Title of the research: Vessel Loops in Pediatric Stoma Closure: Improving Healing and Reducing Complications

Title of the research: Vessel Loops in Pediatric Stoma Closure: Improving Healing and Reducing Complications | 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 Title of the research: Vessel Loops in Pediatric Stoma Closure: Improving Healing and Reducing Complications Mazen Nuoraldean Zidan, Osama Abdullah Bawazir, Abdulmajeed Ahmed Alzahrani, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7837366/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Pediatric stoma closure often leads to notable postoperative complications, such as wound seroma, infection, and dehiscence. The use of vessel loops has been suggested to enhance wound drainage and minimize discomfort, potentially leading to better outcomes. Methods : A retrospective cohort study was carried out at King Faisal Specialist Hospital in Jeddah, involving 32 pediatric patients who underwent stoma closure from January 2021 to April 2024. Among these, 14 patients had vessel loop-assisted closures, while 18 underwent conventional methods. The analysis covered demographics, comorbidities, surgical details, and postoperative outcomes, including seroma, wound infection, dehiscence, rehospitalization, and reoperation rates. Results : The average age at surgery was 2.04 ± 2.04 years, with an average weight of 10.15 ± 7 kg, and 59.4% of the cohort were male. Vessel loops were predominantly utilized in patients without comorbidities (42.9% vs. 16.7%, p 0.05). The most common complication was wound seroma (14.3% vs. 27.8%), with all cases in the vessel loop group managed conservatively with home-based care. No significant differences were noted between the groups in terms of infection, dehiscence, rehospitalization, or reoperation rates. Conclusion : Vessel loop-assisted closure is a safe and effective technique in pediatric stoma surgeries, promoting wound drainage, minimizing discomfort, allowing for home-based care, and achieving satisfactory cosmetic results without increasing complications. These findings support wider adoption of the technique in pediatric surgical practice. Pediatric stoma closure Vessel loop Wound drainage Surgical site infection Wound healing Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Stoma closure is a vital surgical procedure in pediatrics aimed at restoring bowel continuity after temporary diversion due to conditions such as anorectal malformations, Hirschsprung’s disease, and bowel atresia [ 1 ]. Despite its frequent application, the complication rates remain significant, ranging from 15% to 55%, primarily attributed to the delicate nature of pediatric tissues [ 2 , 3 ]. Surgical site infections occur in 10% to 30% of cases, with wound dehiscence and seroma affecting up to 20% and 25%, respectively [ 4 , 5 ]. These complications can extend recovery times and heighten the risk of reoperation. Traditional closure techniques, including linear and purse-string methods, exhibit inconsistent efficacy, with some studies indicating that complete wound closure may correlate with increased risks of fluid accumulation and infection [ 5 , 7 ]. As a response, advanced wound management techniques have been explored to mitigate complications following pediatric colostomy closures. Prophylactic negative-pressure wound therapy (NPWT) can enhance drainage and blood flow; however, it has not consistently shown significant reductions in surgical site infections or hospital stays, even though it may expedite healing [ 8 ]. Small case series have reported successful outcomes using NPWT in conjunction with purse-string closure without infections [ 9 ]. Antimicrobial dressings, particularly those containing silver, have demonstrated potential in lowering infection rates and accelerating recovery in higher-risk wounds [ 10 ]. Nonetheless, no single method has completely resolved these challenges, emphasizing the necessity for innovative approaches to optimize drainage and minimize wound tension [ 11 , 12 ]. Vessel loops, initially designed for tissue retraction and anatomical identification [ 13 ], have recently been repurposed for wound management. Their application in fasciotomy and traumatic closures has yielded improved cosmetic outcomes and reduced reliance on skin grafts [ 14 ]. In pediatric surgery, they have acted as seton-like drains, facilitating continuous drainage of infected fluids [ 15 ]. Research in adult abdominal wounds has shown significantly lower rates of surgical site infections with vessel loop-assisted closures compared to conventional techniques [ 16 ]. Though not previously reported in pediatric stoma closures, vessel loops may enhance drainage, alleviate wound tension, and promote healing, warranting further exploration. This retrospective cohort study at King Faisal Specialist Hospital aims to assess the impact of vessel loops on drainage efficiency in pediatric stoma closures by comparing rates of seroma, wound dehiscence, and surgical site infections between patients treated with and without vessel loops. Methods Study Design and Population Following institutional review board approval (RAC#2251311), a retrospective review was conducted of 32 pediatric patients (<14 years old) who underwent stoma closure at King Faisal Specialist Hospital & Research Centre, Jeddah, between January 2021 and April 2024. Fourteen of these patients underwent vessel loop-assisted closures. Inclusion criteria required patients to be under the age of 14 with complete medical records, while exclusions were made for incomplete records, patients older than 14 at the time of surgery, or those who passed away before postoperative evaluation. Data Collection Collected data included age, sex, weight, comorbidities, surgical indication, and operative details. Postoperative variables included time to first dressing change, time to oral feeding, need for nutritional support, wound seroma, infection, dehiscence, incisional hernia, rehospitalization, and reoperation rates Surgical Technique All patients were admitted one day before surgery, received clear fluids and oral metronidazole, and were given prophylactic first-generation cephalosporins before incision. After stoma resection and bowel anastomosis (stapled or hand-sewn), the fascia was closed with interrupted 2/0 Vicryl, and the subcutaneous layer was irrigated with sterile saline and closed with 4/0 Vicryl. Skin closure was performed using 5/0 Monocryl in a subcuticular fashion. In the vessel loop group, a sterile vessel loop was placed above the fascia before subcutaneous closure with 4/0 Vicryl and skin closure via subcuticular 5/0 Monocryl. Steri-Strips were applied, the loop was tied over the wound, and dressings were positioned above and below the loop, followed by a pressure dressing (Figure 1). Postoperative Management Patients received intravenous antibiotic including metronidazole for 4–5 days. Oral feeding was initiated based on the surgeon’s preference; most patients began with sips of water 6–12 hours post-surgery, gradually advancing as tolerated without necessitating total parenteral nutrition. The first dressing changes typically occurred on postoperative days 4–5. In the vessel loop group, the loop was removed prior to discharge if the wound was clean, dry, and free of seroma or discharge; otherwise, it remained in