Intestinal Stomas

Abstract

Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel and the colon. The most common intestinal stomas are the ileostomies (end and loop) and the colostomies (end and loop). Preoperative counseling, choice of procedure, and selection of stoma site are described. The general principles of the operative technique are listed, as is the creation of the stoma aperture. Types of colostomies are described and include end, loop, and double-barrel. For ileostomy, end, loop, loop-end, split, and continent are described. Details are provided on the stoma closure for loop ileostomy and loop colostomy. The chapter has sections on troubleshooting and complications, including ischemia, stenosis, prolapse, retraction, parastomal hernia, obstruction, and fistula. Figures show an end colostomy, loop colostomy, preparation of terminal ileum and placement of sutures for an end ileostomy, stoma closure for loop ileostomy, stabilization of retracted ileostomy, preperitoneal mesh repair of parastomal hernia, and laparoscopic intra-abdominal placement of polytetrafluoroethylene-coated mesh. Tables show indications for different types of intestinal stomas, incidence of common complications of the intestinal stomas, incidence of parastomal hernia formation, and additional complications arising after stoma formation. This review contains 12 figures, 5 tables, and 106 references.