Prosthetic mesh placement for the prevention of parastomal herniation

Lived Experience of Parastomal Bulging: A Mixed Methods Study

Aim

This United Kingdom study aimed to explore people's experiences of living with, and self-managing parastomal bulging.

Methods

Seventeen people were interviewed and 61 people completed an online survey.

Results

Parastomal bulging has a detrimental impact on quality of life including a negative impact on stoma function, daily activities, body image, physical intimacy, and socialising; access to specialist information and support for addressing the problem of bulging was inequitable; support garments were the most common self-management intervention; there was confusion about what exercise would be beneficial or how being active would help in terms of parastomal bulging self-management; peer support is no substitute for high quality specialist support.

Conclusion

People need equitable access to information and support to self-manage and treat parastomal bulging. Research about other types of self-management interventions, for example, exercise is required so that people do not have to rely solely on support garments to self-manage parastomal bulging.

How often is prophylactic parastomal mesh placement performed after rectal resection without sphincter preservation? An analysis of German nationwide hospital discharge data among 41,697 patients

PURPOSE

The European Hernia Society guidelines of parastomal hernias, published in 2017, strongly recommend prophylactic synthetic non-absorbable mesh upon the construction of a permanent end colostomy to reduce the incidence of parastomal hernias. This study aims to evaluate the implementation of the guidelines in Germany.

METHODS

This is a retrospective multicentric analysis conducted in December 2022 at the University Hospital Brandenburg an der Havel. Anonymous data on rectal resection without sphincter preservation in the period 2010-2020 were extracted from the German nationwide hospital discharge data set. Individuals with a hernia and < 18 years old were excluded. Another exclusion criterion was a performed colectomy or proctocolectomy with an ileoanal pouch and placement of an absorbable mesh. The primary endpoint was the annual rate of prophylactic parastomal mesh placement following rectal resection without sphincter preservation in Germany. Cases reporting both non-absorbable mesh placement and rectal resection without sphincter preservation were considered prophylactic mesh insertions.

RESULTS

A total of 41,697 patients received a rectal resection without sphincter preservation and without non-absorbable mesh placement. Among these individuals, 27,089 were male and 14,608 were female. The rate of reoperations (3.1%) and the length of hospital stay (25.3 days ± 19.32) remained almost constant during these 10 years. The rate of prophylactic mesh placement was increasing from 0.2% (n = 8) in 2010 to 6.4% (n = 198) in 2020.

CONCLUSIONS

Currently, only the minority of patients who have undergone rectal resection without sphincter preservation receive prophylactic mesh insertion.

Abdominal Core Health: What Is It?

Abdominal core health encompasses the stability and function of the abdominal core and associated quality of life. Interventions to maintain core health include surgical and non-surgical therapies that integrate the functional relatedness of the abdominal core components.

The same parastomal hernia repairs rate in the different approaches to colostomy

PURPOSE

This study aimed to compare the parastomal hernia repairs rate in the different approaches to colostomy and investigate the risk factors for parastomal hernia formation in patients with permanent colostomies.

METHODS

Consecutive rectal cancer patients who underwent abdominoperineal resection from June 2014 to July 2020 in West China Hospital were divided into two groups according to their surgical approach for permanent colostomies. The impact of different approaches to colostomy on parastomal hernia repairs was determined by comparing a group of patients receiving an extraperitoneal route to colostomy with a group receiving transperitoneal. Potential variables were evaluated first with univariate and then multivariate analyses to identify the risk factors for the formation of parastomal hernia.

