Impact of stoma revision surgery on quality of life: the STICK I-I retrospective cohort study

Impact of stoma revision surgery on quality of life: the STICK I-I retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of stoma revision surgery on quality of life: the STICK I-I retrospective cohort study Raisa D.A.T. van der Kolk, Rudolf van den Berg, Sarah van Egmond, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7535279/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Introduction Stoma placement is a frequently performed procedure. Short- and long-term stoma-related complications affect up to 80% of patients and are known to reduce quality of life (QoL). Stoma revision surgery may be indicated, but its influences on QoL has not been studied. Methods A retrospective cohort study was conducted across three hospitals between 2019 and 2022. Patients with a colostomy, ileostomy, or certain type of urostomy for at least one year were included. The stoma-QoL score was compared between a stoma revision surgery and a control group using propensity matching. Patients with available stoma-QoL scores before and after revision surgery were separately analyzed as their own controls. Results Out of 643 patients, 336 completed the questionnaire of which 65 were assigned to the revision group, 216 to the control group and 10 to the own control group. Matching resulted in comparable baseline parameters, except for sex. Other baseline characteristics were equally distributed among the groups. The stoma-QoL scores in patients who had undergone stoma revision did not significantly differ from those who did not undergo stoma revision (mean difference 2.61, p = 0.160). Patients in the own control group scored significantly higher on the stoma-QoL after revision surgery compared to before (mean difference 6.90, p = 0.048), indicating improvement. Conclusions Post-operative stoma-QoL scores were similar to controls who did not undergo revision, but were significantly higher as compared to pre-operative stoma-QoL scores. Figures Figure 1 Figure 2 Figure 3 1 | Introduction In the Netherlands the prevalence of stoma formation is approximately 38,000, with an annual incidence of 7,000 cases ( 1 ). The indications for stoma formation are diverse and include diseases of the small bowel, colon, rectum, bladder, and gynecology diseases with involvement of bowel. Some examples are malignancy, inflammatory diseases, ischemia, trauma, and incontinence ( 2 , 3 ). The most frequently created stomas include end colostomy, loop colostomy, end ileostomy, loop ileostomy, and ileal conduit ( 2 , 3 ). Although stoma formation is a widely used surgical intervention, it is associated with various complications with a reported incidence up to 80% ( 4 ). Examples of stoma-related complications requiring surgery are necrosis, stoma dehiscence, retraction, prolapse, parastomal hernia, stenosis and bleeding ( 5 ). In some cases, these complications necessitate revision surgery. Stoma formation is known to impact patients’ quality of life (QoL) ( 6 – 11 ) and specific stoma related complications have been associated with a reduction of QoL ( 12 , 13 ). A study by Kald et al. ( 12 ) showed a statistical significant difference of the stoma-QoL when comparing patients with and without bulging. Similarly, Van Dijk et al. ( 13 ) reported a statistical significant difference on all four domains of the physical QoL of the SF-36 when comparing patients with and without a parastomal hernia. However, it remains unclear whether patients who undergo stoma revision surgery have worse QoL compared to those who did not have revision surgery, and whether QoL improves after stoma revision. Therefore, the primary objective of this study was to compare QoL between stoma patients with and without the need for stoma revision surgery and to compare pre- and post-operative QoL in patients undergoing stoma revision surgery. Secondary, we aimed to evaluate whether QoL outcomes depend on the indication for revision surgery. 2 | Methods 2.1 Patients This study is based on a retrospective multicenter study which started in 2019 in the Netherlands. Patients were recruited from three hospitals in Rotterdam, the Netherlands; Franciscus Gasthuis & Vlietland hospital, Maasstad hospital and Erasmus University Medical Center. Eligible participants were adults (≥ 18 years) who had received an end or loop colostomy, an end or loop ileostomy, or an urostomy (Indiana pouch, Bricker’s urostomy, or cutaneous ureterostomy) between December 2019 and May 2022, with the stoma in place for at least one year. Patients who underwent stoma reversal or had oesophagostomy were excluded. Eligible patients were identified through hospital medical records and databases, and were invited by telephone to participate in the study between October 2020 and May 2022. Patients who did not answer the phone were invited by mail. The medical ethics committee of the Erasmus University Medical Centre in Rotterdam approved the trial; we also obtained approval from the local ethics committees of the participating hospitals. The STROBE guidelines for reporting of observational studies were followed. 2.2 Questionnaires Participants received an invitation letter containing an informed consent form and two or three questionnaires, which had to be completed and returned to our research team. The first questionnaire was the stoma-QoL questionnaire ( 14 ) (appendix 1). Depending on the type of stoma (ileostomy, colostomy and/or urostomy), a second self-designed questionnaire was included (appendix 2). Both questionnaires were provided in the Dutch language. The stoma-QoL questionnaire ( 14 ) is a validated questionnaire especially designed for patients with an ileostomy or colostomy. It assesses four domains - sleep, sexual activity, relations to family and close friends and social relations to other than family and close friends - with a total of twenty questions. Responses are scored on a four-point Likert scale (always, sometimes, rarely, not at all), with total score ranging from 20 (lowest stoma-QoL) to 80(highest stoma-QoL). The stoma specific questionnaires were specifically designed for the purpose of the present study. These questionnaires included items on baseline patient characteristics at time of completion, whether the stoma placement was planned, whether the stoma place was marked before surgery, number of stoma leaks annually, bulging of the stoma, retraction of the stoma, prolapse of the stoma, shrinkage of the stoma and skin problems of the stoma. Additional baseline characteristics were extracted from medical records: gender, age, center, stoma type, stoma indication, operation type, surgical setting, American Society of Anesthesiologists physical status classification (ASA), time living with a stoma upon completion of the questionnaire, time between completion of the stoma-QoL questionnaire before and after revision surgery, time between stoma placement and first revision surgery, number of revision surgeries, first revision surgery indication, body mass index (BMI), smoking status, pack-years and medical history. Patients who signed the informed consent form and completed the stoma-QoL questionnaire were included in this study and assigned to the appropriate group (own control group, revision group or no-revision control group). 