Major Stoma Complications in Pediatric Patients in a Tertiary Hospital in a Low Middle-income Country: A Retrospective Cohort Study

Major Stoma Complications in Pediatric Patients in a Tertiary Hospital in a Low Middle-income Country: A 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 Major Stoma Complications in Pediatric Patients in a Tertiary Hospital in a Low Middle-income Country: A Retrospective Cohort Study Alexa Ynez Tan, Jan Miguel Deogracias This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4648734/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Jul, 2024 Read the published version in Pediatric Surgery International → Version 1 posted 7 You are reading this latest preprint version Abstract Introduction: Intestinal stomas are one of the most common parts of pediatric surgical care and complications arising from it have significant impact on over-all 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 1,041 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. Conclusion: 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. Figures Figure 1 INTRODUCTION Intestinal stoma creation is one of the most frequently performed procedures in pediatric surgery. It can be an initial primary procedure or more commonly, a temporary part of a multi-stage procedure. [ 1 ] Complications can arise from surgical creation, during the immediate and long-term post-operative phase, and up to its reversal or closure. These can include bleeding, stoma necrosis, infection, peristomal skin irritation, parastomal hernia, stomal stenosis, and prolapse. [ 2 , 3 , 4 , 5 ] Based on recent literature, reported complication rates for both stoma formation and closure vary from 8–39%. [ 2 , 6 , 7 , 8 , 9 ] Fortunately, most complications can be effectively managed conservatively, reducing the need for surgical intervention. Some studies highlight the possibility of under-reporting minor stoma complications [ 6 , 10 ] , although major complications are unlikely to be overlooked or underestimated. Risk factors associated with stoma complications can be divided into patient-related factors or surgery-related factors. Patient-related risk factors include the child’s age, prematurity, co-morbidities, concomitant chemotherapy, or corticosteroid therapy, and nutritional status. Surgery-related risk factors include the surgeon experience, the type of stoma and surgical technique, and urgency of the procedure (i.e. emergency vs elective procedures). [ 5 ] Currently, there is no reported data on stoma complications among pediatric patients in the Philippines. This study aims to comprehensively describe clinicopathologic characteristics and outcomes of pediatric patients with major stoma-related complication classified as Clavien-Dindo III and IV and stoma-related mortalities in the University of the Philippines - Philippine General Hospital (UP-PGH), the largest tertiary referral center in Metro Manila, Philippines. Specific objectives include determining the prevalence of major stoma complications, identifying the different types of major complications, their frequencies, and the corresponding interventions, and investigating potential associations between patient-related and surgery-related factors to the development of major stoma complications. Through these objectives, the research aims to provide pilot data into the scope of pediatric stoma complications, and to potentially recommend strategies for improving surgical and over-all patient outcomes. METHODS This is a retrospective cohort study that involved a review of medical records of pediatric patients with major stoma-related complications classified as Clavien-Dindo III, IV and V (mortality) in UP-PGH from June 01, 2018 to June 30, 2023. This study was approved by the UP-PGH Research Ethics Board. All patients age 18 and below who underwent stoma creation and/or closure in UP-PGH, as well as patients with a pre-existing small or large intestinal stoma managed in PGH were included in the initial review for major stoma complications. Cases involving stomas for urinary diversion (urostomy), or tube feeding (gastrostomy or jejunostomy) were excluded in the study. Likewise, patients who had their primary stoma procedure performed in another institution but whose clinical and operative data could not be retrieved were excluded. Data collection involved patient-related factors and demographic information such as age, prematurity, sex, weight, height, and indication for stoma creation or the primary diagnosis. Surgery-related factors that were collected include the type of stoma (loop, double barrel or end), its location (ileum, proximal transverse colon, distal transverse colon or sigmoid colon), and the level of expertise and specialization of the surgeon (general surgeon versus pediatric surgeon, in-training versus consultant), urgency in which the stoma was created (elective versus an emergency procedure), and the presence or absence of major stoma-related complications. For those with complications, the type of complication, the time interval from stoma creation to presentation of complication, the intervention done to manage the complication, and the eventual outcome (mortality) were determined. Appendix 1 outlines the operational definitions of the data parameters collected. Descriptive statistics was used to present demographic and clinicopathologic profiles of the included subjects. To analyze the relationship between patient-related and surgery-related factors, and the development of major stoma complications, chi-square was used for categorical variables, and t-test for continuous parameters. Multivariable logistic regression analysis was done to assess independent association between the various factors and the occurrence of major stoma complications, reporting significant risk