place with regular home care provided, being removed during outpatient follow-up within a week (Figure 2). Statistical Analysis Data was analyzed using SPSS version 29.0.0. Descriptive statistics were presented as means ± SD or frequencies (%). Chi-square or Fisher’s exact tests compared categorical variables. Logistic regression and Kaplan-Meier analysis were performed where appropriate. A p -value < 0.05 was considered statistically significant. Results Patient Characteristics A total of 32 patients were included: 14 in the vessel loop group and 18 in the conventional closure group (Table 1). The mean age at surgery was 2.04 ± 2.04 years, with a current mean age of 4.24 ± 3.69 years and a mean weight of 10.15 ± 7 kg. Males represented 59.4% of the cohort. Comorbidities were present at 71.9%, most commonly congenital heart disease (47.8%), Down syndrome (30.4%), and hypothyroidism (26%). Vessel loops were used more frequently in patients without comorbidities (42.9% vs. 16.7%, P < 0.05). No significant differences were observed between groups regarding age, weight, sex, or surgical indication Perioperative Data All procedures were elective, with a mean operative time of 3.61 ± 1.07 hours. All patients received prophylactic antibiotics. Oral feeding resumed earlier in the vessel loop group (2.3 ± 1.87 vs. 3.7 ± 1.41 days; P < 0.05). The first dressing change occurred at a mean of 4.26 ± 1.31 days, with no significant intergroup difference (P = 0.899). Postoperative Results Overall, 37.5% of patients experienced complications. Wound seroma was the most common, occurring in 14.3% of the vessel loop group versus 27.8% of the conventional group. In the vessel loop group, seromas were managed with gentle wound squeezing and pressure dressings, whereas the conventional group seromas required more vigorous mechanical manipulation such as suture removal and packing (Figure 3). Each group had one case of wound infection and one of wound dehiscence, all managed conservatively. One patient in the vessel loop group developed an unrelated enterocutaneous fistula. Rehospitalization and reoperation occurred in one patient from the conventional group due to septic shock from an unrelated anastomotic leak. No significant differences were observed in overall complications, rehospitalization, or reoperation rates (P > 0.05) (Table 2). Cosmetic outcomes were assessed during routine outpatient follow-up visits at one and three months postoperatively (Figures 2b and 4). Discussion This study evaluated the impact of vessel loop–assisted wound closure in pediatric stoma patients. Among 32 patients (14 vessel loop, 18 conventional), the mean age at surgery was 2.04 ± 2.04 years and mean weight 10.15 ± 7 kg, with 59.4% male. Vessel loops were more frequently used in patients without comorbidities (42.9% vs. 16.7%, P < 0.05). No significant differences were observed in demographics, weight, or surgical indications between groups. The primary indications for stoma creation were anorectal malformation (59.4%) and Hirschsprung disease (18.8%), aligning with findings by Ezomike et al., who identified anorectal malformations (70.2%) and Hirschsprung disease (21.2%) as the major causes [ 1 ]. All patients received prophylactic antibiotics, including oral metronidazole starting one day preoperatively and continuing for 4–5 days. WHO guidelines recommend cephalosporins combined with metronidazole for colorectal surgery [ 2 ]. A previous prospective randomized study comparing one-day and seven-day prophylactic regimens in 30 patients undergoing colostomy closure utilized cotrimoxazole (8 mg/kg/day trimethoprim) and ornidazole (20 mg/kg/day). Mechanical bowel preparation and surgical techniques were standardized. Subcutaneous wound infections occurred in two patients (6.6%), one per group, with no intraperitoneal infections, anastomotic leaks, or dehiscence [ 17 ]. All patients received clear liquids preoperatively without mechanical bowel preparation. Evidence on mechanical bowel preparation benefit in pediatric colorectal surgery is conflicting. Retrospective pediatric studies report higher surgical site infection rates and longer hospital stays with preparation (14.4% vs. 5.8%) [ 18 ], while U.S. data show similar trends (14% vs. 5%) [ 19 , 20 ]. Current evidence suggests omitting bowel preparation does not increase complications [ 2 ], though its use remains common [ 21 ]. On the other hand, Koller et al. (2017) reported that in 32,359 adults combining mechanical bowel preparation with oral antibiotics reduced surgical site infection, anastomotic leaks, and postoperative ileus [ 22 ]. Postoperative oral feeding varied according to surgeon preference and resumed earlier in the vessel loop group than in the conventional closure group (2.3 ± 1.87 vs. 3.7 ± 1.41 days, P < 0.05). The first dressing change occurred 4–5 days postoperatively. Most patients in the vessel loop group were complication-free (64.3%), like the conventional closure group (61.1%) [ 12 ]. Wound seroma was the most common complication in vessel loop group (14.3%), with one case each of infection (7.1%) and dehiscence (7.1%), all managed conservatively without rehospitalization or reoperation. No significant differences in complication rates were observed. Reported surgical site infection rates range from 9.9% to 11.3% [ 2 , 3 , 23 ], with one study reporting 28.3% [ 24 ], consistent with the current findings The use of vessel loops enabled effective wound drainage through simple dressings and gentle manual squeezing, allowing families to manage care at home and reducing the need for frequent outpatient visits. This approach lowered hospital costs, minimized patient discomfort, and improved cosmetic outcomes via subcuticular closure, compared with techniques such as suture removal, wound gapping, or packing that were used in conventional groups. Based on these findings, vessel loops have also been successfully applied in other procedures, including pilonidal sinus treatment, lipoma excision, and tumor resections, demonstrating excellent results in both wound drainage and aesthetic outcomes Conclusion Vessel loop-assisted closure in pediatric stoma surgery is safe and effective, improving wound drainage, reducing discomfort, and enhancing cosmetic outcomes. It simplifies home care and limits outpatient visits without increasing complications. These findings support broader use in pediatric stoma closures and other procedures requiring optimal drainage. Larger, multi-center studies are warranted. Declarations Ethics approval and consent to participate: This retrospective study was approved by the Institutional Review Board at King Faisal Specialist Hospital & Research Centre (RAC#2251311). Consent to participate was waived due to retrospective anonymized data review. Consent for publication: Not applicable. Availability of data and materials: No datasets were generated or analyzed during the current study Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions: MNZ, OAB & AMA conceived the study concept, designed the study protocol, performed the literature search, data extraction, and quality assessment. AMA, NK, AAA, MAA & RTA conducted data analysis and statistical interpretation. MNZ & AMA provided expert clinical guidance on surgical aspects, critically reviewed the manuscript for scientific accuracy and wrote the main manuscript text. All authors reviewed, edited, and approved the final version of the manuscript for submission. Acknowledgements: Not applicable. 