RESULTS

Two hundred two subjects in the transperitoneal group and 103 in the extraperitoneal group attended the follow-up visit with a median follow-up period of 33 (25th-75th percentiles, 17-46) months. Clinically and radiologically detectable parastomal hernias were present in 76 of 202 (37.6%) and 14 of 103 (13.6%) subjects in the transperitoneal and extraperitoneal groups during the follow-up period (p＜0.01). Besides, 10 of 76 (13.1%) subjects in the transperitoneal group and 2 of 14 (14.3%) subjects in the extraperitoneal group underwent a parastomal hernia operation during the follow-up (p = 0.82). In addition, the transperitoneal approach of colostomy (p = 0.002), older age (p＜0.001), and higher body mass index (p = 0.013) were identified as independent risk factors for the occurrence of parastomal hernia.

CONCLUSIONS

Extraperitoneal colostomy decreased the detectable parastomal hernias but did not reduce the surgical repair rate of parastomal hernias.

Diagnosis, Treatment, and Prevention of Ileostomy Complications: An Updated Review

An ileostomy is associated with multiple complications that may frequently or persistently affect the life of ostomates. All healthcare professionals should have knowledge of the diagnosis, treatment, and prevention of ileostomy complications. Peristomal dermatitis is caused by watery and highly alkaline effluent. Skin protective products are typically used for local treatment. Ischemia/necrosis occurs due to insufficient arterial blood supply. Retraction is seen in patients with a bulky mesentery and occurs following ischemia. Convex stoma appliances can be used for skin protection against fecal leakage. Small bowel obstruction (SBO) is common and occurs only at the stoma site. Trans-stomal decompression is most effective in these cases. High output stoma (HOS) is defined as a condition when the output exceeds 1,000- 2,000 ml/day, lasting for one to three days. Treatment includes intravenous fluid and electrolyte resuscitation followed by restriction of hypotonic fluid and the use of antimotility (and antisecretory) drugs. Stomal prolapse is a full-thickness protrusion of an inverted bowel. Manual reduction is attempted initially, whereas emergency bowel resection may be needed for incarcerated cases. A parastomal hernia (PSH) is an incisional hernia of the stoma site. Surgery is considered in cases of incarceration, but most cases are manageable with non-surgical treatment.

Prophylactic parastomal mesh sublay at the time of ileal conduit: surgical technique

OBJECTIVE

To demonstrate the surgical technique for prophylactic mesh placement in the sublay position during ileal conduit creation because literature suggests that prophylactic mesh placement at the time of cystectomy may reduce the risk of parastomal hernias with low risk of mesh-related complications. Parastomal hernias are one of the most common complications following ileal conduit construction and occur in 17-65% of patients undergoing cystectomy with urinary diversion. Review of our institutions data demonstrated a high incidence of hernias associated with ileal conduits, which have substantial burden to patients, surgeons, and the healthcare system.

METHODS

This is a retrospective chart review of data from a single surgeon who performed cystectomy with ileal conduit for 12 patients with bladder cancer between 1/2021-3/2022 at our institution. These dates were chosen based on the timing of availability of literature suggesting a benefit from prophylactic mesh placement. Preliminary data was analyzed determine the incidence of parastomal hernia and mesh-related complications.

RESULTS

A total of 12 patients underwent cystectomy with ileal conduit between 1/2021-3/2022 at our institution. Eleven patients (92%) had prophylactic mesh placed during their procedure. Median follow up was 5.4 months (0.8-8 months). Two patients (17%) developed a parastomal hernia which was detected clinically and/or radiographically. The hernias occurred in patients with mesh and within 6 months of cystectomy. One patient had stomal stenosis eventually requiring surgical revision. There were no mesh infections or mesh removals.

CONCLUSIONS

Parastomal hernias are a common and morbid complication of ileal conduit urinary diversion. Our early experience demonstrates that the procedure is straightforward, adds little time to the surgical procedure, and is associated with a low complication rate. Our experience is too small and follow up too short to confirm that the results of the randomized trial can be matched at our center.

Stoma-Related Complications: A Single-Center Experience and Literature Review

Introduction: The creation of an abdominal stoma is a common procedure performed by surgeons as a part of the treatment for benign and malignant conditions in general surgery. Stoma formation is simple, but sometimes the associated postoperative complications have an impact on the patients’ physical and psychological state. The majority of complications do not require reoperation, but when it is indicated, we have to assess the most appropriate option for the patient.