factors as odd ratios with 95% confidence intervals. RESULTS In the five-year period, a total of 1,041 pediatric patients were initially included in the study. Out of these patients with stoma, 102 cases had major stoma complications classified as Clavien-Dindo III-V, accounting for a 9.8% prevalence rate of major complications. In this cohort, there were 14 reported deaths directly caused by the stoma complications, accounting for 1.3% of total number of pediatric patients with stoma seen in UP-PGH for 5 years. This represents 13.7% of those who developed major stoma complications. Most of the patients had their stoma created during the newborn period (neonates age 0–28 days) accounting for 48% of all patients with stoma. This correlates with the top two most common diagnosis that required the stoma creation: anorectal malformation (49.4%) and Hirschsprung’s disease (30.4%). Both conditions are congenital and are diagnosed primarily at the neonatal period. The male-to-female ratio in the cohort with major complications is 1.9: 1. Unfortunately, prematurity, weight, height, and body mass index data were inconsistent and lacking in the medical records, thus was no longer included in the analysis. Similar frequencies and ratios on age, sex, and primary diagnosis were seen in the cohort with major stoma complications. Neonates who developed stoma complication accounted for 47% of the cohort. The male: female ratio was also the same. And the most common diagnoses were also the same. Among all the patients with stoma, 42.6% (391/1041) had a double-barrel transverse colostomy which is also the most frequent type of stoma in patients with major complications (34/102). However, looking at the incidence of major complications per type of stoma, those patients with ileostomy had the highest percentage of complications at 12.3% (29/236) which showed significant statistical correlation. However, statistical analysis showed no significant association between the type of stoma (loop vs double-barrel). Surgeon expertise (surgery trainee vs consultant) and specialty (pediatric surgeon vs general surgeon) at the time of stoma creation also showed no significant association to the development of major stoma complications. Similarly, whether the stoma was created at an elective setting or as an emergency procedure also did not show significant statistical association. Table 1 below shows the demographic and clinicopathologic profiles, patient-related factors, and surgery-related parameters and the presence of major stoma complications. Table 2 then shows the statistical analysis among the different risk factors and development of complication. Table 1 Demographic Profiles, Patient-related and Surgery-related Factors Full cohort With Major Stoma-related Complication n = 1041 n = 102 Frequency Percentage Frequency Percentage General data Age [n = 920] Neonate (0-30days) 446 48.48% 44 47.31% Infant (1mo-1 year) 197 21.41% 18 19.35% Toddler (1-2yrs) 119 12.93% 11 11.83% Pre-schooler (3–5 yrs) 55 5.98% 8 8.60% School-aged (6–12 yrs) 50 5.43% 6 6.45% Adolescent (13-18yrs) 53 5.76% 6 6.45% Sex [n = 1030] Male 684 66.41% 67 65.69% Female 346 33.59% 35 34.31% Indication for stoma creation [n = 1023] Anorectal malformation 506 49.46% 46 45.54% Hirschsprung Disease 311 30.40% 32 31.68% Necrotizing enterocolitis 16 1.56% 2 1.98% Intestinal atresia 17 1.66% 1 0.99% Intussusception 47 4.59% 7 6.93% Others 126 12.32% 13 12.87% Type and location of stoma [n = 917] Transverse loop 123 13.41% 10 11.36% Sigmoid loop 31 3.38% 1 1.14% Transverse DB 391 42.64% 34 38.64% Sigmoid DB 115 12.54% 9 10.23% Ileostomy 236 25.74% 29 32.95% Others 21 2.29% 5 5.68% Surgeon performing the stoma [n = 989] GS trainee 3 0.30% 0 0 General Surgeon 112 11.32% 16 16.16% Pediatric surgery trainee 770 77.86% 68 68.69% Pediatric Surgeon 104 10.52% 15 15.15% Presence of major complication [n = 1038] None/ I-II 936 90.17% Class III 75 7.23% Class IV 13 1.25% Class V 14 1.35% Table 2 Factors associated with major stoma-related complications of pediatric patients with intestinal stomas Patient and Surgery-related Factors Presence of complications Absence of complications p-value n = 102 n = 936 Frequency Percentage Frequency Percentage Indication for stoma creation [n = 1021] 0.827 Anorectal malformation 46 45.54% 458 49.78% Hirschsprung Disease 32 31.68% 279 30.33% Necrotizing enterocolitis 2 1.98% 14 1.52% Intestinal atresia 1 0.99% 16 1.74% Intussusception 7 6.93% 40 4.35% Others 13 12.87% 113 12.28% Type of stoma [n = 917] 0.020 Colostomy 54 61.36% 606 73.10% Ileostomy 34 38.64% 223 26.90% Type of colostomy [n = 660] 0.591 Loop 11 20.37% 143 23.60% Double barrel 43 79.63% 463 76.40% Surgeon performing the stoma [n = 989] 0.110 GS trainee 0 0.00% 3 0.34% General Surgeon 16 16.16% 96 10.79% Pediatric surgery trainee 68 68.69% 702 78.88% Pediatric Surgeon 15 15.15% 89 10.00% Urgency [n = 1018] Emergency 92 90.20% 777 84.83% Elective 10 9.80% 139 15.17% The most common major complication encountered in this cohort was stomal prolapse and post-operative adhesions or obstruction, both accounting for 39.2% of all major complications. Table 3 summarizes the types and frequencies of major stoma complications encountered in the cohort. Table 3 Type and Frequency of Major Stoma Complication Frequency of specific type of major complications n: 102 Stomal prolapse 20 Postoperative adhesions/obstruction 20 Intussusception 10 High output stoma 10 Dehiscence 9 Stomal necrosis 8 Wrong locations 5 Leak 4 Stomal retraction 3 Fecaloma 3 Iatrogenic perforation 2 Incisional hernia 2 Others 6 The most common surgical intervention for the major complications was a stoma revision which was done in 36.2%. Other surgical procedures reported are a bowel diversion in 15.9%, closure of the intestinal stoma in 7.2%. Table 