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Pediatr Surg Int 7:279–281. https://doi.org/10.1007/BF00183980 Serrurier K, Liu J, Breckler F, et al (2012) A multicenter evaluation of the role of mechanical bowel preparation in pediatric colostomy takedown. J Pediatr Surg 47:190–193. https://doi.org/10.1016/j.jpedsurg.2011.10.044 Breckler FD, Rescorla FJ, Billmire DF (2010) Wound infection after colostomy closure for imperforate anus in children: utility of preoperative oral antibiotics. J Pediatr Surg 45:1509–1513. https://doi.org/10.1016/j.jpedsurg.2009.10.054 Leys CM, Austin MT, Pietsch JB, Lovvorn HN (2010) Elective intestinal operations in infants. J Pediatr Surg 45:1514–1520. Feng C, Sidhwa F, Anandalwar S, et al (2015) Contemporary practice among pediatric surgeons in the use of bowel preparation for elective colorectal surgery: a survey of the American Pediatric Surgical Association. J Pediatr Surg 50:1–5. https://doi.org/10.1016/j.jpedsurg.2015.04.005 Koller SE, Bauer ÅKW, Egleston BL, et al (2017) Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg 266:1–9. https://doi.org/10.1097/SLA.0000000000002159 Ameh EA, Lukong CS, Mshelbwala PM, Anumah MA, Gomna A (2011) One-day bowel preparation in children with colostomy using normal saline. Afr J Paediatr Surg 8:291–294. https://doi.org/10.4103/0189-6725.91670 Hassan KQ (2018) Colostomy closure in pediatric age group: analysis of outcome in single-center experience. J Fac Med Baghdad 60:33. https://doi.org/10.32007/jfacmedbagdad.60133 Tables Table 1: Demographic, clinical characteristics, and surgical indications of patients undergoing vessel loop versus conventional colostomy closure (N = 32). Variable Total No. (%) Intervention Test of significance P value Vessel loop No. (%) conventional closures No. (%) Age at time of surgery (years) (Mean ± SD) 2.04 ± 2.04 2.83 ± 3.01 1.67 ± 1.27 t=1.48 P=0.149 Current age (years) (Mean ± SD) 4.24 ± 3.69 3.56 ± 2.93 4.56 ± 4.03 t=0.78 P=0.441 Body weight (kg) (Mean ± SD) 10.15 ± 7 12.49 ± 10.85 8.98 ± 3.84 t=1.28 P=0.211 Gender Male 19 (59.4) 9 (28.1) 10 (31.3) χ2=0.249 P=0.618 Female 13 (40.6) 5 (15.6) 8 (25) Comorbidity No 9 (28.1) 6 (18.8) 3 (9.4) χ2=2.67 P=0.102 Yes 23 (71.9) 8 (25) 15 (46.9) If having comorbidity, specify: (no.: 23) Down syndrome 7 (30.4) 0 (0.0) 7 (46.7) χ2=6.97 P=0.008* Congenital heart disease 11 (47.8) 3 (37.5) 8 (53.3) χ2=1.85 P=0.174 Hypothyroidism 6 (26) 0 (0.0) 6 (40) χ2=5.74 P=0.017* Renal malformation/chronic kidney disease /renal impairment 3 (13) 1 (12.5) 2 (13.3) χ2=0.15 P=0.702 Acute lymphoblastic leukemia (ALL) 1 (4.3) 1 (12.5) 0 (0.0) χ2=1.33 P=0.249 Acute lymphoblastic leukemia (ALL) 1 (4.3) 1 (12.5) 0 (0.0) χ2=1.33 P=0.249 Bronchopulmonary dysplasia (BPD) 1 (4.3) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 Type 1 DM 1 (4.3) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 Cystic fibrosis (CF) 1 (4.7) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 Neural tube defects (NTDS) 2 (8.7) 0 (0.0) 2 (13.3) χ2=1.66 P=0.198 Global developmental delay (GDD) 1 (4.3) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 Hydrocephalus 1 (4.3) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 Laryngomalacia 1 (4.3) 0 (0.0) 1 (6.7) χ2=0.80 P=0.370 VACTERL association 2 (8.7) 1 (12.5) 1 (6.8) χ2=0.04 P=0.854 Indication for stoma surgery χ2=9.14 P=0.243 Anorectal malformation 19 (59.4) 4 (28.6) 15 (83.3) χ2=13.49 P<0.001* Anal abscess 1 (3.1) 1 (7.1) 0 (0.0) χ2=1.33 P=0.249 Constipation 1 (3.1) 1 (7.1) 0 (0.0) χ2=1.33 P=0.249 Hirschsprung disease 6 (18.8) 3 (21.4) 3 (16.7) χ2=0.12 P=0.732 Intestinal perforation 1 (3.2) 1 (7.1) 0 (0.0) χ2=1.33 P=0.249 meconium plug (CF) 1 (3.2) 0 (0.0) 1 (5.6) χ2=0.80 P=0.370 NEC 2 (6.3) 1 (7.1) 1 (5.6) χ2=0.03 P=0.854 Perforated NEC 1 (3.2) 0 (0.0) 1 (5.6) χ2=0.80 P=0.370 *: Statistically significant, t: Student t test, χ2: Chi-square test “Down syndrome, hypothyroidism, and anorectal malformation were significantly more prevalent in the conventional closure group (P < 0.05).” Table 2 : Preoperative, operative, and postoperative outcomes in vessel loop–assisted versus conventional colostomy closure (N = 32). Variable Total No. (%) Intervention Test of significance P value Vessel loop No. (%) Conventional closure No. (%) Operative data Surgical type Elective 32 (100) 14 (100) 18 (100) χ2=.00 P=1.000 Emergency 0 (0.0) 0 (0.0) 0 (0.0) Operative time (hours) (Mean ± SD) 3.61 ± 1.07 3.65 ± 1.21 3.59 ± 1.04 t=0.15 P=0.881 Post-operative data Antibiotic use No 0 (0.0) 0 (0.0) 0 (0.0) χ2=.00 P=1.000 Yes 32 (100) 14 (100) 18 (100) Oral feeding time (days) (Mean ± SD) 3.53 ± 1.57 2.3 ± 1.87 3.7 ± 1.41 t=2.42 P=0.021* First dressing (days) (Mean ± SD) 4.26 ± 1.31 4.3 ± 0.94 4.24 ± 1.52 t=0.13 P=0.899 Complications No 20 (62.5) 9 (64.3) 11 (61.1) χ2=0.03 P=0.854 Yes 12 (37.5) 5 (35.7) 7 (38.9) Type of complications: (no.: 23) Seroma 7 (21.9) 2 (14.3) 5 (27.8) χ2=0.84 P=0.359 Wound infection 2 (6.3) 1 (7.1) 1 (5.6) χ2=0.03 P=0.54 Wound dehiscence 2 (6.3) 1 (7.1) 1 (5.6) χ2=0.03 P=0.54 Incisional hernia 0 0 0 χ2=.00 P=1.000 Enterocutaneous fistula 1 (3.1) 1 (7.1) 0 χ2=0.80 P=0.370 Other 0 0 0 χ2=.00 P=1.000 Rehospitalization No 31 (96.9) 14 (100) 17(94.4) χ2=0.80 P=0.370 Yes 1 (3.1) 0 1 (5.6) Reoperations No 31 (96.9) 14 (100) 17 (94.4) χ2=0.80 P=0.370 Yes 1 (3.1) 0 1 (5.6) *: Statistically significant, t: Student t test, χ2: Chi-square test Oral feeding was initiated earlier in the vessel loop group (P 0.05). 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04:18:52","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":92877,"visible":true,"origin":"","legend":"","description":"","filename":"8f7d2b7d45f94f2584f92c102970971c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/5a4bdf852d9a792efb498b42.xml"},{"id":94623024,"identity":"553b3d0f-cfc8-43c8-8ff5-1958b5098409","added_by":"auto","created_at":"2025-10-29 04:18:44","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100565,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/2f12d57acd8b3f8b57b72f28.html"},{"id":94623327,"identity":"3a660d29-a863-4ee6-a135-5c2630f61a71","added_by":"auto","created_at":"2025-10-29 04:19:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":647668,"visible":true,"origin":"","legend":"\u003cp\u003eTechnique of vessel loop–assisted colostomy closure: \u003cstrong\u003e(a)\u003c/strong\u003e placement after fascial closure, \u003cstrong\u003e(b)\u003c/strong\u003e subcutaneous closure over the loop, \u003cstrong\u003e(c)\u003c/strong\u003e subcuticular skin closure, \u003cstrong\u003e(d)\u003c/strong\u003eSteri-Strip application beneath the loop, \u003cstrong\u003e(e) \u003c/strong\u003edressing applied over the loop, \u003cstrong\u003e(f)\u003c/strong\u003e final pressure dressing.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/79716e51ad1eea806ab0ed69.png"},{"id":94623274,"identity":"31d18102-6730-4ebc-bd82-beb782b8f2c9","added_by":"auto","created_at":"2025-10-29 04:19:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":460087,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003eOutpatient clinics follow up for loop removal. \u003cstrong\u003e(b)\u003c/strong\u003e Postoperative cosmetic result after vessel loop–assisted closure.