Intestinal stomal complications are common, occurring in almost half of patients. There are certain irremediable risk factors, allowing appropriate preoperative counselling.

Simple cutaneous advancement flap anoplasty should be considered as a first-line surgical treatment of chronic anal fissure, irrespective of patient gender and anal tone.

Risk may be defined as 'the chance that something may happen to cause loss or an adverse effect' (Concise Oxford Medical Dictionary, 2003). Patients undergoing stoma formation are at risk of developing a wide range of complications following surgery. A parastomal hernia is an adverse effect that can contribute to postoperative morbidity. The risk of developing a parastomal hernia is dependent upon a number of variables, and stoma care nurses need to be aware of these to plan the appropriate care for patients undergoing stoma formation. This article discusses the issues surrounding the development of parastomal hernias and also looks at ways in which the risk factors associated with the development of a parastomal hernia may be minimized.

Leakage from an ostomy appliance impairs peristomal skin integrity and quality of life (QoL). The proportion of participants who reported that they ‘never’ had leakage increased from 13% at visit 1 (i.e. with their pre-study appliance) to 36% at visit 2 (i.e. after using the double-layer adhesive appliance, SenSura (Coloplast A/S)) (P<0.0001). The proportion of participants reporting that they ‘never’ had unplanned changes increased from 12% at Visit 1 to 34% at visit 2 (P<0.0001). The double-layer adhesive appliance, SenSura, in conjunction with advice/intervention from a stoma care nurse (SCN), was superior to the pre-study appliance across all performance parameters (P<0.0001), including adhesion, flexibility and erosion. Higher leakage frequency at baseline correlated with worse peristomal skin (P<0.0001). Peristomal skin improved from visit 1 to visit 2, across all leakage frequencies. The use of an appropriate double-layer adhesive appliance in conjunction with SCN intervention, reduced leakage and improved peristomal skin conditions.