4 shows the different surgical interventions done to manage the stoma complications. Table 4 Type and Frequency of Surgical Intervention Frequency of surgical intervention done to manage complications n: 69 Revision of stoma 25 Diversion 11 Re-siting 6 Adhesiolysis 4 Reduction, closure of colostomy 4 Fecal disimpaction 3 Reduction alone 3 Repair of dehiscence 3 Drainage 2 Repair of hernia 2 Adhesiolysis, closure of colostomy 1 Adhesiolysis, evacuagion of abscess 1 Reduction, stomal biopsy 1 Repair of hernia, closure of colostomy 1 Resection - anastomosis 1 Resection of prolapse + definitive surgery 1 As for the median time from stoma creation to the presentation of major stoma complication due to its creation was 433.5 days or 14 months with a wide range of 1 day to 18 years. However, looking at the histogram showing distribution of the frequencies of the stoma complication across yearly-time intervals from stoma creation, almost half of the complications have occurred within the first year of stoma creation. DISCUSSION In this retrospective study of over 1000 patients in 5 years, the prevalence of major stoma complications necessitating re-operation, intensive care admission, or even resulting in death, was 9%, which is within the range of the complication rates described in literature but in the lower end of the range. However, mortality directly linked to stoma complications accounted for 1.3% of all the patients with stomas in the cohort but represents 13.7% of those who developed major complications, highlighting the severity of these complications. However, since this study only included major complications classified as Clavien-Dindo III and above, it therefore underestimates the over-all stoma-related complication rate and will not be able to assess the potential impact of minor stoma complications to over-all patient outcomes. Our findings also emphasize the significance of the stoma care in the neonatal period. Almost half of the patients that had stoma creation, as well as major stoma complications, belong to this critical age group. However, data on prematurity, weight, height, and nutritional status has been inconsistent in our data collection, thus were no longer included in the analysis. This severely affects our analysis of patient profiles and their potential impact on the development of major stoma complications. Among the types of stomas, patients with ileostomies exhibited a notably higher incidence of major complications, underscoring the importance of considering this stoma type. Our analysis, however, did not investigate the indication for the stoma creation, the appropriateness of the type of stoma to the indication, and the availability of acceptable alternatives. This finding can only suggest that patients with ileostomies will likely require more vigilance in their follow-up. While no significant associations were found between surgeon expertise, specialty, or the setting of stoma creation and the development of major stoma complications, further investigation into potential contributing factors is warranted since this study is limited in its retrospective analysis. These potential contributing factors can include variations in surgical techniques, perioperative management practices, and patient-specific factors that can alter surgical approaches. Additionally, our study examined the time interval from stoma creation to the presentation of major complications, revealing a median time of 14 months and a wide range up to 18 years. However, analyzing the histogram showing the frequency distribution, majority of the major complications occurred within 1 year from stoma creation. This underscores the importance of timely completion of definitive procedures to facilitate early reversal of temporary stomas. The finding of a wide range of time intervals also emphasizes the need for long-term follow-up of pediatric stoma care, even up to the transition period to adult care. CONCLUSION AND RECOMMENDATIONS In conclusion, our study provides preliminary data into the prevalence, types, and management of major stoma complications in pediatric patients in UP-PGH. To address the limitations identified, future research efforts should focus on improving data collection methods, standardizing reporting protocols, and conducting prospective studies with larger sample sizes. Further studies incorporating minor stoma complications (Clavien Dindo I and II), could provide a more comprehensive understanding of the spectrum of complications associated with pediatric stomas. By addressing these challenges and building upon our findings, clinicians can better tailor interventions and optimize outcomes in pediatric stoma care, ultimately improving the quality of care for pediatric patients with stomas. Declarations Author Contribution J.D. came up with the research topic, served as the consultant adviser of A.T., and wrote the discussion and conclusion part of the manuscript. A.T. prepared the research proposal and performed most of the data collection and analysis. A. T. wrote the introduction and methodology. Both authors reviewed the final manuscript. References Taylor P (2005) An introduction to stomas: reasons for their formation. Nurs Times 19–25;101(29):63–64. PMID: 16052949. Peña A, Migotto-Krieger M, Levitt M (2006) Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg, 41 4 , 748 – 56; discussion 748 – 56. Ahmad Z, Sharma A, Saxena P, Choudhary A, Ahmed M (2013) A clinical study of intestinal stomas: its indications and complications. International Journal of Research in Medical Sciences. Int J Res Med Sci. 2013; 1(4):536–540. https://doi.org/10.5455/2320-6012.ijrms20131140 Vriesman MH, Noor N, Koppen IJ, Di Lorenzo C, de Jong JR, Benninga MA (2020) Outcomes after enterostomies in children with and without motility