2.3 Primary outcome and patient selection The primary objective of this study was to compare QoL between stoma patients with and without the need for stoma revision surgery and to compare pre- and post-operative QoL in patients undergoing stoma revision surgery. The stoma-QoL was calculated from the stoma-QoL questionnaire ( 14 ). Each question answered with “always” was worth 1 point, with “sometimes” 2 points, with “rarely” 3 points and with “not at all” 4 points. These points were added to form a total score. Patients who underwent a stoma revision surgery before the completion of the initial questionnaires were selected and assigned to the revision group. Patients who did not undergo stoma revision surgery were assigned to the control group (Fig. 1). Matching was applied for comparative analysis of these two groups. For analysing the impact of revision surgery with the patients serving as their own controls, patients were selected if they had undergone a stoma revision surgery after completion of the initial questionnaires. These patients were asked to fill in the stoma-QoL questionnaire for a second time after the stoma revision. For subgroup analyses regarding type of revision surgery, patients who underwent parastomal hernia repair in the matched population were selected, as this was the most common indication. Additional subgroup analyses were performed based on the different stoma types in the matched groups. Subgroup analyses could not be performed for patients who were their own controls due to the small sample size. 2.4 Statistical analyses Statistical analysis was done using IBM SPSS Statistics version 28.0.1.0 and R-studio version 4.3.2. Numerical variables were reported as the mean and standard deviation (± SD). Categorical variables were reported as frequency (%). For the comparison between results the mean difference (MD) or absolute standardized mean difference (ASMD) was reported. For all analyses, a p value of < 0.05 was considered to be statistically significant. Missing data for categorical variables were imputed using polynomial regression, while continuous variables were imputed using the predictive mean matching method. For each missing piece of data twenty imputations were performed. The following variables were included in the imputation model: age, gender, American Society of Anesthesiologists physical status classification (ASA), body mass index (BMI), diabetes, smoking status, stoma type, stoma indication, time living with a stoma, number of stoma leaks per year, surgical setting, operation type and time between last operation and the questionnaire. Matching was performed using propensity score matching. The following variables were included in the propensity score model: age, gender, BMI, stoma type, stoma indication, operation type and number of stoma leaks per year. The propensity scores of the imputed datasets were collected and patients who underwent stoma revision surgery were matched to controls by the optimal full matching method ( 15 ). Patients who could not be matched were outliers and were excluded from further analyses. The quality of the matching model was evaluated visually using an absolute standardized mean difference plot. The outcomes were assessed using linear regression. For the parastomal hernia subgroup, fewer variables were included in the propensity score model due to a smaller sample size. The following variables were included; gender, stoma type and operation type. For analysis of the primary endpoint in the group of patients who formed their own controls, the paired t-test was used in case of a normal distribution, while the Wilcoxon signed ranks test was used for non-normally distributed data. To decide the cutoff point of clinically relevant change, the minimal clinically important difference (MCID) ( 16 ) was determined based on the standard deviation (SD) of the mean change; a value of 0.5 SD was used, as this threshold has been suggested to correspond to the MCID. 3 | Results 3.1 Baseline characteristics Out of 643 screened patients, 336 (52.3%) completed and returned the questionnaires (Fig. 2). A total number of 316 patients were potentially eligible for the matched groups. A total of 45 patients were excluded due to an incomplete stoma-QoL questionnaire, after which 65 patients who underwent revision surgery and 216 control patients remained available for matching. Ten patients completed a questionnaire both before and after revision surgery and were included for analysis with the patients as their own controls. The baseline characteristics of the revision and control group before and after matching, as well as the patients that were their own controls, are displayed in Table 1. Before matching, several characteristics were significantly different between the revision and control group. Patients who had undergone revision surgery were more likely to be female (63.1% vs. 39.4%), had more often an end ileostomy (21.5% vs. 13.0%) or loop ileostomy (18.5% vs. 3.7%), and less often an end colostomy (38.5% vs. 55.1%) or Bricker urostomy (9.2% vs. 25.5%). Furthermore, patients who had undergone revision surgery were less often treated for malignancy (30.2% vs. 50.9%), and more often for inflammatory bowel disease (17.5% vs. 8.4%). The proportion of open surgery was similar in both groups (53.1% vs 47.2%), and minimally invasive surgery was more often robot-assisted in the control group (10.2% vs 29.2%). The patients of the revision group had annually more stoma leakages compared to the control group (54 vs. 15). Optimal full matching resulted in 63 patients for the adjusted revision group and 214 patients for the adjusted control group. Baseline characteristics were balanced between the groups as the ASMD for the distance equals 0.001 (table1, Fig. 3) and the propensity scores were equally distributed (supplementary 1). Only gender still differed significantly after matching (54.9% vs. 44.2% female, ASMD = 0.222) (table 1). Out of the ten patients in the own control group, six were female and the mean age was 63 (± 13) (table 1). Four patients had an end ileostomy, three patients an end colostomy, one patient a Bricker urostomy, one patient a loop ileostomy and one patient an end colostomy and a Bricker urostomy. The indication for the stoma was malignancy or inflammatory bowel disease in four patients each. For one patient the indication was diverticulitis and for one patient it was urinary incontinence. Most patients received a revision surgery due to parastomal hernia (n = 8). 3.2 Stoma Quality of Life The stoma-QoL questionnaire was filled out with a median interval from stoma creation of 61 months (IQR 43–106) in the revision group and 42 months (IQR 32–54) in the control group. The time interval between revision surgery and the post-operative stoma-QoL questionnaire was 38 months (IQR 24–41). In the patients who were their own controls, the questionnaires were filled out with a median pre-operative and post-operative interval relative to revision surgery of 18 and 44 months, respectively. In the matched population, the stoma-QoL after revision surgery did not significantly differ from the control group (MD 2.6, p = 0.160) (table 2). The power equals 0.999. For the own control group, patients scored significantly higher on the stoma-QoL after stoma revision surgery compared to before (MD 6.9, p = 0.048) (table 3, supplementary 2). This difference is clinically relevant as the MCID equals 4.8. Using Cohen’s d formula, a medium effect size was calculated which equals 0.72 (0.01–1.41). The power equals 0.530. 