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Diverting Ostomy: For Whom, When, What, Where, and Why
Alexis Plasencia1, Heidi Bahna2,3
1Jackson Memorial Hospital, University of Miami, Miami, Florida.
Clinics in Colon and Rectal Surgery
|May 8, 2019
Summary
This review highlights the critical role of fecal diversion in surgery. It recommends loop ileostomy over loop colostomy and outlines key indications for diverting stomas in various colorectal conditions.
Area of Science:
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Fecal diversion is a crucial surgical technique.
- Clinical indications for diversion remain debated.
- Recent literature provides guidance on ostomy use.
Purpose of the Study:
- To analyze current literature on fecal diversion.
- To discuss common applications of diverting stomas.
- To clarify controversies in ostomy usage.
Main Methods:
- Systematic review of recent surgical literature.
- Analysis of clinical scenarios requiring fecal diversion.
- Discussion of ostomy use in specific patient groups.
Main Results:
- Loop ileostomy is preferred over loop colostomy.
- Ostomy is recommended for pelvic anastomoses <5-6 cm.
- Diversion is frequently needed for severe perianal Crohn's disease.
- Primary anastomosis with diverting ileostomy is safe for diverticular perforation.
- Diverting stomas can facilitate primary resection in obstructing cancers.
Conclusions:
- Diverting stomas are essential in specific colorectal surgical scenarios.
- Evidence supports loop ileostomy preference and use in low anastomoses.
- Fecal diversion offers safe and effective management options for complex conditions.