disorders: A description and comparison of postoperative complications. J Pediatr Surg 55(11):2413–2418. https://doi.org/10.1016/j.jpedsurg.2020.05.027 Babakhanlou R, Larkin K, Hita AG et al (2022) Stoma-related complications and emergencies. Int J Emerg Med 15:17. https://doi.org/10.1186/s12245-022-00421-9 Vogel I, Schattenkerk E, Venema LD, Pandey E, de Jong K, Tanis JR, Gorter PJ, van Heurn R, Musters E, G. D., Derikx JPM (2022) Major stoma related morbidity in young children following stoma formation and closure: A retrospective cohort study. J Pediatr Surg 57(10):402–406. https://doi.org/10.1016/j.jpedsurg.2021.11.021 Steinau G, Ruhl KM, Hörnchen H, Schumpelick V (2001) Enterostomy complications in infancy and childhood. Langenbeck's archives Surg 386(5):346–349. https://doi.org/10.1007/s004230100243 Massenga A, Chibwae A, Nuri AA, Bugimbi M, Munisi YK, Mfinanga R, Chalya PL (2019) Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience. BMC Gastroenterol 19(1):157. https://doi.org/10.1186/s12876-019-1070-5 Van den Hondel D, Sloots C, Meeussen C, Wijnen R (2013) To split or not to split: colostomy complications for anorectal malformations or hirschsprung disease: a single center experience and a systematic review of the literature. Eur J Pediatr Surg. 2014;24(1):61 – 9. 10.1055/s-0033-1351663 . Epub 2013 Aug 5. PMID: 23918670 Aguayo P, Fraser JD, Sharp S, St Peter SD, Ostlie DJ (2009) Stomal complications in the newborn with necrotizing enterocolitis. J Surg Res. 2009;157(2):275-8. 10.1016/j.jss.2009.06.005 . Epub 2009 Jul 10. PMID: 19815238 Additional Declarations No competing interests reported. Supplementary Files APPENDIXs.docx Cite Share Download PDF Status: Published Journal Publication published 23 Jul, 2024 Read the published version in Pediatric Surgery International → Version 1 posted Editorial decision: Accepted 14 Jul, 2024 Reviews received at journal 14 Jul, 2024 Reviewers agreed at journal 14 Jul, 2024 Reviewers invited by journal 14 Jul, 2024 Editor assigned by journal 29 Jun, 2024 Submission checks completed at journal 28 Jun, 2024 First submitted to journal 27 Jun, 2024 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4648734","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":326763781,"identity":"4f42429d-936a-44c8-808b-c72ba5e15820","order_by":0,"name":"Alexa Ynez Tan","email":"","orcid":"","institution":"University of the Philippines Manila","correspondingAuthor":false,"prefix":"","firstName":"Alexa","middleName":"Ynez","lastName":"Tan","suffix":""},{"id":326763782,"identity":"180bc2dd-acf6-479c-a049-f03442ef99a2","order_by":1,"name":"Jan Miguel Deogracias","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBACxgYGAwiLGYg/gFkJYGHitDDOIEYLEBjAWcw8xGhhbj+88cGHX/fk+duZH3+2bbvDwM+eY8BcuAOPw3rSig1n9hUbzjjMZiad2/aMQbLnjQHzzDN4tMzgMZPm7Ulg3MDMYMac23aYweAG0BbeNrxazH8DtdhvYGb//NkSqMWeCC1mzDw/EhI3MPMYSDOCbJEgpAXoF8mZDQnJMw7zlEn2nHvGI3HmWcHhmXi0GAJD7MOHPwm2/f3HN3/4UXZHjr89eePjQnxaGkBWIRQcAEfNYdwaGBjkweQfhBYwyYxPyygYBaNgFIw4AAAW+lHJ8vPV6QAAAABJRU5ErkJggg==","orcid":"","institution":"University of the Philippines Manila","correspondingAuthor":true,"prefix":"","firstName":"Jan","middleName":"Miguel","lastName":"Deogracias","suffix":""}],"badges":[],"createdAt":"2024-06-27 13:06:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4648734/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4648734/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00383-024-05791-0","type":"published","date":"2024-07-23T16:16:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60851203,"identity":"4011b7a7-1299-403d-a419-13093fb8d7ba","added_by":"auto","created_at":"2024-07-22 21:00:04","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88481,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHistogram showing Frequency Distribution of Time Interval from Stoma Creation to Complication\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4648734/v1/54ee23e01ab2591060751837.jpeg"},{"id":61596596,"identity":"fa50638f-366e-408d-bc36-eacb876c78f4","added_by":"auto","created_at":"2024-08-01 17:28:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":730391,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4648734/v1/6b78c74b-9e38-46fe-9c20-42396f5696e4.pdf"},{"id":60851204,"identity":"bd4e1690-9f09-4ec5-a21c-03dd2acd3beb","added_by":"auto","created_at":"2024-07-22 21:00:04","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18471,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIXs.docx","url":"https://assets-eu.researchsquare.com/files/rs-4648734/v1/33893e761bc9eed805737326.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMajor Stoma Complications in Pediatric Patients in a Tertiary Hospital in a Low Middle-income Country: A Retrospective Cohort Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIntestinal stoma creation is one of the most frequently performed procedures in pediatric surgery. It can be an initial primary procedure or more commonly, a temporary part of a multi-stage procedure.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Complications can arise from surgical creation, during the immediate and long-term post-operative phase, and up to its reversal or closure. These can include bleeding, stoma necrosis, infection, peristomal skin irritation, parastomal hernia, stomal stenosis, and prolapse. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eBased on recent literature, reported complication rates for both stoma formation and closure vary from 8\u0026ndash;39%.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e Fortunately, most complications can be effectively managed conservatively, reducing the need for surgical intervention. Some studies highlight the possibility of under-reporting minor stoma complications\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, although major complications are unlikely to be overlooked or underestimated.