3.3 Parastomal hernia Subgroup analysis was done for parastomal hernia repair. In the matched population, 17 patients underwent stoma revision surgery due to a parastomal hernia, and nine of those patients were successfully matched to 93 controls as the ASMD for the distance equals 0.015 (supplementary 3–5). The stoma-QoL did not significantly differ between the groups. The mean stoma-QoL for the revision group was 52.0 and for the control group 57.2 (MD 5.2, p = 0.272) (supplementary 6). For the own control approach, the stoma-QoL did not differ significantly before and after stoma revision surgery for this subgroup. The mean stoma-QoL before and after surgery were 56.0 and 62.9, respectively (MD 6.9 (-0.4-14.2), p = 0.061). 3.4 Stoma type For the matched population, the stoma-QoL did not differ significantly between the revision and control group for all but one stoma type (supplementary 7). Only patients with a Bricker urostomy who had undergone a stoma revision surgery scored significantly higher on the stoma-QoL compared to patients with a Bricker urostomy who had not undergone a stoma revision surgery. The mean stoma-QoL for the patients with a Bricker urostomy who had undergone a stoma revision surgery was 71.2 and the mean stoma-QoL for the patients with a Bricker urostomy who had not undergone a stoma revision surgery was 61.5 (MD 9.7, p = 0.047). 4 | Discussion The present study investigated whether stoma revision surgery improves the QoL. As far as we are aware of, no study to date has specifically examined this question. The findings suggest that stoma revision surgery enhances QoL. This conclusion is supported by the results from the own-control analysis, which demonstrated a significant increase in stoma-QoL following revision surgery compared to the pre-operative questionnaires. For the matched population, no difference in stoma-QoL was seen between the post-operative scores after revision and the scores in the control group. This might indicate that the stoma-QoL after revision surgery is comparable to the stoma-QoL in the control group. Based on our matched approach, it is not possible to conclude that the stoma-QoL increases after revision surgery. However, this is in accordance with earlier studies ( 12 , 13 ). These two studies show that the QoL of patients with stoma complications is lower in comparison to patients without stoma complications. Therefore, when QoL improves for patients with stoma complications - possibly due to revision surgery - the difference in QoL between the two patient groups might vanish. Moreover, a significant difference in stoma-QoL before and after revision surgery for the subgroup of patients with a parastomal hernia was found, with a p-value of 0.061. Additionally, there was no difference in stoma-QoL between the revision and control group for most stoma types. Only the stoma-QoL for patients with a Bricker urostomy and revision surgery was significantly higher compared to patients with a Bricker urostomy and no revision surgery. The underlying cause of this difference remains unclear. A hypothesis is that stoma leaks are more frequent in the Bricker control group compared to the Bricker revision group. However, whether the number of stoma leaks are related to QoL still requires further research. This study differs from the previous two studies in several aspects ( 12 , 13 ). It included a greater variety of stoma types and stoma indications, whereas the study by Kald et al. ( 13 ) only included end colostomies, and the study by van Dijk et al. ( 14 ) only included end colostomies and patients who underwent a Hartmann procedure or abdominoperineal resection. Furthermore, this is a multicenter study with three centers, while Kald et al. ( 13 ) performed a single-center study and van Dijk et al. ( 14 ) a multicenter study with two centers. Moreover, cases were matched to controls in the present study in order to reduce confounding, whilst this was not incorporated into the other study designs ( 13 , 14 ). A limitation of this study is the low power of the own control analysis which equals 0.530 due to a low sample size. This power in combination with a relatively high effect size of 0.722 indicates that the chance of a type-1 error, and therefore a false positive result, is higher than ideal. Nevertheless, the power of the match analysis equals 0.999, which strengthens the chance that there is a significant difference in stoma-QoL before and after revision surgery. As mentioned earlier the stoma-QoL did not differ between the revision and control group, which suggests that the revision group gained QoL. Taking this into account, the true difference in stoma-QoL is expected to be lower than the found 6.90, but will still be expected to be higher than the MCID of 4.78. Subgroup analysis for patients with parastomal hernia indicated an improvement in QoL, although statistical significance was not reached. This could be explained due to a small sample size (n = 8), which resulted in limited statistical power. Given that the p-value of 0.061 is close to the statistical significance threshold, it is likely that a larger sample size would yield statistically significant results. The retrospective design of this study presents additional limitations. For instance, the follow-up time differed, whereas a standardized follow-up period would have minimized potential confounding. Additionally, patients who died during this study could not complete the stoma-QoL for a second time, reducing the sample size and consequently, the statistical power. Furthermore, selection bias might have occurred if only patients suffering from stoma leaks have responded to the questionnaires. Considering the use of data of the retrospective multicenter study which started in 2019 in the Netherlands - whose focus is on risk factors for and preventive treatments of stoma leaks - this bias could have led to an overestimation of the observed effects. Additionally causal inferences cannot be drawn from this observational study. Moreover, retrospective studies have a high risk of recall bias in general. However, this study has no such risk as the stoma-QoL questionnaire evaluates how patients feel at the time of completing the questionnaire. This constitutes an additional strength of the study. 