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/03029b7d506dd88577f25149.png"},{"id":94623168,"identity":"fe8f8283-5110-479f-b15f-e6ad6d3c6bda","added_by":"auto","created_at":"2025-10-29 04:18:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":695943,"visible":true,"origin":"","legend":"\u003cp\u003eWound seroma management: \u003cstrong\u003e(a)\u003c/strong\u003e soaked dressing in vessel loop group, \u003cstrong\u003e(b)\u003c/strong\u003egentle evacuation in vessel loop group, \u003cstrong\u003e(c) \u003c/strong\u003ewound gapping and packing in conventional colostomy closure.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/41868b3b308d2ef7121f3954.png"},{"id":94623164,"identity":"8ef13c9e-6200-4e9c-8008-051dd537455a","added_by":"auto","created_at":"2025-10-29 04:18:56","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":350884,"visible":true,"origin":"","legend":"\u003cp\u003eWound closure cosmesis: \u003cstrong\u003e(a)\u003c/strong\u003e conventional simple interrupted closure, \u003cstrong\u003e(b)\u003c/strong\u003e purse-string closure in an adult stoma patient.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/28d242399e2248f90e74f260.png"},{"id":95802813,"identity":"102d9ae9-fecf-4163-ac9d-780ec037fd28","added_by":"auto","created_at":"2025-11-13 08:28:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4145510,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7837366/v1/ad2ce8c2-55b2-4490-b399-c0dd2456b71e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Title of the research: Vessel Loops in Pediatric Stoma Closure: Improving Healing and Reducing Complications","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStoma closure is a vital surgical procedure in pediatrics aimed at restoring bowel continuity after temporary diversion due to conditions such as anorectal malformations, Hirschsprung\u0026rsquo;s disease, and bowel atresia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite its frequent application, the complication rates remain significant, ranging from 15% to 55%, primarily attributed to the delicate nature of pediatric tissues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Surgical site infections occur in 10% to 30% of cases, with wound dehiscence and seroma affecting up to 20% and 25%, respectively [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. These complications can extend recovery times and heighten the risk of reoperation.\u003c/p\u003e\u003cp\u003eTraditional closure techniques, including linear and purse-string methods, exhibit inconsistent efficacy, with some studies indicating that complete wound closure may correlate with increased risks of fluid accumulation and infection [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As a response, advanced wound management techniques have been explored to mitigate complications following pediatric colostomy closures. Prophylactic negative-pressure wound therapy (NPWT) can enhance drainage and blood flow; however, it has not consistently shown significant reductions in surgical site infections or hospital stays, even though it may expedite healing [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Small case series have reported successful outcomes using NPWT in conjunction with purse-string closure without infections [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAntimicrobial dressings, particularly those containing silver, have demonstrated potential in lowering infection rates and accelerating recovery in higher-risk wounds [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nonetheless, no single method has completely resolved these challenges, emphasizing the necessity for innovative approaches to optimize drainage and minimize wound tension [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVessel loops, initially designed for tissue retraction and anatomical identification [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], have recently been repurposed for wound management. Their application in fasciotomy and traumatic closures has yielded improved cosmetic outcomes and reduced reliance on skin grafts [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In pediatric surgery, they have acted as seton-like drains, facilitating continuous drainage of infected fluids [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Research in adult abdominal wounds has shown significantly lower rates of surgical site infections with vessel loop-assisted closures compared to conventional techniques [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThough not previously reported in pediatric stoma closures, vessel loops may enhance drainage, alleviate wound tension, and promote healing, warranting further exploration. This retrospective cohort study at King Faisal Specialist Hospital aims to assess the impact of vessel loops on drainage efficiency in pediatric stoma closures by comparing rates of seroma, wound dehiscence, and surgical site infections between patients treated with and without vessel loops.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing institutional review board approval (RAC#2251311), a retrospective review was conducted of 32 pediatric patients (\u0026lt;14 years old) who underwent stoma closure at King Faisal Specialist Hospital \u0026amp; Research Centre, Jeddah, between January 2021 and April 2024. Fourteen of these patients underwent vessel loop-assisted closures. Inclusion criteria required patients to be under the age of 14 with complete medical records, while exclusions were made for incomplete records, patients older than 14 at the time of surgery, or those who passed away before postoperative evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCollected data included age, sex, weight, comorbidities, surgical indication, and operative details. Postoperative variables included time to first dressing change, time to oral feeding, need for nutritional support, wound seroma, infection, dehiscence, incisional hernia, rehospitalization, and reoperation rates\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were admitted one day before surgery, received clear fluids and oral metronidazole, and were given prophylactic first-generation cephalosporins before incision. After stoma resection and bowel anastomosis (stapled or hand-sewn), the fascia was closed with interrupted 2/0 Vicryl, and the subcutaneous layer was irrigated with sterile saline and closed with 4/0 Vicryl. Skin closure was performed using 5/0 Monocryl in a subcuticular fashion.