Stoma Colostomy

Loop ileostomy and loop colostomy are both used as protective stomas after anterior resection. There is a lack of evidence on the superiority of loop ileostomy versus loop colostomy. This is a multicenter, open-label, superiority, individually randomized controlled trial including patients undergoing anterior rectal resection with primary anastomosis and a protective stoma. Patients scheduled for anterior rectal resection are randomized 1:1 to loop ileostomy or loop colostomy intraoperatively. Primary outcome is cumulative stoma-related adverse events within 60 days post-primary surgery (scored using Comprehensive Complication Index (CCI)).

* Ileostomy or colostomy is a common surgical procedure used for diverting the lower gastrointestinal content away from distal pathology or anastomotic insufficiency. Once the distal problem has been fixed, the plan is to reverse the stoma. However, the reversal of a stoma is associated with complications, including anastomotic leaks, wound infection, and incisional hernias which can reach up to 33-50%. * The ideal site for a stoma on the abdominal wall depends on several factors, including the patient's anatomy, the type of stoma (colostomy or ileostomy), operative findings, and the patient's preferences. Stomas have traditionally been fashioned through the rectus muscle, away from the midline of the abdomen, and below the umbilicus. * Management of a stoma placed at the center of a long midline laparotomy wound is challenging with the risk of faecal contamination of midline incision. However in many scenarios, the surgeon is left without options rather than to exteriorize the bowel loop through the midline. Moreover, advantages of midline stoma may include: 1. Easy to create and save operative time. 2. Minimize destruction of the anterior abdominal wall (less tissue injury). 3. Eliminate the long-term risk of incisional hernia at the site of previous stoma. Only, few reports assess the outcomes of midline ostomy as a temporary stoma

The planned research aims to evaluate the impact of a training program on self-efficacy in patients with permanent colostomies. It highlights the importance of holistic patient education in preventing complications and improving adaptation to stomas, which can positively affect patients' quality of life and self-efficacy.

This study is planned as a randomized controlled trial to determine the effect of education provided through the flipped learning model on students' levels of knowledge and self-efficacy regarding stoma care. The research will be conducted on 100 first-year nursing students between 05.2024-06.2024. Randomization will be ensured for students who meet the inclusion criteria, and they will be divided into two random groups: the experimental group (n=50) and the control group (n=50). All participating students will be administered the "Introductory Characteristics Form," "Stoma Care Knowledge Assessment Form (pre-test)," and "General Self-Efficacy Scale (pre-test)." For students in the experimental group, digital materials required for preparedness for the course based on the flipped learning model (such as course presentation materials and demonstration videos) will be prepared by the researchers. After the implementation and 4 weeks later, the 'Stoma Care Knowledge Assessment Form (post-test)' and the 'General Self-Efficacy Scale (post-test)' will be administered online. All students in the control group will be administered the 'Introductory Characteristics Form,' the 'Stoma Care Knowledge Assessment Form (pre-test),' and the 'General Self-Efficacy Scale (pre-test).' Subsequently, stoma care will be provided to the control group solely through traditional teaching methods. No additional resources will be provided. After the implementation and 4 weeks later, the 'Stoma Care Knowledge Assessment Form (post-test)' and the 'General Self-Efficacy Scale (post-test)' will be administered online.

This observational study aims to test proteomics, metabolomics and proteoglycans as predictors of postoperative complications after colorectal surgery and as biomarkers of colorectal cancer. The main questions to answer are: * can these biomarkers predict anastomotic leakages * can these biomarkers predict recurrence after colorectal cancer * can these biomarkers be used as diagnostic tests for colorectal cancer * can these biomarkers be identified in the tumor Participants will undergo elective colorectal resection or stoma closure.

This study aims to enhance the physical, psychological, and social aspects of stoma care by providing a self-management service via a smartphone application, and to evaluate the impact of this digital-based application on patients' quality of life.