5 | Conclusions To the best of our knowledge, this is the first study that evaluated the influence of stoma revision surgery on QoL in patients with a stoma. Although in a small group of patients, the stoma-QoL appeared to improve following revision surgery. The finding that post-operative stoma-QoL scores were similar to controls that did not underwent revision surgery supports this observation. Future research should seek to confirm these findings through prospective studies with standardized pre- and post-operative QoL assessment to enhance statistical power. Declarations Competing interest statement: No competing interests are present for any of the authors Author Contribution S.E. and R.K. collected the study data. R.K. and R.B. wrote the main manuscript text. All authors reviewed the final manuscript. Data Availability Data used in this study is available upon request. Grants and funding . No funding was received for this study Data availability statement Data used in this study is available upon request References Smelt JJG, Baas HG, Beekhuizen H, Bremer-Goossens T, de Buck JEC, Broekhof M, et al. Richtlijn Stomazorg Nederland [Internet]: V&VN; 2012 [updated 2018; cited 2024 Apr 4]. Available from: https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/VVN%20Rapport_Richtlijn%20stomazorg%20herziening%202018.pdf1__0.pdf . Mulita F, Lotfollahzadeh S. Intestinal Stoma [Internet]: StatPearls Publishing; 2024 [updated 2023; cited 2024 Apr 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565910 . Berti-Hearn L, Elliott B. Urostomy Care: A Guide for Home Care Clinicians. Home Healthc Now. 2019;37(5):248–55. Malik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity - a systematic review of randomised controlled trials. Ann R Coll Surg Engl. 2018;100(7):501–8. Parini D, Bondurri A, Ferrara F, Rizzo G, Pata F, Veltri M, et al. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg. 2023;18(1):48. Baker DM, Folan AM, Lee MJ, Jones GL, Brown SR, Lobo AJ. A systematic review and meta-analysis of outcomes after elective surgery for ulcerative colitis. Colorectal Dis. 2021;23(1):18–33. 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Health Qual Life Outcomes 18, 136 (2020). https://doi.org/10.1186/s12955-020-01344-w Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.xlsx Table2.xlsx Table3.xlsx Supplementary.xlsx Appendix1stomaQoL.docx Appendix2ileocolostomyandurostomyquestionnaire.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Nov, 2025 Reviews received at journal 10 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 05 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviews received at journal 02 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviewers invited by journal 31 Oct, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 05 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":62984,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/313444a41bdcfd409489374b.jpg"},{"id":95797802,"identity":"227611b6-05b3-4766-9741-6414407b2b78","added_by":"auto","created_at":"2025-11-13 08:11:05","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":79577,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/424874e59fabb54b6b7e0c60.jpg"},{"id":95665540,"identity":"7a438342-3334-4df3-a66a-8e170decd3c6","added_by":"auto","created_at":"2025-11-11 16:46:23","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":104926,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/1c38b40d9f1fb9ef81215a0e.jpg"},{"id":95804491,"identity":"bda65650-757f-448f-9fca-a81cd86b79c5","added_by":"auto","created_at":"2025-11-13 08:37:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":724854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/50cf6290-3a54-4410-a126-6512d9a7bdf3.pdf"},{"id":95797470,"identity":"73fca1c3-2dea-4f4f-8829-95eb41d7e373","added_by":"auto","created_at":"2025-11-13 08:05:44","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20186,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/81b8f61bd42fb76a514a5fa5.xlsx"},{"id":95665541,"identity":"d0307c69-a415-4f4b-9af6-804289ee89fe","added_by":"auto","created_at":"2025-11-11 16:46:23","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":9241,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/a4e1ae4569ae0c81087381b9.xlsx"},{"id":95665544,"identity":"e806b313-a7b4-4bfb-b219-34a7dc094d2f","added_by":"auto","created_at":"2025-11-11 16:46:24","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":9230,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/a2d60922d3341969f7ccbfc3.xlsx"},{"id":95665547,"identity":"15e53e14-84d2-4cb0-b8f2-329eb9b6aac1","added_by":"auto","created_at":"2025-11-11 16:46:24","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":105537,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/70451fab3e81b90097d88f9e.xlsx"},{"id":95665543,"identity":"5b88e4a1-fd21-465a-9cc7-e0f48a9a0d13","added_by":"auto","created_at":"2025-11-11 16:46:23","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":31526,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1stomaQoL.docx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/cebaf3e9a8e458af4fd2c389.docx"},{"id":95665553,"identity":"4a199695-5845-48b9-a8a6-18093bac29a3","added_by":"auto","created_at":"2025-11-11 16:46:24","extension":"docx","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":32709,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2ileocolostomyandurostomyquestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7535279/v1/a2b7d4b8693741fa45d99c84.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of stoma revision surgery on quality of life: the STICK I-I retrospective cohort study","fulltext":[{"header":"1 | Introduction","content":"\u003cp\u003eIn the Netherlands the prevalence of stoma formation is approximately 38,000, with an annual incidence of 7,000 cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The indications for stoma formation are diverse and include diseases of the small bowel, colon, rectum, bladder, and gynecology diseases with involvement of bowel. Some examples are malignancy, inflammatory diseases, ischemia, trauma, and incontinence (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The most frequently created stomas include end colostomy, loop colostomy, end ileostomy, loop ileostomy, and ileal conduit (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although stoma formation is a widely used surgical intervention, it is associated with various complications with a reported incidence up to 80% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Examples of stoma-related complications requiring surgery are necrosis, stoma dehiscence, retraction, prolapse, parastomal hernia, stenosis and bleeding (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In some cases, these complications necessitate revision surgery.\u003c/p\u003e\u003cp\u003eStoma formation is known to impact patients\u0026rsquo; quality of life (QoL) (\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and specific stoma related complications have been associated with a reduction of QoL (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A study by Kald et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) showed a statistical significant difference of the stoma-QoL when comparing patients with and without bulging. Similarly, Van Dijk et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) reported a statistical significant difference on all four domains of the physical QoL of the SF-36 when comparing patients with and without a parastomal hernia. However, it remains unclear whether patients who undergo stoma revision surgery have worse QoL compared to those who did not have revision surgery, and whether QoL improves after stoma revision.