Purpose: The present study aimed to clarify problems nurses faced with stoma care in home nursing care and the usefulness of consultation and visits with accompanying expert ostomy care nurses.

Methods: A survey questionnaire of 940 home health care nursing stations throughout Japan was performed to determine what problems nurses encountered with stoma care, where patients go for advice, and the usefulness of visits with accompanying expert ostomy care nurses.

Results: Responses were obtained from 250 facilities (valid response rate:26.6%). The problems encountered in stoma care included skin irritation (66.0%), fecal and/or urinary leakage (53.6%), application of an ostomy appliance (42.0%), stomal prolapse (32.0%), and bleeding (30.8%). The most common source of consultation for patients in times of trouble was expert ostomy care nurses at the hospital from which the patient was discharged (66.0%).

Visits with accompanying expert nurses were conducted by 62 facilities (24.8%), and 92.6% of the respondents answered that they were helpful in stoma care.

Conclusion: This nationwide survey elucidated the usefulness of consultation and visits with accompanying expert ostomy care nurses in home nursing care.

Purpose: This study aimed to investigate the results of temporary stomas created during anus-preserving surgery and to evaluate the usefulness of anorectal physiology examinations and defecography (exams).

Methods: The subjects were patients who underwent anus-preserving surgery with stomas between 2014 and 2019. The results of stoma closure and the usefulness of exams for decision-making were retrospectively investigated.

Results: The subjects were 97 patients (median age 62 years, 72 males). The stoma was closed in 91 patients (94%). Exams were performed in 11 patients, showing reduced capacity of the neorectum in all. Of 6 patients whose stomas were not closed, 4 (67%) had no choice but to keep their stomas due to original disease aggravation, anastomotic stenosis, or anastomotic leakage, whereas 2 female (33%) patients opted not to have their stoma closed. Of the 2 patients, one whose exam results were good attributed the results to her decision not to close her stoma, whereas the other whose exam results were poor did not attribute the results to her decision.

Conclusion: Anorectal physiology examinations and defecography could be useful in shared decision-making for stoma closure by giving patients and surgeons an opportunity to discuss low anterior resection syndrome, although stoma closure is not decided solely based on the exam results.

Most patients following a sphincter-preserving operation (SPO) for middle and low rectal cancer develop defecatory dysfunction, including frequent bowel movements, fecal and gas incontinence, soiling, urgency, and so on;this is well known as low anterior resection syndrome (LARS).

LARS occurs in 80-90% of patients following an SPO for rectal cancer. Around 40% of patients following an SPO for rectal cancer have a major LARS. LARS is also persistent;in the literature, around 50% of patients following an SPO have had LARS for more than 10 years since they underwent the SPO for rectal cancer. Risk factors of a major LARS are reported to be radiation therapy, total mesorectal excision, anastomotic leakage, creation of a diverting stoma, and height of the anastomosis.

While SPOs are performed more frequently even for lower rectal cancer, multidisciplinary and multimodal treatments for LARS are required with dietary modifications, constipating agents, pelvic floor muscle training and biofeedback therapy, transanal irrigation, sacral neuromodulation, and creation of a permanent stoma.

Background: A case of a wide postoperative infectious seroma after stoma closure combined with an incisional hernia repair is presented. It was successfully treated with sequential combination therapy involving a locally closed-drainage system (LCDS), followed by negative-pressure wound therapy (NPWT).

Cases: The patient was a 59-year-old man who underwent Hartmann's operation for rectal cancer, after which a postoperative incisional hernia developed. Stoma closure and repair of the incisional hernia, which required wide subcutaneous undermining around the midline incision, were performed. At the surgery, a subcutaneous drain was placed for the wide subcutaneous space around the midline incision, and the stoma site was semi-closed with a purse-string suture. After the surgery, a wide infectious seroma developed around the semi-closed stoma closure wound and was difficult to treat.

On postoperative day (POD) 10, therefore, continuous drainage therapy with LCDS was started for the seroma. On POD 17, the subcutaneous space was significantly reduced with the LCDS, which was then followed by NPWT to cure the semi-closed stoma closure wound. The wound was completely healed on POD 30.

Discussion & Conclusion: Sequential combination therapy with LCDS followed by NPWT seems effective and useful for the treatment of a complex wide infectious seroma.