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the vessel loop group, a sterile vessel loop was placed above the fascia before subcutaneous closure with 4/0 Vicryl and skin closure via subcuticular 5/0 Monocryl. Steri-Strips were applied, the loop was tied over the wound, and dressings were positioned above and below the loop, followed by a pressure dressing (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients received intravenous antibiotic including metronidazole for 4\u0026ndash;5 days. Oral feeding was initiated based on the surgeon\u0026rsquo;s preference; most patients began with sips of water 6\u0026ndash;12 hours post-surgery, gradually advancing as tolerated without necessitating total parenteral nutrition. The first dressing changes typically occurred on postoperative days 4\u0026ndash;5. In the vessel loop group, the loop was removed prior to discharge if the wound was clean, dry, and free of seroma or discharge; otherwise, it remained in place with regular home care provided, being removed during outpatient follow-up within a week (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was analyzed using SPSS version 29.0.0. Descriptive statistics were presented as means \u0026plusmn; SD or frequencies (%). Chi-square or Fisher\u0026rsquo;s exact tests compared categorical variables. Logistic regression and Kaplan-Meier analysis were performed where appropriate. A \u003cem\u003ep\u003c/em\u003e-value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 32 patients were included: 14 in the vessel loop group and 18 in the conventional closure group (Table 1). The mean age at surgery was 2.04 \u0026plusmn; 2.04 years, with a current mean age of 4.24 \u0026plusmn; 3.69 years and a mean weight of 10.15 \u0026plusmn; 7 kg. Males represented 59.4% of the cohort. Comorbidities were present at 71.9%, most commonly congenital heart disease (47.8%), Down syndrome (30.4%), and hypothyroidism (26%). Vessel loops were used more frequently in patients without comorbidities (42.9% vs. 16.7%, P \u0026lt; 0.05). No significant differences were observed between groups regarding age, weight, sex, or surgical indication\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerioperative Data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were elective, with a mean operative time of 3.61 \u0026plusmn; 1.07 hours. All patients received prophylactic antibiotics. Oral feeding resumed earlier in the vessel loop group (2.3 \u0026plusmn; 1.87 vs. 3.7 \u0026plusmn; 1.41 days; P \u0026lt; 0.05). The first dressing change occurred at a mean of 4.26 \u0026plusmn; 1.31 days, with no significant intergroup difference (P = 0.899).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 37.5% of patients experienced complications. Wound seroma was the most common, occurring in 14.3% of the vessel loop group versus 27.8% of the conventional group. In the vessel loop group, seromas were managed with gentle wound squeezing and pressure dressings, whereas the conventional group seromas required more vigorous mechanical manipulation such as suture removal and packing (Figure 3).\u003c/p\u003e\n\u003cp\u003eEach group had one case of wound infection and one of wound dehiscence, all managed conservatively. One patient in the vessel loop group developed an unrelated enterocutaneous fistula. Rehospitalization and reoperation occurred in one patient from the conventional group due to septic shock from an unrelated anastomotic leak. No significant differences were observed in overall complications, rehospitalization, or reoperation rates (P \u0026gt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003eCosmetic outcomes were assessed during routine outpatient follow-up visits at one and three months postoperatively (Figures 2b and 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the impact of vessel loop\u0026ndash;assisted wound closure in pediatric stoma patients. Among 32 patients (14 vessel loop, 18 conventional), the mean age at surgery was 2.04\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04 years and mean weight 10.15\u0026thinsp;\u0026plusmn;\u0026thinsp;7 kg, with 59.4% male. Vessel loops were more frequently used in patients without comorbidities (42.9% vs. 16.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were observed in demographics, weight, or surgical indications between groups. The primary indications for stoma creation were anorectal malformation (59.4%) and Hirschsprung disease (18.8%), aligning with findings by Ezomike et al., who identified anorectal malformations (70.2%) and Hirschsprung disease (21.2%) as the major causes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll patients received prophylactic antibiotics, including oral metronidazole starting one day preoperatively and continuing for 4\u0026ndash;5 days. WHO guidelines recommend cephalosporins combined with metronidazole for colorectal surgery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A previous prospective randomized study comparing one-day and seven-day prophylactic regimens in 30 patients undergoing colostomy closure utilized cotrimoxazole (8 mg/kg/day trimethoprim) and ornidazole (20 mg/kg/day). Mechanical bowel preparation and surgical techniques were standardized. Subcutaneous wound infections occurred in two patients (6.6%), one per group, with no intraperitoneal infections, anastomotic leaks, or dehiscence [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAll patients received clear liquids preoperatively without mechanical bowel preparation. Evidence on mechanical bowel preparation benefit in pediatric colorectal surgery is conflicting. Retrospective pediatric studies report higher surgical site infection rates and longer hospital stays with preparation (14.4% vs. 5.8%) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], while U.S. data show similar trends (14% vs. 5%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Current evidence suggests omitting bowel preparation does not increase complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], though its use remains common [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. On the other hand, Koller et al. (2017) reported that in 32,359 adults combining mechanical bowel preparation with oral antibiotics reduced surgical site infection, anastomotic leaks, and postoperative ileus [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePostoperative oral feeding varied according to surgeon preference and resumed earlier in the vessel loop group than in the conventional closure group (2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87 vs. 3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The first dressing change occurred 4\u0026ndash;5 days postoperatively. Most patients in the vessel loop group were complication-free (64.3%), like the conventional closure group (61.1%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Wound seroma was the most common complication in vessel loop group (14.3%), with one case each of infection (7.1%) and dehiscence (7.1%), all managed conservatively without rehospitalization or reoperation. No significant differences in complication rates were observed. Reported surgical site infection rates range from 9.9% to 11.3% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], with one study reporting 28.3% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], consistent with the current findings\u003c/p\u003e\u003cp\u003eThe use of vessel loops enabled effective wound drainage through simple dressings and gentle manual squeezing, allowing families to manage care at home and reducing the need for frequent outpatient visits. This approach lowered hospital costs, minimized patient discomfort, and improved cosmetic outcomes via subcuticular closure, compared with techniques such as suture removal, wound gapping, or packing that were used in conventional groups. Based on these findings, vessel loops have also been successfully applied in other procedures, including pilonidal sinus treatment, lipoma excision, and tumor resections, demonstrating excellent results in both wound drainage and aesthetic outcomes\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eVessel loop-assisted closure in pediatric stoma surgery is safe and effective, improving wound drainage, reducing discomfort, and enhancing cosmetic outcomes. It simplifies home care and limits outpatient visits without increasing complications. These findings support broader use in pediatric stoma closures and other procedures requiring optimal drainage. Larger, multi-center studies are warranted.