\u003c/p\u003e \u003cp\u003eRisk factors associated with stoma complications can be divided into patient-related factors or surgery-related factors. Patient-related risk factors include the child\u0026rsquo;s age, prematurity, co-morbidities, concomitant chemotherapy, or corticosteroid therapy, and nutritional status. Surgery-related risk factors include the surgeon experience, the type of stoma and surgical technique, and urgency of the procedure (i.e. emergency vs elective procedures).\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCurrently, there is no reported data on stoma complications among pediatric patients in the Philippines. This study aims to comprehensively describe clinicopathologic characteristics and outcomes of pediatric patients with major stoma-related complication classified as Clavien-Dindo III and IV and stoma-related mortalities in the University of the Philippines - Philippine General Hospital (UP-PGH), the largest tertiary referral center in Metro Manila, Philippines. Specific objectives include determining the prevalence of major stoma complications, identifying the different types of major complications, their frequencies, and the corresponding interventions, and investigating potential associations between patient-related and surgery-related factors to the development of major stoma complications. Through these objectives, the research aims to provide pilot data into the scope of pediatric stoma complications, and to potentially recommend strategies for improving surgical and over-all patient outcomes.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis is a retrospective cohort study that involved a review of medical records of pediatric patients with major stoma-related complications classified as Clavien-Dindo III, IV and V (mortality) in UP-PGH from June 01, 2018 to June 30, 2023. This study was approved by the UP-PGH Research Ethics Board. All patients age 18 and below who underwent stoma creation and/or closure in UP-PGH, as well as patients with a pre-existing small or large intestinal stoma managed in PGH were included in the initial review for major stoma complications. Cases involving stomas for urinary diversion (urostomy), or tube feeding (gastrostomy or jejunostomy) were excluded in the study. Likewise, patients who had their primary stoma procedure performed in another institution but whose clinical and operative data could not be retrieved were excluded.\u003c/p\u003e \u003cp\u003eData collection involved patient-related factors and demographic information such as age, prematurity, sex, weight, height, and indication for stoma creation or the primary diagnosis. Surgery-related factors that were collected include the type of stoma (loop, double barrel or end), its location (ileum, proximal transverse colon, distal transverse colon or sigmoid colon), and the level of expertise and specialization of the surgeon (general surgeon versus pediatric surgeon, in-training versus consultant), urgency in which the stoma was created (elective versus an emergency procedure), and the presence or absence of major stoma-related complications. For those with complications, the type of complication, the time interval from stoma creation to presentation of complication, the intervention done to manage the complication, and the eventual outcome (mortality) were determined. Appendix 1 outlines the operational definitions of the data parameters collected.\u003c/p\u003e \u003cp\u003eDescriptive statistics was used to present demographic and clinicopathologic profiles of the included subjects. To analyze the relationship between patient-related and surgery-related factors, and the development of major stoma complications, chi-square was used for categorical variables, and t-test for continuous parameters. Multivariable logistic regression analysis was done to assess independent association between the various factors and the occurrence of major stoma complications, reporting significant risk factors as odd ratios with 95% confidence intervals.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn the five-year period, a total of 1,041 pediatric patients were initially included in the study. Out of these patients with stoma, 102 cases had major stoma complications classified as Clavien-Dindo III-V, accounting for a 9.8% prevalence rate of major complications. In this cohort, there were 14 reported deaths directly caused by the stoma complications, accounting for 1.3% of total number of pediatric patients with stoma seen in UP-PGH for 5 years. This represents 13.7% of those who developed major stoma complications.\u003c/p\u003e \u003cp\u003eMost of the patients had their stoma created during the newborn period (neonates age 0\u0026ndash;28 days) accounting for 48% of all patients with stoma. This correlates with the top two most common diagnosis that required the stoma creation: anorectal malformation (49.4%) and Hirschsprung\u0026rsquo;s disease (30.4%). Both conditions are congenital and are diagnosed primarily at the neonatal period. The male-to-female ratio in the cohort with major complications is 1.9: 1. Unfortunately, prematurity, weight, height, and body mass index data were inconsistent and lacking in the medical records, thus was no longer included in the analysis.\u003c/p\u003e \u003cp\u003eSimilar frequencies and ratios on age, sex, and primary diagnosis were seen in the cohort with major stoma complications. Neonates who developed stoma complication accounted for 47% of the cohort. The male: female ratio was also the same. And the most common diagnoses were also the same.