\u003c/p\u003e\u003cp\u003eTherefore, the primary objective of this study was to compare QoL between stoma patients with and without the need for stoma revision surgery and to compare pre- and post-operative QoL in patients undergoing stoma revision surgery. Secondary, we aimed to evaluate whether QoL outcomes depend on the indication for revision surgery.\u003c/p\u003e"},{"header":"2 | Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Patients\u003c/h2\u003e\u003cp\u003eThis study is based on a retrospective multicenter study which started in 2019 in the Netherlands. Patients were recruited from three hospitals in Rotterdam, the Netherlands; Franciscus Gasthuis \u0026amp; Vlietland hospital, Maasstad hospital and Erasmus University Medical Center. Eligible participants were adults (\u0026ge;\u0026thinsp;18 years) who had received an end or loop colostomy, an end or loop ileostomy, or an urostomy (Indiana pouch, Bricker\u0026rsquo;s urostomy, or cutaneous ureterostomy) between December 2019 and May 2022, with the stoma in place for at least one year. Patients who underwent stoma reversal or had oesophagostomy were excluded. Eligible patients were identified through hospital medical records and databases, and were invited by telephone to participate in the study between October 2020 and May 2022. Patients who did not answer the phone were invited by mail. The medical ethics committee of the Erasmus University Medical Centre in Rotterdam approved the trial; we also obtained approval from the local ethics committees of the participating hospitals. The STROBE guidelines for reporting of observational studies were followed.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Questionnaires\u003c/h2\u003e\u003cp\u003e Participants received an invitation letter containing an informed consent form and two or three questionnaires, which had to be completed and returned to our research team. The first questionnaire was the stoma-QoL questionnaire (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) (appendix 1). Depending on the type of stoma (ileostomy, colostomy and/or urostomy), a second self-designed questionnaire was included (appendix 2). Both questionnaires were provided in the Dutch language.\u003c/p\u003e\u003cp\u003eThe stoma-QoL questionnaire (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) is a validated questionnaire especially designed for patients with an ileostomy or colostomy. It assesses four domains - sleep, sexual activity, relations to family and close friends and social relations to other than family and close friends - with a total of twenty questions. Responses are scored on a four-point Likert scale (always, sometimes, rarely, not at all), with total score ranging from 20 (lowest stoma-QoL) to 80(highest stoma-QoL).\u003c/p\u003e\u003cp\u003eThe stoma specific questionnaires were specifically designed for the purpose of the present study. These questionnaires included items on baseline patient characteristics at time of completion, whether the stoma placement was planned, whether the stoma place was marked before surgery, number of stoma leaks annually, bulging of the stoma, retraction of the stoma, prolapse of the stoma, shrinkage of the stoma and skin problems of the stoma. Additional baseline characteristics were extracted from medical records: gender, age, center, stoma type, stoma indication, operation type, surgical setting, American Society of Anesthesiologists physical status classification (ASA), time living with a stoma upon completion of the questionnaire, time between completion of the stoma-QoL questionnaire before and after revision surgery, time between stoma placement and first revision surgery, number of revision surgeries, first revision surgery indication, body mass index (BMI), smoking status, pack-years and medical history. Patients who signed the informed consent form and completed the stoma-QoL questionnaire were included in this study and assigned to the appropriate group (own control group, revision group or no-revision control group).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Primary outcome and patient selection\u003c/h2\u003e\u003cp\u003eThe primary objective of this study was to compare QoL between stoma patients with and without the need for stoma revision surgery and to compare pre- and post-operative QoL in patients undergoing stoma revision surgery. The stoma-QoL was calculated from the stoma-QoL questionnaire (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Each question answered with \u0026ldquo;always\u0026rdquo; was worth 1 point, with \u0026ldquo;sometimes\u0026rdquo; 2 points, with \u0026ldquo;rarely\u0026rdquo; 3 points and with \u0026ldquo;not at all\u0026rdquo; 4 points. These points were added to form a total score.\u003c/p\u003e\u003cp\u003ePatients who underwent a stoma revision surgery before the completion of the initial questionnaires were selected and assigned to the revision group. Patients who did not undergo stoma revision surgery were assigned to the control group (Fig.\u0026nbsp;1). Matching was applied for comparative analysis of these two groups.\u003c/p\u003e\u003cp\u003eFor analysing the impact of revision surgery with the patients serving as their own controls, patients were selected if they had undergone a stoma revision surgery after completion of the initial questionnaires. These patients were asked to fill in the stoma-QoL questionnaire for a second time after the stoma revision.\u003c/p\u003e\u003cp\u003eFor subgroup analyses regarding type of revision surgery, patients who underwent parastomal hernia repair in the matched population were selected, as this was the most common indication. Additional subgroup analyses were performed based on the different stoma types in the matched groups. Subgroup analyses could not be performed for patients who were their own controls due to the small sample size.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical analyses\u003c/h2\u003e\u003cp\u003eStatistical analysis was done using IBM SPSS Statistics version 28.0.1.0 and R-studio version 4.3.2. Numerical variables were reported as the mean and standard deviation (\u0026plusmn;\u0026thinsp;SD). Categorical variables were reported as frequency (%). For the comparison between results the mean difference (MD) or absolute standardized mean difference (ASMD) was reported. For all analyses, a p value of \u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e\u003cp\u003eMissing data for categorical variables were imputed using polynomial regression, while continuous variables were imputed using the predictive mean matching method. For each missing piece of data twenty imputations were performed. The following variables were included in the imputation model: age, gender, American Society of Anesthesiologists physical status classification (ASA), body mass index (BMI), diabetes, smoking status, stoma type, stoma indication, time living with a stoma, number of stoma leaks per year, surgical setting, operation type and time between last operation and the questionnaire.