Clin Colon Rectal Surg 2017; 30(03): 193-200
DOI: 10.1055/s-0037-1598160
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Stoma Complications

Devi Mukkai Krishnamurty
1   Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
,
Jeffrey Blatnik
2   Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
,
Matthew Mutch
1   Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
22 May 2017 (online)

Abstract

When 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 associated with stoma creation conveying high rates of both early and late-term complications. Early complications include stomal ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess. Late complications include parastomal hernia, prolapse, retraction, and varices. This review will discuss commonly occurring nondermatological stoma complications and detail management strategies for the ostomate and the surgeon.

 
  • References

  • 1 The Ostomy Files: Ostomy Statistics: The $64,000 Question. Available at http://www.o-wm.com/content/ostomy-statistics-the-64000-question . Accessed February 2, 2016
  • 2 Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12 (10) 958-964
  • 3 Formijne Jonkers HA, Draaisma WA, Roskott AM, van Overbeeke AJ, Broeders IA, Consten EC. Early complications after stoma formation: a prospective cohort study in 100 patients with 1-year follow-up. Int J Colorectal Dis 2012; 27 (08) 1095-1099
  • 4 Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005; 87 (06) 427-431
  • 5 Bafford AC, Irani JL. Management and complications of stomas. Surg Clin North Am 2013; 93 (01) 145-166
  • 6 Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 2007; 9 (09) 834-838
  • 7 Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP. ; Greater Manchester and Cheshire Colorectal Cancer Network. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Colorectal Dis 2011; 13 (08) 935-938
  • 8 Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg 2003; 90 (07) 784-793
  • 9 Hansson BM, Slater NJ, van der Velden AS. , et al. Surgical techniques for parastomal hernia repair: a systematic review of the literature. Ann Surg 2012; 255 (04) 685-695
  • 10 Rubin MS, Schoetz Jr DJ, Matthews JB. Parastomal hernia. Is stoma relocation superior to fascial repair?. Arch Surg 1994; 129 (04) 413-418 , discussion 418–419
  • 11 Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications following colostomy. Dis Colon Rectum 1994; 37 (09) 916-920
  • 12 Kald A, Juul KN, Hjortsvang H, Sjödahl RI. Quality of life is impaired in patients with peristomal bulging of a sigmoid colostomy. Scand J Gastroenterol 2008; 43 (05) 627-633
  • 13 Ripoche J, Basurko C, Fabbro-Perray P, Prudhomme M. Parastomal hernia. A study of the French federation of ostomy patients. J Visc Surg 2011; 148 (06) e435-e441
  • 14 Etherington RJ, Williams JG, Hayward MW, Hughes LE. Demonstration of para-ileostomy herniation using computed tomography. Clin Radiol 1990; 41 (05) 333-336
  • 15 Ortiz H, Sara MJ, Armendariz P, de Miguel M, Marti J, Chocarro C. Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall?. Int J Colorectal Dis 1994; 9 (02) 65-67
  • 16 Sjödahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma. Br J Surg 1988; 75 (04) 339-341
  • 17 Goligher JC. Extraperitoneal colostomy or ileostomy. Br J Surg 1958; 46 (196) 97-103
  • 18 Lian L, Wu XR, He XS. , et al. Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis 2012; 27 (01) 59-64
  • 19 Whittaker M, Goligher JC. A comparison of the results of extraperitoneal and intraperitoneal techniques for construction of terminal iliac colostomies. Dis Colon Rectum 1976; 19 (04) 342-344
  • 20 Koltun L, Benyamin N, Sayfan J. Abdominal stoma fashioned by a used circular stapler. Dig Surg 2000; 17 (02) 118-119
  • 21 Christakis C, Chatzidimitrou C, Kontos N, Papadopoulou S, Karanikas M. Use of intraluminal stapler device for creation of a permanent colostomy. Tech Coloproctol 2004; 8 (Suppl. 01) s93-s96
  • 22 Resnick S. New method of bowel stoma formation. Am J Surg 1986; 152 (05) 545-548
  • 23 Jänes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a 5-year follow-up of a randomized study. World J Surg 2009; 33 (01) 118-121 , discussion 122–123
  • 24 Moisidis E, Curiskis JI, Brooke-Cowden GL. Improving the reinforcement of parastomal tissues with Marlex mesh: laboratory study identifying solutions to stomal aperture distortion. Dis Colon Rectum 2000; 43 (01) 55-60
  • 25 Rosin JD, Bonardi RA. Paracolostomy hernia repair with Marlex mesh: a new technique. Dis Colon Rectum 1977; 20 (04) 299-302
  • 26 Brandsma HT, Hansson BM, Aufenacker TJ. , et al. Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia 2016; 20 (04) 535-541
  • 27 Jänes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg 2004; 91 (03) 280-282
  • 28 López-Cano M, Lozoya-Trujillo R, Quiroga S. , et al. Use of a prosthetic mesh to prevent parastomal hernia during laparoscopic abdominoperineal resection: a randomized controlled trial. Hernia 2012; 16 (06) 661-667
  • 29 Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J. , et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 2009; 249 (04) 583-587