\u003c/p\u003e \u003cp\u003eAmong all the patients with stoma, 42.6% (391/1041) had a double-barrel transverse colostomy which is also the most frequent type of stoma in patients with major complications (34/102). However, looking at the incidence of major complications per type of stoma, those patients with ileostomy had the highest percentage of complications at 12.3% (29/236) which showed significant statistical correlation. However, statistical analysis showed no significant association between the type of stoma (loop vs double-barrel).\u003c/p\u003e \u003cp\u003eSurgeon expertise (surgery trainee vs consultant) and specialty (pediatric surgeon vs general surgeon) at the time of stoma creation also showed no significant association to the development of major stoma complications. Similarly, whether the stoma was created at an elective setting or as an emergency procedure also did not show significant statistical association. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below shows the demographic and clinicopathologic profiles, patient-related factors, and surgery-related parameters and the presence of major stoma complications. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e then shows the statistical analysis among the different risk factors and development of complication.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Profiles, Patient-related and Surgery-related Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFull cohort\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eWith Major Stoma-related Complication\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePercentage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePercentage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneral data\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge [n\u0026thinsp;=\u0026thinsp;920]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonate (0-30days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfant (1mo-1\u0026nbsp;year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eToddler (1-2yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.83%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-schooler (3\u0026ndash;5 yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.60%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool-aged (6\u0026ndash;12 yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent (13-18yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex [n\u0026thinsp;=\u0026thinsp;1030]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndication for stoma creation\u003c/b\u003e [n\u0026thinsp;=\u0026thinsp;1023]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnorectal malformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.46%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHirschsprung Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecrotizing enterocolitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal atresia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.66%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntussusception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.93%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.87%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType and location of stoma\u003c/b\u003e [n\u0026thinsp;=\u0026thinsp;917]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse loop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.36%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoid loop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.14%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransverse DB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.64%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigmoid DB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.23%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32.95%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.68%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgeon performing the stoma\u003c/b\u003e [n\u0026thinsp;=\u0026thinsp;989]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGS trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric surgery trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68.69%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric Surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of major complication\u003c/b\u003e [n\u0026thinsp;=\u0026thinsp;1038]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone/ I-II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e936\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with major stoma-related complications of pediatric patients with intestinal stomas\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePatient and Surgery-related Factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePresence of complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eAbsence of complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;102\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;936\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ePercentage\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eFrequency\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ePercentage\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndication for stoma creation [n\u0026thinsp;=\u0026thinsp;1021]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnorectal malformation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.78%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHirschsprung Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNecrotizing enterocolitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal atresia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.99%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntussusception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.93%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of stoma [n\u0026thinsp;=\u0026thinsp;917]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of colostomy [n\u0026thinsp;=\u0026thinsp;660]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble barrel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgeon performing the stoma [n\u0026thinsp;=\u0026thinsp;989]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGS trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric surgery trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e78.88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric Surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrgency [n\u0026thinsp;=\u0026thinsp;1018]\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.83%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common major complication encountered in this cohort was stomal prolapse and post-operative adhesions or obstruction, both accounting for 39.2% of all major complications. