Attitudes and technical maneuvers regarding enterostomy management and stoma creation among surgeons: A cross-sectional study

Table 1 Demographic characteristics of participants, n (%)

Items	n = 401
Hospital classification
Tertiary general hospitals	310 (77.3)
Tertiary specialized hospitals	50 (12.5)
Secondary hospitals and below	41 (10.2)
Department
General surgery	130 (32.4)
Gastrointestinal surgery	210 (52.4)
Surgical oncology	50 (12.5)
Other departments involved in stoma creation	11 (2.7)
Professional title of surgeon
Chief surgeon	163 (40.6)
Associate chief surgeon	122 (30.4)
Attending surgeon	84 (21.0)
Resident surgeon	32 (8.0)
Working years
> 15 years	254 (63.3)
5-15 years	114 (28.4)
< 5 years	33 (8.2)

Table 2 Personnel qualification and training, n (%)

Items	n = 401
Stoma creation is most commonly performed by
Operator	211 (52.6)
First assistant	182 (45.4)
Second assistant or lower	8 (2.0)
Surgeon responsible for enterostomy
Associate chief surgeon or above	199 (49.6)
Attending surgeon (guided by superior surgeon)	191 (47.6)
Resident surgeon (guided by superior surgeon)	11 (2.7)
Source of ostomy-related knowledge (multiple answers)
Mentorship by senior surgeon	338 (84.3)
Mentorship by attending/resident surgeon	69 (17.2)
Learning based on surgical atlases	122 (30.4)
Mentorship combined with surgical atlases	187 (46.6)
Self-education	174 (43.4)
Have not been exposed to the relevant knowledge	1 (0.3)
Departmental attitude toward training in the prevention of stoma-related complications
Attach great importance	286 (71.3)
Attach moderate importance	109 (27.2)
Attach little importance	6 (1.5)
Have you received training related to stoma creation?
Yes	242 (60.4)
No	159 (39.6)

For multiple-answer items, percentages indicate the response rate for each option and therefore do not sum to 100%.

Table 3 Concepts and attitudes toward stoma-related complications, n (%)

Items	n = 401
How concerned are you about the correlation between surgical procedures and stoma-related complications?
Closely related	325 (81.0)
Related	74 (18.5)
Slightly related	2 (0.5)
In your view, which of the following complications are related to surgical procedures (multiple answers)?
Irritant dermatitis	29 (7.2)
Stomal bleeding	138 (34.4)
Stomal necrosis	188 (46.9)
Stomal stenosis	186 (46.4)
Parastomal hernia	175 (43.6)
Stomal prolapse	135 (33.7)
Ileus	140 (34.9)
All the above	190 (47.4)
Which complications have you encountered that required unplanned surgery (multiple answers)?
Stomal bleeding	123 (30.7)
Stomal necrosis	233 (58.1)
Stomal retraction	220 (54.9)
Stomal prolapse	151 (37.7)
Necrotizing fasciitis	109 (27.2)
Abdominal wall abscess	118 (29.4)
Stenosis or ileus	250 (62.3)
None	37 (9.2)
What is your perception of stoma-related complications (multiple answers)?
Not uncommon, but should be managed by an enterostomal therapist	77 (19.2)
Not uncommon, and surgeons should participate in treatment	256 (63.8)
Closely related to surgical procedures and most complications can be avoided	321 (80.1)
Probably related to surgical procedures and should be managed exclusively by an enterostomal therapist postoperatively	81 (20.2)
Have never paid much attention	4 (1.0)
Have you participated in discussions or training on prevention or treatment of stoma-related complications?
Yes	225 (56.1)
No	176 (43.9)
What is your perception of joint training and discussions on stoma-related complications between surgeons and enterostomal therapists?
Necessary	397 (99.0)
Unnecessary	4 (1.0)

For multiple-answer items, percentages indicate the response rate for each option and therefore do not sum to 100%.

Table 4 Concepts and attitudes toward preoperative stoma site marking, n (%)