  • 30 Fleshman JW, Beck DE, Hyman N, Wexner SD, Bauer J, George V. ; PRISM Study Group. A prospective, multicenter, randomized, controlled study of non-cross-linked porcine acellular dermal matrix fascial sublay for parastomal reinforcement in patients undergoing surgery for permanent abdominal wall ostomies. Dis Colon Rectum 2014; 57 (05) 623-631
  • 31 Hammond TM, Huang A, Prosser K, Frye JN, Williams NS. Parastomal hernia prevention using a novel collagen implant: a randomised controlled phase 1 study. Hernia 2008; 12 (05) 475-481
  • 32 Wijeyekoon SP, Gurusamy K, El-Gendy K, Chan CL. Prevention of parastomal herniation with biologic/composite prosthetic mesh: a systematic review and meta-analysis of randomized controlled trials. J Am Coll Surg 2010; 211 (05) 637-645
  • 33 Figel NA, Rostas JW, Ellis CN. Outcomes using a bioprosthetic mesh at the time of permanent stoma creation in preventing a parastomal hernia: a value analysis. Am J Surg 2012; 203 (03) 323-326 , discussion 326
  • 34 Allen-Mersh TG, Thomson JP. Surgical treatment of colostomy complications. Br J Surg 1988; 75 (05) 416-418
  • 35 Cheung MT, Chia NH, Chiu WY. Surgical treatment of parastomal hernia complicating sigmoid colostomies. Dis Colon Rectum 2001; 44 (02) 266-270
  • 36 Fernández Lobato R, Martínez Santos C, Ortega Deballon P, Fradejas López JM, Marín Lucas FJ, Moreno Azcoita M. Colocutaneous fistula due to polypropylene mesh. Hernia 2001; 5 (02) 107-109
  • 37 Steele SR, Lee P, Martin MJ, Mullenix PS, Sullivan ES. Is parastomal hernia repair with polypropylene mesh safe?. Am J Surg 2003; 185 (05) 436-440
  • 38 Slater NJ, Hansson BM, Buyne OR, Hendriks T, Bleichrodt RP. Repair of parastomal hernias with biologic grafts: a systematic review. J Gastrointest Surg 2011; 15 (07) 1252-1258
  • 39 Hotouras A, Murphy J, Thaha M, Chan CL. The persistent challenge of parastomal herniation: a review of the literature and future developments. Colorectal Dis 2013; 15 (05) e202-e214
  • 40 Warwick AM, Velineni R, Smart NJ, Daniels IR. Onlay parastomal hernia repair with cross-linked porcine dermal collagen biologic mesh: long-term results. Hernia 2016; 20 (02) 321-325
  • 41 Aldridge AJ, Simson JN. Erosion and perforation of colon by synthetic mesh in a recurrent paracolostomy hernia. Hernia 2001; 5 (02) 110-112
  • 42 Kasperk R, Klinge U, Schumpelick V. The repair of large parastomal hernias using a midline approach and a prosthetic mesh in the sublay position. Am J Surg 2000; 179 (03) 186-188
  • 43 Raigani S, Criss CN, Petro CC, Prabhu AS, Novitsky YW, Rosen MJ. Single-center experience with parastomal hernia repair using retromuscular mesh placement. J Gastrointest Surg 2014; 18 (09) 1673-1677
  • 44 Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann Surg 1985; 201 (03) 344-346
  • 45 Shah NR, Craft RO, Harold KL. Parastomal hernia repair. Surg Clin North Am 2013; 93 (05) 1185-1198
  • 46 Virzí G, Scaravilli F, Ragazzi S, Piazza D. Laparoscopic paracolostomy hernia mesh repair. Surg Laparosc Endosc Percutan Tech 2007; 17 (06) 548-550
  • 47 Fleshman JL, Lewis MG. Complications and quality of life after stoma surgery: a review of 16,470 patients in the UOA data registry. Semin Colon Rectal Surg 2007; 18 (01) 19-24
  • 48 Park JJ, Del Pino A, Orsay CP. , et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 1999; 42 (12) 1575-1580
  • 49 Maeda K, Maruta M, Utsumi T. , et al. Local correction of a transverse loop colostomy prolapse by means of a stapler device. Tech Coloproctol 2004; 8 (01) 45-46
  • 50 Tepetes K, Spyridakis M, Hatzitheofilou C. Local treatment of a loop colostomy prolapse with a linear stapler. Tech Coloproctol 2005; 9 (02) 156-158
  • 51 Masumori K, Maeda K, Koide Y. , et al. Simple excision and closure of a distal limb of loop colostomy prolapse by stapler device. Tech Coloproctol 2012; 16 (02) 143-145
  • 52 Pennick MO, Artioukh DY. Management of parastomal varices: who re-bleeds and who does not? A systematic review of the literature. Tech Coloproctol 2013; 17 (02) 163-170
  • 53 Nayar M, Saravanan R, Rowlands PC. , et al. TIPSS in the treatment of ectopic variceal bleeding. Hepatogastroenterology 2006; 53 (70) 584-587
  • 54 Saad WE, Saad NE, Koizumi J. Stomal varices: management with decompression tips and transvenous obliteration or sclerosis. Tech Vasc Interv Radiol 2013; 16 (02) 176-184
  • 55 Vangeli M, Patch D, Terreni N. , et al. Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt (TIPS) and embolisation. J Hepatol 2004; 41 (04) 560-566
  • 56 Cairns BA, Herbst CA, Sartor BR, Briggaman RA, Koruda MJ. Peristomal pyoderma gangrenosum and inflammatory bowel disease. Arch Surg 1994; 129 (07) 769-772
  • 57 Funayama Y, Kumagai E, Takahashi K, Fukushima K, Sasaki I. Early diagnosis and early corticosteroid administration improves healing of peristomal pyoderma gangrenosum in inflammatory bowel disease. Dis Colon Rectum 2009; 52 (02) 311-314
  • 58 Kiran RP, O'Brien-Ermlich B, Achkar JP, Fazio VW, Delaney CP. Management of peristomal pyoderma gangrenosum. Dis Colon Rectum 2005; 48 (07) 1397-1403