Material and Methods: We conducted a retrospective study in a single surgical center, the Department of Surgery, Mureș County Hospital, Târgu Mureș, Romania, using data from patients who have been admitted under elective conditions for stoma-related complications between 2005 and 2019.

Results: A total number of 877 ostomies (653 colostomies and 224 ileostomies) were performed, and 157 patients (17.9%) developed some type of stoma complication and required surgical intervention. The mean age was 64.5 ± 2.1 years, with a male-female ratio of 1.3 to 1. The leading comorbidities included cardiovascular disease (52.2% of cases), obesity (22.2%), and diabetes (18.4%). Parastomal hernia was the most frequent complication (47.5% of cases), followed by stoma prolapse (23.4%), parastomal stenosis (20.3%), and parastomal infection (8.2%). There was an association between age and the type of complication: parastomal hernia, stoma prolapse, and stenosis were more frequent in the elderly; parastomal infection was more prevalent in young patients. A longer hospital stay was observed in case of parastomal hernia.

Conclusions: Stoma formation is associated with significant morbidity. Typically, the complications appear in the elderly. Conservative treatment is essential, but some of the late complications, such as parastomal hernia, stoma stenosis, stoma prolapse, and parastomal infection, require a surgical solution. Parastomal hernias are the most common complications, frequently associated with comorbidities and prolonged hospitalization.

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis

PURPOSE

Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition.

METHODS

Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively.

RESULTS

Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study.

CONCLUSIONS

The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

Meta-analysis and Systematic Review of the Use of a Prosthetic Mesh for Prevention of Parastomal Hernia

OBJECTIVE

The primary endpoint of this meta-analysis was the PSH rate at 1 year of follow-up with or without the use of a mesh.

SUMMARY OF BACKGROUND DATA

European guidelines currently recommend the use of a mesh at the time of a stoma formation for the prevention of PSH. These recommendations are based on the RCT and meta-analyses published before 2017. More recently 2 large RCT found no benefit in the mesh group. We investigated whether these latest results could change the conclusion of a meta-analysis.

METHODS

We conducted a comprehensive literature search and analyzed RCT investigating the use of a mesh to prevent PSH formation. All studies including end colostomies were included in the qualitative analysis no matter the surgical technique or the type of mesh. All studies with a limited risk of bias and presenting with usable data were used in the quantitative analysis.

RESULTS

There is a large heterogeneity among the studies, in terms of position of the mesh, surgical technique, and diagnostic method for the PSH.No statistically significant difference was found on the PSH rate at 1 or 2 years between the mesh and non-mesh groups.

CONCLUSIONS

Based on this meta-analysis including the latest RCT on the prevention of PSH, the use of a mesh should not be recommended.

[Stoma-associated complications-Prevention strategy and treatment concepts]

Postoperative complications after the creation of an intestinal stoma have a considerable impact on the patient's quality of life. The accurate surgical technique is very important for their prevention and requires profound surgical knowledge as well as sufficient experience. The importance of the preoperative consultation as well as the postoperative care by stoma therapists is clearly proven. Depending on the severity of the complication, outpatient conservative treatment is initially indicated. A surgical local revision or laparotomy should only be considered if conservative treatment is no longer sufficient, whereby the indications for surgery should be set very cautiously. This article provides an overview of the current evidence regarding the prevention and treatment of postoperative stoma complications.

Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies

PURPOSE

Parastomal hernia (PSH) is the most common complication of stoma formation. The safety and efficiency of prophylactically placing mesh to prevent PSH remain controversial. To address this question, we examined the incidence of clinical and radiological PSH when using parastomal prophylactic mesh (PPM).

METHODS

We performed a retrospective, single-center, cohort study that included all patients with permanent stoma creation between 2015 and 2018. Patients were divided into two groups according to the utilization of PPM or not.

