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Stoma creations are common procedures in surgical specialties. They can be created either as a temporary or a permanent measure. Despite advancements in surgical technique and stoma care, complications are common. Patients experiencing stoma-related complications often present to the emergency department. Emergency physicians are not expected to be stoma experts, yet they are often the first point of contact for patients experiencing stoma-related complications. Accordingly, emergency physicians should be familiar with the types of stomas and complications and emergencies associated with them so that they can appropriately address the problems related to stomas. This article will provide a review of emergencies and complications associated with ileostomies, colostomies, and urostomies.

Background The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding. Material and methods A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011–2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript. Conclusion Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.

Objection This study was conducted to examine the effect of self-efficacy levels on stoma adaptation in patients with intestinal stoma. Methods The study was planned as descriptive and analytical and was carried out in the university adult hospital general surgery stoma and wound care unit. Sixty-two patients with intestinal stoma who met the admission criteria were included in the study. Ethics committee approval, institutional permission and patient consent were obtained for the study. Data were collected from June to September 2021 using the Descriptive Feature Information Form, the Self Efficacy Scale for Individuals with Ostomy, and the Ostomy Adjustment Inventory (OAI-23). Data were analyzed by number, percentage, mean, standard deviation, Mann Whitney U, t test, ANOVA, Pearson’s correlation, and linear regression analysis tests. Results The mean age of the patients with intestinal stoma who participated in our study was 53.12 ± 12.30 years; 71% of them were women, 83.9% were married, and 32.2% were primary and secondary school graduates. The duration of stoma was 8.45 ± 4.69 months, 80.6% of them were opened due to cancer, and 54.8% of them had temporary colostomy. There was a weak and significant correlation between the duration of stoma of the patients and their self-efficacy and stoma adaptation, and as their self-efficacy levels increased, their stoma adaptation increased ( p < .05). Conclusions Self-efficacy is one of the important factors affecting patients’ adaptation with the stoma. For this reason, it is recommended to plan trainings to support the self-efficacy levels of patients and to conduct interventional studies in this direction.

Purpose Defunctioning stoma (DS) has been suggested to mitigate the consequences of anastomotic leak (AL) after low anterior resection. Stoma reversal (SR) is commonly delayed for nonmedical reasons in many healthcare systems. This study investigated the impact of the elapsed time from AR to SR on postoperative 90-day complications. The secondary aim was to explore the independent factors associated with a delayed SR. M&M This multicenter retrospective cohort study included rectal cancer patients who underwent anterior resection (AR) and DS between 2014 and 2018. Multivariable logistic regression was used to evaluate the influence of the elapsed time from AR to SR on postoperative complications within 90 days. Results Out of 905 patients subjected to AR with DS, 116 (18%) patients experienced at least one postoperative 90-day complication after SR. Multivariable analysis revealed an association between the elapsed time to SR and complications within 90 days from SR (OR 1.02; 95% CI, 1.00–1.04). The association with SR complications was further highlighted in patients who experienced delayed SR > 6 months after AR (OR 1.73; 95% CI, 1.04–2.86). AL after AR and nodal disease were both related to delayed SR. Conclusion This study demonstrated that postoperative 90-day complications are associated with the time elapsed to SR. These findings emphasize the importance of early SR, preferably within 6 months, to prevent complications.

PurposeThe published data on the outcomes of an operative repair for stoma prolapse are limited. This study aimed to clarify the long-term outcomes of stapler repair with anastomosis for stoma prolapse.MethodsTwenty-four patients (15 men, median age 64 years, range 33–88 years) undergoing 25 stapler repairs with anastomosis were prospectively registered, and their medical records were retrospectively reviewed.ResultsThe median length of prolapse was 10 cm (range 5–22). Stoma prolapse repair was performed by means of 16 loop colostomies, four end colostomies, three loop ileostomies, and one end ileostomy. A stapler was used 4.6 times on average (range 4–8). The average operative time and bleeding were 40.8 (range 15–75) min and 40 (range 0–214) mL, respectively. No mortality and morbidity were observed after surgery. A recurrence of stoma prolapse was reported in only one of 25 repairs (4%) at the proximal limb of loop ileostomy during a median follow-up period of 1 year (range 1–120 months). However, a new stoma prolapsed in one untreated limb of loop stoma.ConclusionsStapler repair with anastomosis is a safe and minimally invasive treatment option for stoma prolapse with a low recurrence. However, the effectiveness of reparing stoma prolapse on the proximal limb of loop ileostomy might be limited.

This study investigates the effects of topical solution of Scrophularia Striata in the healing process of peristomal skin wounds in patients attending the Stoma. One hundred participants from June 2023 to September 2023 were selected using convenience sampling and randomly assigned to two groups (experimental and control) in blocks using software. The experimental group was instructed to apply the topical solution of Scrophularia Striata once daily, saturating the ulcer area completely using an applicator on the peristomal skin, repeating this process every day for 14 consecutive days. The control group received the usual Stoma Center instructions (using chamomile ointment). The study compared the impact of topical solution of Scrophularia Striata on Ostomy Skin Tool to assess ulcer‐healing progress between the two groups. The analysis revealed that on the 21 days post‐intervention. The wound ulcer improvement in the experimental group was significantly greater than in the control group (p < 0.001). The results of the study indicate that the topical solution of Scrophularia Striata has been effective and more efficient in improving peristomal skin wounds compared to other routine treatments in these patients. Considering the impact of this solution on peristomal skin ulcer healing, its use is recommended.