Items	n = 401
What do you think of preoperative stoma site marking?
Meaningful and should be strictly observed	186 (46.4)
Meaningful, and the area around the marking site is also appropriate	33 (8.2)
Meaningful, but the judgment of the surgeon should be the primary consideration	111 (27.7)
Meaningful, but not all marked sites (identified by enterostomal therapists) are suitable for stoma creation	70 (17.5)
Meaningless and can be omitted	1 (0.3)
In your impression, the rate of preoperative stoma site marking in your department is approximately
80%-100%	134 (33.4)
60%-80%	118 (29.4)
40%-60%	62 (15.5)
< 40%	87 (21.7)
In your impression, what are the reasons for not choosing the preoperatively marked stoma site by an enterostomal therapist as the primary site (multiple answers)?
Inappropriate marking	179 (44.6)
The stoma site marked preoperatively is not a suitable trocar site	219 (54.6)
Defunctioning stoma marking according to standards for permanent stoma	209 (52.1)
Prior site marking is inconsistent with the surgeon’s operating habits	108 (26.9)
Which temporary ileostomy skin site position do you prefer?
Right umbilical level, trocar site	90 (22.4)
Right lower quadrant, McBurney point (trocar site)	159 (39.7)
Right rectus abdominis muscle, specimen incision	113 (28.2)
Hypogastrium region, specimen incision	13 (3.2)
No fixed position	26 (6.5)
Which permanent colostomy skin site position do you prefer?
Left umbilical level, trocar site (outer margin of the rectus abdominis muscle)	74 (18.5)
Lower left quadrant of the umbilicus, outer margin of the rectus abdominis muscle	124 (30.9)
Lower left quadrant of the umbilicus, through the rectus abdominis muscle	160 (39.9)
Lower left quadrant of the umbilicus, lateral rectus abdominis muscle	29 (7.2)
No fixed position	14 (3.5)
Which transverse colostomy skin site position do you prefer?
Right subcostal margin	120 (29.9)
Left subcostal margin	124 (30.9)
Linea alba above the umbilicus	138 (34.4)
No fixed position	19 (4.7)

For multiple-answer items, percentages indicate the response rate for each option and therefore do not sum to 100%.

Table 5 Technical maneuvers in stoma creation, n (%)

Items	n = 401
Shape of skin incision
Straight	110 (27.4)
Subcircular	286 (71.3)
Other	5 (1.3)
What do you think about the correlation between skin incision length and the size of the exteriorized intestine?
Incision size should be larger than the diameter of the intestine	111 (27.7)
Incision size should be close to the diameter of intestine	244 (60.9)
Incision size should be smaller than the diameter of intestine	46 (11.5)
Management of subcutaneous tissue
Excision	207 (51.6)
Preservation	110 (27.4)
Selective management	84 (21.0)
Shape of the obliquus externus abdominis aponeurosis incision
Cruciform	217 (54.1)
Cross shape, random direction	44 (11.0)
Straight shape, along the long axis	103 (25.7)
Straight shape, along the abdominal fascia	29 (7.2)
Flexible performance	8 (2.0)
Management of rectus abdominis/ abdominal wall muscle
Blunt dissection without complete muscle rupture	214 (53.4)
Partial dissection until the posterior sheath or peritoneum is exposed	145 (36.2)
Sharp dissection of the muscle in the projection region of the stoma	10 (2.5)
Selective management	32 (8.0)
Retention length of the proximal intestine in permanent stoma
Preserve the shortest possible length while ensuring adequate exteriorization of the bowel	123 (30.7)
Preserve as long as possible	92 (23.0)
Selectively performance	186 (46.4)
Layers for suturing and fixation in defunctioning stoma creation (multiple answers)
Peritoneum (or posterior rectus abdominis sheath)	274 (68.3)
Muscle	18 (4.5)
Anterior rectus abdominis sheath	218 (54.4)
Subcutaneous tissue	107 (26.7)
Skin	323 (80.6)
No suture or fixation	12 (3.0)
Layers for suturing and fixation in permanent stoma creation (multiple answers)
Peritoneum (or posterior rectus abdominis sheath)	349 (87.0)
Muscle	29 (7.2)
Anterior rectus abdominis sheath	304 (75.9)
Subcutaneous tissue	131 (32.7)
Skin	339 (84.5)
No suture or fixation	6 (1.5)
Opening direction of loop stomas
Along the long axis of the intestine	277 (69.1)
Perpendicular to the long axis of the intestine	99 (24.7)
Selective orientation	25 (6.2)

For multiple-answer items, percentages indicate the response rate for each option and therefore do not sum to 100%.

Table 6 Awareness and utilization of relevant procedures and instruments, n (%)

Relevant procedure and instrument	Awareness		Utilization
	Known	Unknown	Regular use	Occasional use	Rare use or non-use
Application of support rod in loop ileostomy	382 (95.3)	19 (4.7)	226 (56.4)	85 (21.2)	90 (22.4)
Application of iodoform gauze in intestine and skin	303 (75.6)	98 (24.4)	131 (32.7)	77 (19.2)	193 (48.1)
Application of circular stapler in permanent stoma creation	257 (64.1)	144 (35.9)	54 (13.5)	89 (22.2)	258 (64.3)
Application of extraperitoneal ostomy in permanent stoma creation	345 (86.0)	56 (14.0)	139 (34.7)	149 (37.2)	113 (28.2)
Application of mucosal eversion suture (Brooke) in loop ileostomy	312 (77.8)	89 (22.2)	180 (44.9)	110 (27.4)	111 (27.7)
Application of mucosal eversion suture in permanent end colostomy	356 (88.8)	45 (11.2)	263 (65.6)	89 (22.2)	49 (12.2)
Application of protective negative-pressure wound therapy	177 (44.1)	224 (55.9)	30 (7.5)	84 (21.0)	287 (71.6)