\u003c/p\u003e\u003cp\u003eMatching was performed using propensity score matching. The following variables were included in the propensity score model: age, gender, BMI, stoma type, stoma indication, operation type and number of stoma leaks per year. The propensity scores of the imputed datasets were collected and patients who underwent stoma revision surgery were matched to controls by the optimal full matching method (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Patients who could not be matched were outliers and were excluded from further analyses. The quality of the matching model was evaluated visually using an absolute standardized mean difference plot. The outcomes were assessed using linear regression.\u003c/p\u003e\u003cp\u003eFor the parastomal hernia subgroup, fewer variables were included in the propensity score model due to a smaller sample size. The following variables were included; gender, stoma type and operation type.\u003c/p\u003e\u003cp\u003eFor analysis of the primary endpoint in the group of patients who formed their own controls, the paired t-test was used in case of a normal distribution, while the Wilcoxon signed ranks test was used for non-normally distributed data. To decide the cutoff point of clinically relevant change, the minimal clinically important difference (MCID) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) was determined based on the standard deviation (SD) of the mean change; a value of 0.5 SD was used, as this threshold has been suggested to correspond to the MCID.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 | Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Baseline characteristics\u003c/h2\u003e\u003cp\u003eOut of 643 screened patients, 336 (52.3%) completed and returned the questionnaires (Fig.\u0026nbsp;2). A total number of 316 patients were potentially eligible for the matched groups. A total of 45 patients were excluded due to an incomplete stoma-QoL questionnaire, after which 65 patients who underwent revision surgery and 216 control patients remained available for matching. Ten patients completed a questionnaire both before and after revision surgery and were included for analysis with the patients as their own controls.\u003c/p\u003e\u003cp\u003eThe baseline characteristics of the revision and control group before and after matching, as well as the patients that were their own controls, are displayed in Table\u0026nbsp;1. Before matching, several characteristics were significantly different between the revision and control group. Patients who had undergone revision surgery were more likely to be female (63.1% vs. 39.4%), had more often an end ileostomy (21.5% vs. 13.0%) or loop ileostomy (18.5% vs. 3.7%), and less often an end colostomy (38.5% vs. 55.1%) or Bricker urostomy (9.2% vs. 25.5%). Furthermore, patients who had undergone revision surgery were less often treated for malignancy (30.2% vs. 50.9%), and more often for inflammatory bowel disease (17.5% vs. 8.4%). The proportion of open surgery was similar in both groups (53.1% vs 47.2%), and minimally invasive surgery was more often robot-assisted in the control group (10.2% vs 29.2%). The patients of the revision group had annually more stoma leakages compared to the control group (54 vs. 15).\u003c/p\u003e\u003cp\u003eOptimal full matching resulted in 63 patients for the adjusted revision group and 214 patients for the adjusted control group. Baseline characteristics were balanced between the groups as the ASMD for the distance equals 0.001 (table1, Fig.\u0026nbsp;3) and the propensity scores were equally distributed (supplementary 1). Only gender still differed significantly after matching (54.9% vs. 44.2% female, ASMD\u0026thinsp;=\u0026thinsp;0.222) (table 1).\u003c/p\u003e\u003cp\u003eOut of the ten patients in the own control group, six were female and the mean age was 63 (\u0026plusmn;\u0026thinsp;13) (table 1). Four patients had an end ileostomy, three patients an end colostomy, one patient a Bricker urostomy, one patient a loop ileostomy and one patient an end colostomy and a Bricker urostomy. The indication for the stoma was malignancy or inflammatory bowel disease in four patients each. For one patient the indication was diverticulitis and for one patient it was urinary incontinence. Most patients received a revision surgery due to parastomal hernia (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Stoma Quality of Life\u003c/h2\u003e\u003cp\u003eThe stoma-QoL questionnaire was filled out with a median interval from stoma creation of 61 months (IQR 43\u0026ndash;106) in the revision group and 42 months (IQR 32\u0026ndash;54) in the control group. The time interval between revision surgery and the post-operative stoma-QoL questionnaire was 38 months (IQR 24\u0026ndash;41). In the patients who were their own controls, the questionnaires were filled out with a median pre-operative and post-operative interval relative to revision surgery of 18 and 44 months, respectively.\u003c/p\u003e\u003cp\u003eIn the matched population, the stoma-QoL after revision surgery did not significantly differ from the control group (MD 2.6, p\u0026thinsp;=\u0026thinsp;0.160) (table 2). The power equals 0.999.\u003c/p\u003e\u003cp\u003eFor the own control group, patients scored significantly higher on the stoma-QoL after stoma revision surgery compared to before (MD 6.9, p\u0026thinsp;=\u0026thinsp;0.048) (table 3, supplementary 2). This difference is clinically relevant as the MCID equals 4.8. Using Cohen\u0026rsquo;s d formula, a medium effect size was calculated which equals 0.72 (0.01\u0026ndash;1.41). The power equals 0.530.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Parastomal hernia\u003c/h2\u003e\u003cp\u003eSubgroup analysis was done for parastomal hernia repair. In the matched population, 17 patients underwent stoma revision surgery due to a parastomal hernia, and nine of those patients were successfully matched to 93 controls as the ASMD for the distance equals 0.015 (supplementary 3\u0026ndash;5). The stoma-QoL did not significantly differ between the groups. The mean stoma-QoL for the revision group was 52.0 and for the control group 57.2 (MD 5.2, p\u0026thinsp;=\u0026thinsp;0.272) (supplementary 6). For the own control approach, the stoma-QoL did not differ significantly before and after stoma revision surgery for this subgroup. The mean stoma-QoL before and after surgery were 56.0 and 62.9, respectively (MD 6.9 (-0.4-14.2), p\u0026thinsp;=\u0026thinsp;0.061).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Stoma type\u003c/h2\u003e\u003cp\u003eFor the matched population, the stoma-QoL did not differ significantly between the revision and control group for all but one stoma type (supplementary 7). Only patients with a Bricker urostomy who had undergone a stoma revision surgery scored significantly higher on the stoma-QoL compared to patients with a Bricker urostomy who had not undergone a stoma revision surgery. The mean stoma-QoL for the patients with a Bricker urostomy who had undergone a stoma revision surgery was 71.2 and the mean stoma-QoL for the patients with a Bricker urostomy who had not undergone a stoma revision surgery was 61.5 (MD 9.7, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003c/div\u003e"},{"header":"4 | Discussion","content":"\u003cp\u003eThe present study investigated whether stoma revision surgery improves the QoL. As far as we are aware of, no study to date has specifically examined this question. The findings suggest that stoma revision surgery enhances QoL.