Preventing Stoma-Related Complications: Techniques for Optimal Stoma Creation

Ostomy construction is an important step in the course of a bowel resection or anastomosis, or as a primary procedure to divert the fecal stream or alleviate obstruction. The basic tenets of proper ostomy construction are shared with basics laws of surgery: selection of an appropriate patient and procedure, preoperative optimization, use of proper technique, avoidance of tension, and proper location. These factors are uniform for the vast majority of ostomies, with accommodations made for specific circumstances, such as morbid obesity, critical illness, or preexisting incontinence. Both the open and laparoscopic approaches remain the workhorses for ostomy construction, with a continued push for the development and refinement of novel methods for more minimally invasive diversion. While it is tempting to relax from the customary strict attention to detail during the creation of a temporary diverting ostomy, it is important to note that a significant number will become permanent. Any potentially avoidable complication may translate into years of agony for both the patient and the surgeon attending to the postoperative care.