RESULTS

During the study period, 185 patients had a permanent stoma created, 144 with colostomy and 41 with ileostomy. PPM was placed in 79 patients. There was no difference in the need for early surgical reintervention (p = 0.652) or rehospitalization (p = 0.314) for stoma-related complications in patients with mesh as compared with patients without. Similarly, there was no difference in operative time (p = 0.782) or in length of hospital stay (p = 0.806). No patients experienced infection of the mesh or required prosthesis removal. There was a lower incidence rate of PSH with PPM placement in patients with permanent colostomy [adjusted hazard ratio (HR) 0.50 (95% confidence interval 0.28-0.89); p = 0.018]. In contrast, a higher incidence rate of PSH was observed in patients with ileostomy and PPM [adjusted HR 5.92 (95% confidence interval 1.07-32.65); p = 0.041].

CONCLUSION

Parastomal prophylactic mesh placement to prevent PSH is a safe and efficient approach to reduce the incidence of PSH in patients requiring a permanent colostomy. However, mesh may increase the rate of PSH after permanent ileostomy.

[Prophylaxis of parastomal, perineal and incisional hernias in colorectal surgery]

This article gives an overview of the relevant evidence from the literature on the topic of prophylactic use of meshes to prevent incisional and parastomal hernias in colorectal surgery. In addition, based on a structured literature search the incidence of hernias in colorectal surgery over the past 5 years was analyzed. A slight majority (54%) of articles recommended the use of prophylactic mesh implantation in colorectal surgery. The prophylactic use of meshes appears to reduce the risk of hernias in colorectal surgery but is associated with a slightly increased perioperative wound infection rate. Parastomal hernias are associated with higher incidence rates compared with incisional hernias and also appear to benefit more from prophylactic mesh implantation. The evidence in the literature is still unclear regarding the use of synthetic or biological implants due to the lack of randomized controlled trials. Perineal hernias were excluded from the analysis due to the incomparability of the mainly casuistic literature. An overview is given in the discussion. The analysis of the literature and also in reflection of our own experience comes to the conclusion that the disrupted integrity of the abdominal wall due to the operation should be prophylactically reinforced with a mesh after colorectal surgery. An evidence-based recommendation is not possible based on the current state of research on implantation techniques, e.g. onlay, sublay intraperitoneal onlay mesh (IPOM) and selection of the implant.

[The paraplegic patient-Characteristics of diagnostics and treatment in visceral surgery]

BACKGROUND

Patients with paraplegia develop syndrome-specific complications relevant to visceral surgery, which occur in the context of the acute spinal shock or as a consequence of the progressive neurogenic bowel dysfunction (NBD) with the formation of an elongated colon and/or megacolon. Moreover, acute abdominal emergencies, such as acute appendicitis, cholecystitis, diverticulitis and ileus images, pose particular challenges for the clinician when the clinical signs are atypical or even absent. The expansion of indications for obesity surgery to include patients with a paraplegic syndrome, whose independence and quality of life can be impaired due to the restricted mobility, especially by obesity, is becoming increasingly more important.

OBJECTIVE

This article provides an overview of the special requirements and aspects in the treatment of this special patient collective and to show the evidence of paraplegia-specific visceral surgery treatment.

MATERIAL AND METHODS

Targeted literature search in Medline and Cochrane library (German and English, 1985-2020).

RESULTS AND CONCLUSION

The clinical treatment of paraplegic patients requires in-depth knowledge of the pathophysiological changes at the different height of the paraplegia (upper versus lower motor neuron) and the phase of the disease (spinal shock versus long-term course). Missing or atypical clinical symptoms of acute diseases delay a quick diagnosis and make early diagnosis essential. The evidence for surgical treatment of the acute and chronic consequences of NBD is based on small retrospective series and case reports, as is that for special indications such as obesity surgery.