\u003c/p\u003e\u003cp\u003eThis conclusion is supported by the results from the own-control analysis, which demonstrated a significant increase in stoma-QoL following revision surgery compared to the pre-operative questionnaires. For the matched population, no difference in stoma-QoL was seen between the post-operative scores after revision and the scores in the control group. This might indicate that the stoma-QoL after revision surgery is comparable to the stoma-QoL in the control group. Based on our matched approach, it is not possible to conclude that the stoma-QoL increases after revision surgery. However, this is in accordance with earlier studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These two studies show that the QoL of patients with stoma complications is lower in comparison to patients without stoma complications. Therefore, when QoL improves for patients with stoma complications - possibly due to revision surgery - the difference in QoL between the two patient groups might vanish.\u003c/p\u003e\u003cp\u003eMoreover, a significant difference in stoma-QoL before and after revision surgery for the subgroup of patients with a parastomal hernia was found, with a p-value of 0.061. Additionally, there was no difference in stoma-QoL between the revision and control group for most stoma types. Only the stoma-QoL for patients with a Bricker urostomy and revision surgery was significantly higher compared to patients with a Bricker urostomy and no revision surgery. The underlying cause of this difference remains unclear. A hypothesis is that stoma leaks are more frequent in the Bricker control group compared to the Bricker revision group. However, whether the number of stoma leaks are related to QoL still requires further research.\u003c/p\u003e\u003cp\u003eThis study differs from the previous two studies in several aspects (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). It included a greater variety of stoma types and stoma indications, whereas the study by Kald et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) only included end colostomies, and the study by van Dijk et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) only included end colostomies and patients who underwent a Hartmann procedure or abdominoperineal resection. Furthermore, this is a multicenter study with three centers, while Kald et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) performed a single-center study and van Dijk et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) a multicenter study with two centers. Moreover, cases were matched to controls in the present study in order to reduce confounding, whilst this was not incorporated into the other study designs (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA limitation of this study is the low power of the own control analysis which equals 0.530 due to a low sample size. This power in combination with a relatively high effect size of 0.722 indicates that the chance of a type-1 error, and therefore a false positive result, is higher than ideal. Nevertheless, the power of the match analysis equals 0.999, which strengthens the chance that there is a significant difference in stoma-QoL before and after revision surgery. As mentioned earlier the stoma-QoL did not differ between the revision and control group, which suggests that the revision group gained QoL. Taking this into account, the true difference in stoma-QoL is expected to be lower than the found 6.90, but will still be expected to be higher than the MCID of 4.78.\u003c/p\u003e\u003cp\u003eSubgroup analysis for patients with parastomal hernia indicated an improvement in QoL, although statistical significance was not reached. This could be explained due to a small sample size (n\u0026thinsp;=\u0026thinsp;8), which resulted in limited statistical power. Given that the p-value of 0.061 is close to the statistical significance threshold, it is likely that a larger sample size would yield statistically significant results. The retrospective design of this study presents additional limitations. For instance, the follow-up time differed, whereas a standardized follow-up period would have minimized potential confounding. Additionally, patients who died during this study could not complete the stoma-QoL for a second time, reducing the sample size and consequently, the statistical power.\u003c/p\u003e\u003cp\u003eFurthermore, selection bias might have occurred if only patients suffering from stoma leaks have responded to the questionnaires. Considering the use of data of the retrospective multicenter study which started in 2019 in the Netherlands - whose focus is on risk factors for and preventive treatments of stoma leaks - this bias could have led to an overestimation of the observed effects.\u003c/p\u003e\u003cp\u003eAdditionally causal inferences cannot be drawn from this observational study. Moreover, retrospective studies have a high risk of recall bias in general. However, this study has no such risk as the stoma-QoL questionnaire evaluates how patients feel at the time of completing the questionnaire. This constitutes an additional strength of the study.\u003c/p\u003e"},{"header":"5 | Conclusions","content":"\u003cp\u003eTo the best of our knowledge, this is the first study that evaluated the influence of stoma revision surgery on QoL in patients with a stoma. Although in a small group of patients, the stoma-QoL appeared to improve following revision surgery. The finding that post-operative stoma-QoL scores were similar to controls that did not underwent revision surgery supports this observation. Future research should seek to confirm these findings through prospective studies with standardized pre- and post-operative QoL assessment to enhance statistical power.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting interest statement:\u003c/h2\u003e\u003cp\u003eNo competing interests are present for any of the authors\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.E. and R.K. collected the study data. R.K. and R.B. wrote the main manuscript text. All authors reviewed the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData used in this study is available upon request.