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the types and frequencies of major stoma complications encountered in the cohort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eType and Frequency of Major Stoma Complication\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of specific type of major complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en: 102\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomal prolapse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative adhesions/obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntussusception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh output stoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomal necrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWrong locations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStomal retraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecaloma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIatrogenic perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncisional hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most common surgical intervention for the major complications was a stoma revision which was done in 36.2%. Other surgical procedures reported are a bowel diversion in 15.9%, closure of the intestinal stoma in 7.2%. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the different surgical interventions done to manage the stoma complications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eType and Frequency of Surgical Intervention\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of surgical intervention done to manage complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en: 69\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRevision of stoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRe-siting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdhesiolysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction, closure of colostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFecal disimpaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepair of dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrainage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepair of hernia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdhesiolysis, closure of colostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdhesiolysis, evacuagion of abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction, stomal biopsy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRepair of hernia, closure of colostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection - anastomosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResection of prolapse\u0026thinsp;+\u0026thinsp;definitive surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs for the median time from stoma creation to the presentation of major stoma complication due to its creation was 433.5 days or 14 months with a wide range of 1 day to 18 years. However, looking at the histogram showing distribution of the frequencies of the stoma complication across yearly-time intervals from stoma creation, almost half of the complications have occurred within the first year of stoma creation.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this retrospective study of over 1000 patients in 5 years, the prevalence of major stoma complications necessitating re-operation, intensive care admission, or even resulting in death, was 9%, which is within the range of the complication rates described in literature but in the lower end of the range. However, mortality directly linked to stoma complications accounted for 1.3% of all the patients with stomas in the cohort but represents 13.7% of those who developed major complications, highlighting the severity of these complications. However, since this study only included major complications classified as Clavien-Dindo III and above, it therefore underestimates the over-all stoma-related complication rate and will not be able to assess the potential impact of minor stoma complications to over-all patient outcomes.\u003c/p\u003e \u003cp\u003eOur findings also emphasize the significance of the stoma care in the neonatal period. Almost half of the patients that had stoma creation, as well as major stoma complications, belong to this critical age group. However, data on prematurity, weight, height, and nutritional status has been inconsistent in our data collection, thus were no longer included in the analysis. This severely affects our analysis of patient profiles and their potential impact on the development of major stoma complications.\u003c/p\u003e \u003cp\u003eAmong the types of stomas, patients with ileostomies exhibited a notably higher incidence of major complications, underscoring the importance of considering this stoma type. Our analysis, however, did not investigate the indication for the stoma creation, the appropriateness of the type of stoma to the indication, and the availability of acceptable alternatives. This finding can only suggest that patients with ileostomies will likely require more vigilance in their follow-up.