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by the Institutional Review Board at King Faisal Specialist Hospital \u0026amp; Research Centre (RAC#2251311). Consent to participate was waived due to retrospective anonymized data review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analyzed during the current study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;MNZ, OAB \u0026amp; AMA conceived the study concept, designed the study protocol, performed the literature search, data extraction, and quality assessment. AMA, NK, AAA, MAA \u0026amp; RTA conducted data analysis and statistical interpretation. MNZ \u0026amp; AMA provided expert clinical guidance on surgical aspects, critically reviewed the manuscript for scientific accuracy and wrote the main manuscript text. All authors reviewed, edited, and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEzomike UO, Nwachukwu IE, Nwangwu EI, Chukwu IS, Aliozor SC, Nwankwo EP, et al (2022) Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital. \u003cem\u003eAfr Health Sci\u003c/em\u003e 22:205\u0026ndash;211. https://doi.org/10.4314/ahs.v22i4.25\u003c/li\u003e\n\u003cli\u003eAseme S, Negussie T, Tadesse A, Dejene B, Temesgen F, Getachew H, et al (2022) Evaluation of factors affecting colostomy closure outcome in children: a one-year prospective cohort study. \u003cem\u003eOpen Access Surg\u003c/em\u003e 15:57\u0026ndash;64. https://doi.org/10.2147/OAS.S360157\u003c/li\u003e\n\u003cli\u003eChandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N (2004) Morbidity and mortality of colostomy and its closure in children. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 39:596\u0026ndash;599. https://doi.org/10.1016/j.jpedsurg.2003.12.016\u003c/li\u003e\n\u003cli\u003eSaxena R, Bhatt S, Pathak M, Goel AD, Rathod KJ, Sinha A, et al (2023) Retrospective analysis of the outcome of stoma closure in children without preoperative mechanical bowel preparation. \u003cem\u003eJ Indian Assoc Pediatr Surg\u003c/em\u003e 28:187\u0026ndash;193. https://doi.org/10.4103/jiaps.jiaps_131_22\u003c/li\u003e\n\u003cli\u003eAmeer A, Mirza MB, Talat N (2024) The outcome of purse-string versus conventional wound closure techniques in patients undergoing stoma reversal: a randomized controlled trial. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 59:1186\u0026ndash;1189. https://doi.org/10.1016/j.jpedsurg.2023.10.062\u003c/li\u003e\n\u003cli\u003eSayuen C, Phannua R, Chusilp S, Tanming P, Areemit S, Decharun K, et al (2022) A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure. \u003cem\u003ePediatr Surg Int\u003c/em\u003e 38:149\u0026ndash;156. https://doi.org/10.1007/s00383-021-05011-z\u003c/li\u003e\n\u003cli\u003eHajibandeh S, Hajibandeh S, Maw A (2022) Purse-string skin closure versus linear skin closure in people undergoing stoma reversal. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e 6:CD014763. https://doi.org/10.1002/14651858.CD014763\u003c/li\u003e\n\u003cli\u003eAnestiadou E, Stamiris S, Ioannidis O, Symeonidis S, Bitsianis S, Bougioukas K, et al (2025) Comparison of negative pressure wound therapy systems and conventional non-pressure dressings on surgical site infection rate after stoma reversal: systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eJ Clin Med\u003c/em\u003e 14:1654. https://doi.org/10.3390/jcm14051654\u003c/li\u003e\n\u003cli\u003eKumata Y, Ishii D, Ishii S, Motoki K, Ueno N, Hinooka R, Miyagi H (2024) A case series of prophylactic negative pressure wound therapy use with purse-string closure in stoma closure wounds in infants. \u003cem\u003eSurg Case Rep\u003c/em\u003e 10:20. https://doi.org/10.1186/s40792-024-01818-9\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Donohoe PK, Leon R, Orr DJA, de Blacam C (2025) Safety of silver dressings in infants: a systematic scoping review. \u003cem\u003eJ Burn Care Res\u003c/em\u003e 46:349\u0026ndash;360. https://doi.org/10.1093/jbcr/irae159\u003c/li\u003e\n\u003cli\u003eVogel I, Eeftinck Schattenkerk LD, Venema E, Pandey K, de Jong JR, Tanis PJ, et al (2022) Major stoma-related morbidity in young children following stoma formation and closure: a retrospective cohort study. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 57:402\u0026ndash;406. https://doi.org/10.1016/j.jpedsurg.2021.11.021\u003c/li\u003e\n\u003cli\u003eAlghamdi HA, Alqahtani MSM, Asiri HMM, Abudasir AMM, Alshahrani KTS, Alamer RA, et al (2024) Investigating colostomy-related morbidity in children following stoma formation and closure in a tertiary hospital, Abha, Saudi Arabia: a retrospective cohort study. \u003cem\u003eBMC Pediatr\u003c/em\u003e 24:630. https://doi.org/10.1186/s12887-024-05089-z\u003c/li\u003e\n\u003cli\u003eSingh H, Khazanchi RK, Aggarwal A, Mahendru S, Brajesh V, Singh S (2018) Uses of vessel loops in plastic surgery. \u003cem\u003eIndian J Plast Surg\u003c/em\u003e 51:103\u0026ndash;105. https://doi.org/10.4103/ijps.IJPS_221_17\u003c/li\u003e\n\u003cli\u003eFowler JR, Kleiner MT, Das R, Gaughan JP, Rehman S (2012) Assisted closure of fasciotomy wounds: a descriptive series and caution in patients with vascular injury. \u003cem\u003eBone Joint Res\u003c/em\u003e 1:31\u0026ndash;35. https://doi.org/10.1302/2046-3758.13.2000022\u003c/li\u003e\n\u003cli\u003eTsoraides SS, Pearl RH, Stanfill AB, Wallace LJ, Vegunta RK (2010) Incision and loop drainage: a minimally invasive technique for subcutaneous abscess management in children. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 45:606\u0026ndash;609. https://doi.org/10.1016/j.jpedsurg.2009.06.013\u003c/li\u003e\n\u003cli\u003eGaszynski R, Wong P, Gray A, Diab J, Das A, Apostolou C, Merrett N (2022) Loop and drain technique for prevention of surgical site infection in upper gastrointestinal surgery. \u003cem\u003eANZ J Surg\u003c/em\u003e 92:2143\u0026ndash;2148. https://doi.org/10.1111/ans.17923\u003c/li\u003e\n\u003cli\u003eAkg\u0026uuml;r FM, Tanyel FC, B\u0026uuml;y\u0026uuml;kpamuk\u0026ccedil;u N, et al (1992) Prophylactic antibiotics for colostomy closure in children: short versus long course. \u003cem\u003ePediatr Surg Int\u003c/em\u003e 7:279\u0026ndash;281. https://doi.org/10.1007/BF00183980\u003c/li\u003e\n\u003cli\u003eSerrurier K, Liu J, Breckler F, et al (2012) A multicenter evaluation of the role of mechanical bowel preparation in pediatric colostomy takedown. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 47:190\u0026ndash;193. https://doi.org/10.1016/j.jpedsurg.2011.10.044\u003c/li\u003e\n\u003cli\u003eBreckler FD, Rescorla FJ, Billmire DF (2010) Wound infection after colostomy closure for imperforate anus in children: utility of preoperative oral antibiotics. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 45:1509\u0026ndash;1513. https://doi.org/10.1016/j.jpedsurg.2009.10.054\u003c/li\u003e\n\u003cli\u003eLeys CM, Austin MT, Pietsch JB, Lovvorn HN (2010) Elective intestinal operations in infants. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 45:1514\u0026ndash;1520.