Implant-Associated Infections: A Review of the Safety of Cardiac Implants

Cardiac implantations are among the most critical, and life-saving patient management procedures. Most cardiac implantations are performed to correct abnormalities in the conduction and the rhythm of the heart. Because the implants are intended for long-term use ranging from months to years, the failure of an implant is considered a major setback both in the patients as well as surgeons' perspectives. Implant failures can have multifactorial reasons, amongst which infectious causes need to be adequately addressed. This review attempts to evaluate the nature of implants, etiology, predisposing factors, infection control, and preventive strategies for cardiac implant-associated infections.

Emergency laparoscopic treatment of complicated parastomal hernias

Parastomal hernia is not a rare event. Being by definition a complication of ostomy creation, a parastomal hernia also carries the risk of becoming symptomatic and complicated. At present, there are not enough solid data in literature to allow an evidence-based approach to this condition and to its possible complications, especially in the emergency setting. The aim of this paper is to describe through a narrative review of the literature the different surgical approaches concerning parastomal hernias. In order to exemplify the emergency complications we also present two cases in which the watchful waiting approach eventually led to the necessity of urgent surgical treatment, due to bowel incarceration into the parastomal hernia. We chose to tailor the surgical plan on the patient's anatomic and clinical condition, pursuing the laparoscopic approach with two different surgical technique (Sugarbaker and keyhole), each time estimated by the operating surgeon to be the more suitable option for the patient. We acknowledge that laparoscopy can be an optimal choice for the emergency and elective treatment of parastomal hernias, whenever an appropriate know-how is present.

Permanent end-colostomy parastomal hernia prevention using a novel three-dimensional mesh

PURPOSE

Prophylactic mesh placement has been proposed to reduce the high occurrence of parastomal hernia (PSH) after stoma formation.

METHODS

This is an observational study comparing two cohorts of patients: a mesh prophylaxis group (who received mesh prevention since introduction at our Institution) and a no mesh prophylaxis group (retrospectively selected from our historical series). Same exclusion criteria were applied for both groups. The study was conducted at a tertiary referral center for colorectal surgery. 43 patients were operated with mesh prophylaxis between May 2015 and may 2019. 45 patients underwent end-colostomy formation without prophylaxis between April 2011 and April 2015. The primary outcome measure was PSH development at 12-month follow up.

RESULTS

Demographic variables and risk factors for PSH were comparable between the two groups. There was no difference between the two cohorts in terms of operative time and main early postoperative outcomes. 37 patients completed the 12-month follow up in each group. PSH occurrence after 12-months was 11% in the mesh prophylaxis group and 54% in the no mesh prophylaxis group (p < 0.0001). There were no differences in long-term complications. 5% of patients who received mesh prophylaxis underwent emergency surgery for bowel occlusion at 7 and 10 months after surgery, with partial or complete mesh removal. At multivariate analysis, mesh prophylaxis was a protective factor for PSH development at 12 months (p < 0.0001).

CONCLUSIONS

Prophylactic intraperitoneal mesh placement appears to be effective in preventing PSH.

HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia

BACKGROUND

Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL).

METHODS

Subjects and sampleThere were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training.Study designThis is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed.InterventionA theoretically informed physical activity intervention was done, targeting people with PSH.Main outcome of feasibility studyThe main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention.Other outcomesWe will evaluate 4 intervention parameters-fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients' consent rate, acceptability of study design and data availability rates for following endpoints): I.Diagnosis and classification of PSHII.Muscle activationIII.Body composition (BMI, waist circumference)IV.Patient reported outcomes: QoL, body image and physical functioningV.Physical activity;VI.Psychological determinants of physical activityOther dataIncluded are other data such as interviews with all participants about the intervention and trial procedures.Data analysis and statistical powerAs this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically.

DISCUSSION

The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression.

TRIAL REGISTRATION

ISRCTN15207595.