\u003c/p\u003e \u003cp\u003eWhile no significant associations were found between surgeon expertise, specialty, or the setting of stoma creation and the development of major stoma complications, further investigation into potential contributing factors is warranted since this study is limited in its retrospective analysis. These potential contributing factors can include variations in surgical techniques, perioperative management practices, and patient-specific factors that can alter surgical approaches.\u003c/p\u003e \u003cp\u003eAdditionally, our study examined the time interval from stoma creation to the presentation of major complications, revealing a median time of 14 months and a wide range up to 18 years. However, analyzing the histogram showing the frequency distribution, majority of the major complications occurred within 1 year from stoma creation. This underscores the importance of timely completion of definitive procedures to facilitate early reversal of temporary stomas. The finding of a wide range of time intervals also emphasizes the need for long-term follow-up of pediatric stoma care, even up to the transition period to adult care.\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS","content":"\u003cp\u003eIn conclusion, our study provides preliminary data into the prevalence, types, and management of major stoma complications in pediatric patients in UP-PGH. To address the limitations identified, future research efforts should focus on improving data collection methods, standardizing reporting protocols, and conducting prospective studies with larger sample sizes. Further studies incorporating minor stoma complications (Clavien Dindo I and II), could provide a more comprehensive understanding of the spectrum of complications associated with pediatric stomas. By addressing these challenges and building upon our findings, clinicians can better tailor interventions and optimize outcomes in pediatric stoma care, ultimately improving the quality of care for pediatric patients with stomas.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.D. came up with the research topic, served as the consultant adviser of A.T., and wrote the discussion and conclusion part of the manuscript. A.T. prepared the research proposal and performed most of the data collection and analysis. A. T. wrote the introduction and methodology. Both authors reviewed the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTaylor P (2005) An introduction to stomas: reasons for their formation. Nurs Times 19\u0026ndash;25;101(29):63\u0026ndash;64. 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PMID: 23918670\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguayo P, Fraser JD, Sharp S, St Peter SD, Ostlie DJ (2009) Stomal complications in the newborn with necrotizing enterocolitis. J Surg Res. 2009;157(2):275-8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jss.2009.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jss.2009.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2009 Jul 10. PMID: 19815238\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4648734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4648734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIntestinal stomas are one of the most common parts of pediatric surgical care and complications arising from it have significant impact on over-all 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.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedical 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.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOut of 1,041 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.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis 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.\u003c/p\u003e","manuscriptTitle":"Major Stoma Complications in Pediatric Patients in a Tertiary Hospital in a Low Middle-income Country: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-22 20:59:59","doi":"10.21203/rs.3.rs-4648734/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2024-07-14T15:13:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-14T15:13:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"340165079514415562491512844803786995236","date":"2024-07-14T15:11:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-14T14:55:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-29T09:55:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-28T10:25:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Surgery International","date":"2024-06-27T13:04:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-surgery-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pesi","sideBox":"Learn more about [Pediatric Surgery International](http://link.springer.com/journal/383)","snPcode":"383","submissionUrl":"https://submission.nature.com/new-submission/383/3","title":"Pediatric Surgery International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"65c2cdaf-8c92-4f4a-abc2-78fc1ae79ee9","owner":[],"postedDate":"July 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T17:12:42+00:00","versionOfRecord":{"articleIdentity":"rs-4648734","link":"https://doi.org/10.1007/s00383-024-05791-0","journal":{"identity":"pediatric-surgery-international","isVorOnly":false,"title":"Pediatric Surgery International"},"publishedOn":"2024-07-23 16:16:29","publishedOnDateReadable":"July 23rd, 2024"},"versionCreatedAt":"2024-07-22 20:59:59","video":"","vorDoi":"10.1007/s00383-024-05791-0","vorDoiUrl":"https://doi.org/10.1007/s00383-024-05791-0","workflowStages":[]},"version":"v1","identity":"rs-4648734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4648734","identity":"rs-4648734","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}