\u003c/li\u003e\n\u003cli\u003eFeng C, Sidhwa F, Anandalwar S, et al (2015) Contemporary practice among pediatric surgeons in the use of bowel preparation for elective colorectal surgery: a survey of the American Pediatric Surgical Association. \u003cem\u003eJ Pediatr Surg\u003c/em\u003e 50:1\u0026ndash;5. https://doi.org/10.1016/j.jpedsurg.2015.04.005\u003c/li\u003e\n\u003cli\u003eKoller SE, Bauer \u0026Aring;KW, Egleston BL, et al (2017) Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. \u003cem\u003eAnn Surg\u003c/em\u003e 266:1\u0026ndash;9. https://doi.org/10.1097/SLA.0000000000002159\u003c/li\u003e\n\u003cli\u003eAmeh EA, Lukong CS, Mshelbwala PM, Anumah MA, Gomna A (2011) One-day bowel preparation in children with colostomy using normal saline. \u003cem\u003eAfr J Paediatr Surg\u003c/em\u003e 8:291\u0026ndash;294. https://doi.org/10.4103/0189-6725.91670\u003c/li\u003e\n\u003cli\u003eHassan KQ (2018) Colostomy closure in pediatric age group: analysis of outcome in single-center experience. \u003cem\u003eJ Fac Med Baghdad\u003c/em\u003e 60:33. https://doi.org/10.32007/jfacmedbagdad.60133\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eDemographic, clinical characteristics, and surgical indications of patients undergoing vessel loop versus conventional colostomy closure (N = 32).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eTest of significance\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP value\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eVessel loop\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003econventional closures\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at time of surgery\u003c/strong\u003e (years)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2.04 \u0026plusmn; 2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e2.83 \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.67 \u0026plusmn; 1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=1.48\u003c/p\u003e\n \u003cp\u003eP=0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent age\u003c/strong\u003e (years) (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.24 \u0026plusmn; 3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3.56 \u0026plusmn; 2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e4.56 \u0026plusmn; 4.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=0.78\u003c/p\u003e\n \u003cp\u003eP=0.441\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody weight\u0026nbsp;\u003c/strong\u003e(kg) (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e10.15 \u0026plusmn; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e12.49 \u0026plusmn; 10.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8.98 \u0026plusmn; 3.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003et=1.28\u003c/p\u003e\n \u003cp\u003eP=0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e9 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e10 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.249\u003c/p\u003e\n \u003cp\u003eP=0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e13 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e5 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e9 (28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e6 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=2.67\u003c/p\u003e\n \u003cp\u003eP=0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e23 (71.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e8 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e15 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eIf having comorbidity, specify: (no.: 23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eDown syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (30.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=6.97\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP=0.008*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eCongenital heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e11 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.85\u003c/p\u003e\n \u003cp\u003eP=0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eHypothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6 (26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e6 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=5.74\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP=0.017*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eRenal malformation/chronic kidney disease /renal impairment\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.15\u003c/p\u003e\n \u003cp\u003eP=0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eAcute lymphoblastic leukemia (ALL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.33\u003c/p\u003e\n \u003cp\u003eP=0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eAcute lymphoblastic leukemia (ALL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.33\u003c/p\u003e\n \u003cp\u003eP=0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eBronchopulmonary dysplasia (BPD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eType 1 DM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eCystic fibrosis (CF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eNeural tube defects (NTDS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.66\u003c/p\u003e\n \u003cp\u003eP=0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eGlobal developmental delay (GDD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eHydrocephalus\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eLaryngomalacia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eVACTERL association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.04\u003c/p\u003e\n \u003cp\u003eP=0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication for stoma surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=9.14\u003c/p\u003e\n \u003cp\u003eP=0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eAnorectal malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e19 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e4 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e15 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=13.49\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP\u0026lt;0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eAnal abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.33\u003c/p\u003e\n \u003cp\u003eP=0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eConstipation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.33\u003c/p\u003e\n \u003cp\u003eP=0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eHirschsprung disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e3 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.12\u003c/p\u003e\n \u003cp\u003eP=0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eIntestinal perforation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=1.33\u003c/p\u003e\n \u003cp\u003eP=0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003emeconium plug (CF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003eNEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.03\u003c/p\u003e\n \u003cp\u003eP=0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 212px;\"\u003e\n \u003cp\u003ePerforated NEC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*: Statistically significant, t: Student t test, \u0026chi;2: Chi-square test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ldquo;Down syndrome, hypothyroidism, and anorectal malformation were significantly more prevalent in the conventional closure group (P \u0026lt; 0.05).