Stoma Complications

Abstract

).Roughly 150,000 stomas are created in the United States annually, equally divided between ileostomies and colostomies.1 When created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Patients with a good functioning stoma can expect to live a normal life with very few lifestyle restrictions. In contrast, when a patient develops complications related to their stoma, the impact on their physical and mental health can be irreparable. Stomas can be created for a multitude of diseases such as colorectal cancer, ulcerative colitis, Crohn's disease, diverticulitis, ischemic colitis, radiation injury, and fecal incontinence. The associated morbidity and overall function of a stoma are dependent upon the indication for the stoma, whether it was created electively or emergently, and patient factors such as body habitus and prior surgery. Unfortunately, significant morbidity is associated with stoma creation and these complications can be grouped into early and late-occurring complications. The literature reports the rate of stoma-related complications ranging from 20 to 70%.2-7 Early complications occur within the first 30 days of the stoma creation and include ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess. Late complications include parastomal hernia, prolapse, retraction, and varices. All of these complications will be discussed to better understand etiologies and management options. Risk Factors for Stoma-Related ComplicationsAs mentioned previously, stoma creation carries significant morbidity, and disease, patient, clinical, and stoma-specific factors influence the outcomes pertaining to their creation. Harris et al found the most common stoma-related complications in 345 ostomates were herniation, retraction, necrosis, infection, prolapse, stenosis, fistula, and small bowel obstruction (SBO). 4 Complications were more common with colostomies except for SBO, which were more prevalent with ileostomies. The authors also found that loop colostomies had the highest complication rate out of all stoma configurations. Postoperative stoma necrosis was strongly and significantly associated with emergency stoma creation. Parmar et al identified that colostomies, short stoma length, body mass index > 30, emergency surgery, and lack of preoperative marking were associated with increased risks of complications. 7 None of the identified studies was adequately powered to stratify postoperative stoma-related complication rates by specific disease processes. Parastomal HerniaParastomal hernias are incisional hernias at ostomy sites and are believed to be an inevitable consequence of having an Keywords ► parastomal hernia ► stoma prolapse ► colostomy ► ileostomy ► parastomal varices AbstractWhen created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Conversely, when a patient develops complications related to their stoma, the impact on physical and mental health can be profound. Unfortunately, significant morbidity is...

Incisional hernia at the site of stoma reversal—incidence and risk factors in a retrospective observational analysis

“…Stoma hernias carry a high burden of disease, with incarceration being a rare but serious complication. Surgical repair is performed in up to 56% of cases [19] but is plagued with a high recurrence rate (about 75% in direct repair and up to 16% in mesh repair, [20]).…”

Racial disparities after stoma construction in colorectal surgery

“…The indications for a stoma are diverse, and both ileostomies and colostomies may be created as the primary procedure or as a component of both emergency and elective procedures. Although there are several benefits to the creation of an intestinal stoma there are also numerous associated complications that can lead to substantial morbidity and mortality, such as myocardial infarction, superficial and deep wound infections, prolonged postoperative ileus, acute renal insufficiency from dehydration and electrolyte abnormalities . Furthermore, 30‐day readmission rates are among the highest of any surgical procedure .…”

Intestinal Ostomy Complications and Care

“…The use of two-piece pouch facilitates the daily observation of the stoma with no need of withdrawal of the skin attached piece. Postoperative nursing assessment and management also help prevent potential impairment of a good blood supply to the stoma [11,16] (Figure 8).…”