Quality Assessment and Risk of Bias of Systematic Reviews of Prophylactic Mesh for Parastomal Hernia Prevention Using AMSTAR and ROBIS Tools

BACKGROUND

Systematic reviews play a crucial role in clinical decision making and resource allocation and are expected to be unbiased and consistent. The aim of this study is a review of systematic reviews on the use of prophylactic mesh to prevent parastomal hernia (PH) formation using ROBIS and AMSTAR tools to assess the risk of bias and methodological quality.

METHODS

We included systematic reviews with or without meta-analysis of which the objective was to assess the use of a prophylactic mesh to prevent PH. A systematic search of the literature in five databases from inception until December 2017 was conducted. For each systematic review, methodologic quality and risk of bias were assessed using the AMSTAR and ROBIS tools, respectively. We estimated the inter-rater reliability for individual domains and for the overall methodological quality and risk of bias using Fleiss' k.

RESULTS

We identified 14 systematic reviews that met the inclusion criteria. Using the AMSTAR scale with a cutoff value, six reviews showed high methodologic quality and eight were of low quality. Using the ROBIS tool, the overall risk of bias was low in 50% of the reviews analyzed. In the remaining studies, the risk of bias was unclear.

CONCLUSIONS

The global evidence in favor of the use of a prophylactic mesh for preventing PH is not uniform regarding quality and risk of bias. Surgeons cannot be equally confident in the results of all systematic reviews published on this topic.

Outcomes of surgically managed recurrent parastomal hernia: the Sisyphean challenge of the hernia world

PURPOSE

The management of a recurrent (symptomatic) parastomal hernia (PSH) presents a dilemma. The aim of this study was to review the outcome of patients who underwent a recurrent PSH repair.

METHODS

Retrospective review of consecutive patients undergoing recurrent PSH repairs at a single institution between 2010 and 2019. Primary outcome recorded was recurrence. Secondary outcomes recorded were 30-day post-operative complications, surgical site occurrence (SSO) incidence and to assess if EHS classification altered with each recurrence.

RESULTS

Thirty-eight patients underwent 59 recurrent PSH repairs during the study period. Median number of PSH repairs per patient from ostomy formation was 2 (2-8). Post-operative complications occurred following 52.5% of repairs. Recurrence rate for all recurrent PSH hernia repairs was 45.7%, with a median follow-up of 58 months (0-115). A trend was seen towards a shorter PSH recurrence-free survival in those who had at least two previous PSH repairs at the start of the study period when compared to those who had less. Recurrence was not associated with operative urgency, type of repair, mesh type or SSO occurrence. A significant decrease in recurrence was seen with retro-rectus mesh placement when compared to onlay (p = 0.003). EHS classification did not change between each recurrence in 70.8% of patients.

CONCLUSION

Recurrence rates after recurrent PSH repair are high. The recurrence-free survival was worse after the second or more attempt at repair for recurrence. Further studies are warranted to explore prophylaxis, optimal repair method, and where re-recurrence occurs, the benefit of repeated surgical intervention.

[Intestinal stomata]

An intestinal stoma (greek στὁμα, stoma: mouth, opening) is a surgically created opening of a gut section through the abdominal wall, which serves as an artificial intestinal exit for excretion of feces (synonym preternatural anus). A stoma of the gastrointestinal (GI) tract is often surgically created at the distal small intestine (ileostomy) and the colon (colostomy). Temporary or permanent deviation of fecal excretion may be required to treat various pathological conditions (e.g. congenital anomalies, ileus, inflammatory bowel diseases, posttraumatic, diverticulitis, colorectal malignancy). The creation of an end vs. a loop stoma is technically different. To achieve sufficient patient satisfaction close collaboration between surgeons, professional stoma care with guidance and training as well as support from self-help groups are required. In this way serious stoma-related complications can be avoided.

Current Management of Intestinal Stomas and Their Complications

Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the “principles of perioperative patient management” section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the “early complications” section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the “late complications” section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre- and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.