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eGrants and funding\u003c/strong\u003e. No funding was received for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in this study is available upon request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSmelt JJG, Baas HG, Beekhuizen H, Bremer-Goossens T, de Buck JEC, Broekhof M, et al. Richtlijn Stomazorg Nederland [Internet]: V\u0026amp;VN; 2012 [updated 2018; cited 2024 Apr 4]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/VVN%20Rapport_Richtlijn%20stomazorg%20herziening%202018.pdf1__0.pdf\u003c/span\u003e\u003cspan address=\"https://www.mdl.nl/sites/www.mdl.nl/files/richlijnen/VVN%20Rapport_Richtlijn%20stomazorg%20herziening%202018.pdf1__0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMulita F, Lotfollahzadeh S. Intestinal Stoma [Internet]: StatPearls Publishing; 2024 [updated 2023; cited 2024 Apr 4]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/books/NBK565910\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/books/NBK565910\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerti-Hearn L, Elliott B. Urostomy Care: A Guide for Home Care Clinicians. Home Healthc Now. 2019;37(5):248\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalik T, Lee MJ, Harikrishnan AB. The incidence of stoma related morbidity - a systematic review of randomised controlled trials. Ann R Coll Surg Engl. 2018;100(7):501\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParini D, Bondurri A, Ferrara F, Rizzo G, Pata F, Veltri M, et al. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg. 2023;18(1):48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaker DM, Folan AM, Lee MJ, Jones GL, Brown SR, Lobo AJ. A systematic review and meta-analysis of outcomes after elective surgery for ulcerative colitis. Colorectal Dis. 2021;23(1):18\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeyer-Berjot L, Maggiori L, Loiseau D, De Korwin JD, Bongiovanni JP, Lesprit P, et al. Emergency Surgery in Acute Diverticulitis: A Systematic Review. Dis Colon Rectum. 2020;63(3):397\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGharbi M, Gazdovich S, Bazinet A, Cornu JN. Quality of life in neurogenic patients based on different bladder management methods: A review. Prog Urol. 2022;32(11):784\u0026ndash;808.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaguire B, Clancy C, Connelly TM, Mehigan BJ, McCormick P, Altomare DF, et al. Quality of life meta-analysis following coloanal anastomosis versus abdominoperineal resection for low rectal cancer. Colorectal Dis. 2022;24(7):811\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRammant E, Van Wilder L, Van Hemelrijck M, Pauwels NS, Decaestecker K, Van Praet C, et al. Health-related quality of life overview after different curative treatment options in muscle-invasive bladder cancer: an umbrella review. Qual Life Res. 2020;29(11):2887\u0026ndash;910.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWaddell O, McCombie A, Frizelle F. Colostomy and quality of life after spinal cord injury: systematic review. BJS Open. 2020;4(6):1054\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKald A, Juul KN, Hjortsvang H, Sjodahl RI. Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol. 2008;43(5):627\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Dijk SM, Timmermans L, Deerenberg EB, Lamme B, Kleinrensink GJ, Jeekel J, et al. Parastomal Hernia: Impact on Quality of Life? World J Surg. 2015;39(10):2595\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrieto L, Thorsen H, Juul K. Development and validation of a quality of life questionnaire for patients with colostomy or ileostomy. Health Qual Life Outcomes. 2005;3:62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHansen, B. B., Klopfer, S. O. Optimal Full Matching and Related Designs via Network Flows. J Comput Graph Stat. 2006;15(3):609\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1198/106186006X137047\u003c/span\u003e\u003cspan address=\"10.1198/106186006X137047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMouelhi, Y., Jouve, E., Castelli, C. et al. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes 18, 136 (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12955-020-01344-w\u003c/span\u003e\u003cspan address=\"10.1186/s12955-020-01344-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7535279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7535279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e\u003cp\u003eStoma placement is a frequently performed procedure. Short- and long-term stoma-related complications affect up to 80% of patients and are known to reduce quality of life (QoL). Stoma revision surgery may be indicated, but its influences on QoL has not been studied.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort study was conducted across three hospitals between 2019 and 2022. Patients with a colostomy, ileostomy, or certain type of urostomy for at least one year were included. The stoma-QoL score was compared between a stoma revision surgery and a control group using propensity matching. Patients with available stoma-QoL scores before and after revision surgery were separately analyzed as their own controls.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOut of 643 patients, 336 completed the questionnaire of which 65 were assigned to the revision group, 216 to the control group and 10 to the own control group. Matching resulted in comparable baseline parameters, except for sex. Other baseline characteristics were equally distributed among the groups. The stoma-QoL scores in patients who had undergone stoma revision did not significantly differ from those who did not undergo stoma revision (mean difference 2.61, p\u0026thinsp;=\u0026thinsp;0.160). Patients in the own control group scored significantly higher on the stoma-QoL after revision surgery compared to before (mean difference 6.90, p\u0026thinsp;=\u0026thinsp;0.048), indicating improvement.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePost-operative stoma-QoL scores were similar to controls who did not undergo revision, but were significantly higher as compared to pre-operative stoma-QoL scores.\u003c/p\u003e","manuscriptTitle":"Impact of stoma revision surgery on quality of life: the STICK I-I retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-11 16:46:19","doi":"10.21203/rs.3.rs-7535279/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-15T07:23:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-10T17:03:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29330627433627109461852054568634736846","date":"2025-11-05T19:33:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224004582795058042997028441725626214090","date":"2025-11-05T05:42:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113675646038129652575398060965690349666","date":"2025-11-03T07:25:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210246576434044618247702112336805708635","date":"2025-11-02T12:52:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T09:36:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282355470659517152538584776064617086759","date":"2025-11-02T08:52:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-31T05:07:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T18:35:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T06:43:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"Techniques in Coloproctology","date":"2025-09-04T10:45:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"433b9e16-a58a-4d38-8930-7e6c2ad095f2","owner":[],"postedDate":"November 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T20:54:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-11 16:46:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7535279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7535279","identity":"rs-7535279","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}