）. Risk factors for SSI could not be identified.
Conclusions:The incidence of SSI was 8.3％ when the purse-string approximation method was used for skin closure. The postoperative hospital stay was significantly prolonged by 8 days when SSIs occurred.

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Purpose:To clarify factors that make it difficult to establish stoma self-care in patients with a stoma and to obtain suggestions on how to support patients who are expected to have difficulty in establishing stoma self-care.
Method:In patients with gastrointestinal stomas, 13 candidate factors that could be associated with difficulty in establishing stoma self-care were compared between a self-care established group and a non-established group.
Results:Nine factors were found to be associated with difficulty in establishing stoma selfcare:age 75 years or older, decreased activities of daily living, impaired understanding, low vision, decreased finger dexterity, paralysis of the upper limbs, postoperative recovery delay, stoma complications, and malignant tumor.
Conclusion:In order to predict patients’ ability for stoma self-care before surgery, it is important to assess every patient using the criteria of age 75 years or older, decreased activities of daily living, impaired understanding, low vision, decreased finger dexterity, and paralysis of the upper limbs. If a patient has any of the above factors, stoma self-care methods that match the patient's ability should be designed even before admission. Moreover, when stoma self-care ability deteriorates, it is necessary to modify care methods and goals and arrange the cooperation of family members and the use of social resources from the early postoperative period.

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Background:Peristomal skin ulcers are often difficult to treat. We report a case of ileal conduit peristomal skin ulcer that was successfully treated with ureteral stenting and negative pressure wound therapy(NPWT).
Case:A 55-year-old woman was diagnosed with muscle invasive bladder cancer. After two courses of neo-adjuvant cisplatin-based chemotherapy, she underwent radical cystectomy with ileal conduit construction. Within a month following the operation, she developed a peristomal skin ulcer that was exacerbated by administration of adjuvant chemotherapeutic drugs. However, ureteral stenting and NPWT improved the ulceration, which resolved after completion of three courses of adjuvant chemotherapy.
Discussion:We assumed that chemotherapeutic agents in the patient's urine caused the ulceration of the peristomal skin. The ureteral stenting and NPWT protected the skin lesion from the urine contamination, leading to a complete resolution of the ulcer. Effective treatments for ileal conduit peristomal skin ulcer are needed because of the growing number of patients with bladder cancer that require radical cystectomy with ileal conduit construction.
Conclusion:A combination of ureteral stenting and NPWT could be an effective treatment for severe ileal conduit peristomal skin ulcer.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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