The “Cone” stoma: stoma creation in the presence of significant bowel dilatation

Excerpt

The creation of either an ileostomy or colostomy is usually perceived as a quick routine “act”; however, considering the potential impact on the patient’s outcome and quality of life, it deserves the utmost attention to detail, particularly if the stoma will be permanent [1]. Stoma-related complications range from 20 to 70%, and span a great variety of problems [2]. Parastomal hernias occur in up 50% of patients with variable incidence according to stoma type and configuration; 1.8–28.3% and 0–6.2% for end and loop ileostomies, and 4–48% and 0–30.8% for end and loop colostomies, respectively [3, 4]. Stoma prolapse, defined as a full-thickness protrusion of bowel through the stoma, occurs in 2–11% of ileostomies and 2% of colostomies [2]. These are usually both considered late complications, and are associated with older age, obesity, surgical technique, and bowel obstruction. Stoma ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess are considered the early complications, and good surgical technique plays a critical role in preventing them. The formation of a “good” stoma is more complex in case of acute bowel obstruction or chronically distended bowel. The dilated bowel requires a large opening in the abdominal wall and results in a wide skin defect and a large mucocutaneous circumference. For any pouching system to fit, a large central opening needs to be cut which reduces the surface for skin adhesion of the pouch baseplate, which inevitably will cause the leaks of stoma content and skin irritation (Fig. 1). …