[Gastrointestinal surgery and gastroenterology. XI. Stomas and stoma surgery]

Stomas are an essential part of gastrointestinal surgery. Indications for stoma construction are faecal diversion from a distal diseased bowel segment, prevention of an intestinal anastomosis in intra-abdominal sepsis, and faecal incontinence. Pre- and postoperative counselling and nursing care is essential for a good functional outcome. Following stoma construction, complications such as dermatitis, retraction, prolapse, stenosis and parastomal hernia occur in 30-60% of cases. Thirty percent of stomas need surgical re-intervention in the first 10 years. For diversion of a distal anastomosis, construction of a loop-ileostomy is preferred to a loop-colostomy. Closure of a temporary stoma should not be done within eight weeks of construction. Preoperative evaluation of the distal segment is mandatory. Stoma closure involves an intra-abdominal anastomosis with all its associated complications. The incidence of complications after stoma closure is about 10%.