Management of Stomal Complications

Creation of an intestinal stoma, be it temporary or permanent, requires good judgement and surgical skill. For the patient the stoma is of constant concern, and a well constructed intestinal stoma can reduce the patient's physical and psychological stress. Peristomal skin irritation should alert a search for surgical complications. Collaboration with an enterostomal therapist is strongly advised. The probability of revision of an ileostomy during the first 10 years reaches 0.44 in patients with ulcerative colitis (UC) and 0.75 in patients with Crohn's disease (CD). The most frequently seen complication are stenosis and sliding retraction. Stomal fistulas are seen more frequently in patients with CD than those with UC. Most ileostomy complications can be treated locally, without a laparotomy. The sigmoid colostomy, a stoma of the elderly, is also frequently complicated by stenosis, particularly after postoperative infection and separation at the mucocutaneous junction. Peristomal herniation is extremely common, and some degree of herniation is almost inevitable. There are no randomized studies to determine the best way to construct a colostomy. Bringing the bowel through the rectus muscle is probably superior to lateral to the muscle. Extraperitoneal colostomy does not provide any advantage over the intraperitoneal route. A colostomy stenosis is best managed locally. Infectious complications and hernias require laparotomy and resiting of the stoma