\u0026rdquo;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e: Preoperative, operative, and postoperative outcomes in vessel loop\u0026ndash;assisted versus conventional colostomy closure (N = 32).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"612\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTest of significance\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eVessel loop\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eConventional closure\u003c/p\u003e\n \u003cp\u003eNo. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eElective\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e32 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=.00\u003c/p\u003e\n \u003cp\u003eP=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEmergency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOperative time\u0026nbsp;\u003c/strong\u003e(hours) (Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.61 \u0026plusmn; 1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.65 \u0026plusmn; 1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.59 \u0026plusmn; 1.04\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003et=0.15\u003c/p\u003e\n \u003cp\u003eP=0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-operative data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=.00\u003c/p\u003e\n \u003cp\u003eP=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e32 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral feeding time\u0026nbsp;\u003c/strong\u003e(days)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e3.53 \u0026plusmn; 1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e2.3 \u0026plusmn; 1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3.7 \u0026plusmn; 1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003et=2.42\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP=0.021*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst dressing\u0026nbsp;\u003c/strong\u003e(days)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(Mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e4.26 \u0026plusmn; 1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e4.3 \u0026plusmn; 0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e4.24 \u0026plusmn; 1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003et=0.13\u003c/p\u003e\n \u003cp\u003eP=0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e20 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e9 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.03\u003c/p\u003e\n \u003cp\u003eP=0.854\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e12 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e5 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of complications: (no.: 23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSeroma\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e2 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.84\u003c/p\u003e\n \u003cp\u003eP=0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eWound infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.03\u003c/p\u003e\n \u003cp\u003eP=0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eWound dehiscence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.03\u003c/p\u003e\n \u003cp\u003eP=0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eIncisional hernia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=.00\u003c/p\u003e\n \u003cp\u003eP=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eEnterocutaneous fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=.00\u003c/p\u003e\n \u003cp\u003eP=1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRehospitalization\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e31 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17(94.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReoperations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e31 (96.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17 (94.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026chi;2=0.80\u003c/p\u003e\n \u003cp\u003eP=0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e1 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*: Statistically significant, t: Student t test, \u0026chi;2: Chi-square test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral feeding was initiated earlier in the vessel loop group (P \u0026lt; 0.05), with no significant differences in operative metrics, overall complications, rehospitalization, or reoperation rates (P \u0026gt; 0.05).\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pediatric stoma closure, Vessel loop, Wound drainage, Surgical site infection, Wound healing","lastPublishedDoi":"10.21203/rs.3.rs-7837366/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7837366/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Pediatric stoma closure often leads to notable postoperative complications, such as wound seroma, infection, and dehiscence. The use of vessel loops has been suggested to enhance wound drainage and minimize discomfort, potentially leading to better outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective cohort study was carried out at King Faisal Specialist Hospital in Jeddah, involving 32 pediatric patients who underwent stoma closure from January 2021 to April 2024. Among these, 14 patients had vessel loop-assisted closures, while 18 underwent conventional methods. The analysis covered demographics, comorbidities, surgical details, and postoperative outcomes, including seroma, wound infection, dehiscence, rehospitalization, and reoperation rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The average age at surgery was 2.04 ± 2.04 years, with an average weight of 10.15 ± 7 kg, and 59.4% of the cohort were male. Vessel loops were predominantly utilized in patients without comorbidities (42.9% vs. 16.7%, p \u0026lt; 0.05). The overall complication rates were 35.7% for the vessel loop group and 38.9% for the conventional group (p \u0026gt; 0.05). The most common complication was wound seroma (14.3% vs. 27.8%), with all cases in the vessel loop group managed conservatively with home-based care. No significant differences were noted between the groups in terms of infection, dehiscence, rehospitalization, or reoperation rates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Vessel loop-assisted closure is a safe and effective technique in pediatric stoma surgeries, promoting wound drainage, minimizing discomfort, allowing for home-based care, and achieving satisfactory cosmetic results without increasing complications. These findings support wider adoption of the technique in pediatric surgical practice.\u003c/p\u003e","manuscriptTitle":"Title of the research: Vessel Loops in Pediatric Stoma Closure: Improving Healing and Reducing Complications","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 04:09:23","doi":"10.21203/rs.3.rs-7837366/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"96927e74-8a1c-4b48-b2c8-66f34a42d435","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-13T06:39:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 04:09:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7837366","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7837366","identity":"rs-7837366","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}