PurposeEven though minor, stoma-related complications significantly impact quality of life, they are often excluded from clinical analyses that compare short-term postoperative outcomes of loop ileostomy and loop colostomy. This study compares stoma-related complications between loop ileostomy and loop colostomy after rectal resection, including minor complications, and discusses the characteristics of diverting stoma types.MethodsA retrospective review was conducted in patients who underwent diverting stoma construction after rectal resection. Data on patient background and postoperative short-term outcomes, including stoma-related complications and morbidity after stoma closure, were collected and compared between loop ileostomy and loop colostomy groups. Morbidities of all severity grades were targeted for analysis.ResultsA total of 47 patients (27 loop ileostomy, 20 loop colostomy) underwent diverting stoma construction following rectal resection. Overall stoma-related complications, incidence of skin irritation, high-output stoma, and outlet obstruction were significantly higher in the loop ileostomy group but high-output stoma and outlet obstruction were absent in the loop colostomy group. Regarding morbidity after stoma closure, operation times and surgical site infections were significantly higher in the loop colostomy group while anastomotic leakage after diverting stoma closure occurred (2 cases; 15%) in the loop colostomy group but not the loop ileostomy group.ConclusionBecause stoma-related complications were significantly higher in the loop ileostomy group, and even these minor complications may impair QOL, early loop ileostomy closure is recommended. For loop colostomy, stoma-related morbidities are lower but post-closure leakage is a calculated risk.

Background Stoma creation is an essential part of general surgery, used in procedures such as protective loop ileostomy formed during low rectal resection or coloanal anastomosis, and in Hartmann’s procedures, often performed in emergency settings. Despite its clinical importance, the optimal wound closure technique following stoma reversal remains controversial. This study aims to identify a more effective wound closure method following stoma takedown. Methods Between June 1, 2017, and January 31, 2020, we prospectively observed 75 patients at the University of Debrecen, Hungary, who underwent stoma closure (29 colostomies and 46 ileostomies). Among these patients, 37 underwent purse-string “Volcano” suture closure (VSC), while 38 underwent primary suture closure (PSC). We recorded demographic data, operative times, and postoperative outcomes, including wound infections. The primary endpoint was the rate of surgical site infection (SSI) in the short-term and the occurrence of postoperative hernia in the long-term period. Secondary endpoints included operative time, duration of wound dressing, and surgical complications according to the Clavien–Dindo classification. The planned follow-up period for long-term complications was 5 years. In this study, Surgical Site Infection (SSI) was defined and classified strictly according to the Centers for Disease Control and Prevention (CDC) Guideline for the Prevention of Surgical Site Infection (2017). Results No significant differences were observed between the VSC and PSC groups in age, sex, BMI, comorbidities, ASA classification, time from primary surgery to stoma closure, or length of hospital stay. However, the operative time was significantly shorter in the VSC group (59 min) compared to the PSC group (87 min; p  = 0.034). Notably, the incidence of postoperative wound infection was 0% in the VSC group and 18.4% in the PSC group respectively ( p  = 0.012). Conclusion Our prospective observational study demonstrates that the “Volcano” (purse-string) wound closure technique provides significant advantages over conventional primary closure, notably lowering surgical site infection rates and operative time. Based on these results, we recommend the Volcano technique for stoma reversal following both ileostomy and colostomy.

Purpose The aim of this study was to assess the effect of early stoma closure on bowel function after low anterior resection (LAR) for rectal cancer. Methods Patients participating in the FORCE trial who underwent LAR with protective stoma were included in this study. Patients were subdivided into an early closure group (< 3 months) and late closure group (> 3 months). Endpoints of this study were the Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and fecal incontinence quality of life (FIQL) scores at 1 year. Results Between 2017 and 2020, 38 patients had received a diverting stoma after LAR for rectal cancer and could be included. There was no significant difference in LARS (31 vs. 30, p  = 0.63) and Wexner score (6.2 vs. 5.8, p  = 0.77) between the early and late closure groups. Time to stoma closure in days was not a predictor for LARS ( R 2  = 0.001, F (1,36) = 0.049, p  = 0.83) or Wexner score ( R 2  = 0.008, F (1,36) = 0.287, p  = 0.60) after restored continuity. There was no significant difference between any of the FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29, body image scored higher in the late closure group (21.3 vs. 1.6, p  = 0.004). Conclusion Timing of stoma closure does not appear to affect long-term bowel function and quality of life, except for body image. To improve functional outcome, attention should be focused on other contributing factors.

Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the literature. A systematic review of randomised controlled trials reporting the incidence of stoma related complications in adults was performed to provide the most comprehensive summary of existing data. Methods PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library were searched for trials assessing the incidence of complications in adults undergoing conventional stoma formation. Data were extracted by two independent reviewers and entered into SPSS for statistical analysis. The Cochrane Collaboration tool for assessing risk of bias was used to critically appraise each study. Cochran's Q statistic and the I statistic were used to measure the level of heterogeneity between studies. Results Overall, 18 trials were included, involving 1,009 patients. The incidence of stoma related complications ranged from 2.9% to 81.1%. Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. There were no trials involving patients with end ileostomy. There was a high level of detection bias and heterogeneity between studies. Conclusions This systematic review has summarised the best available evidence concerning the incidence of stoma related morbidity. The high level of heterogeneity between studies has limited the accuracy with which the true incidence of each stoma related complication can be reported. Large, multicentre trials investigating homogenous participant populations are therefore required.