Ileostomies and colostomies

Abstract Ileostomies and colostomies are surgically created openings of the bowel on the anterior abdominal wall ( stoma is the Greek word for ‘mouth’). They are needed both in emergency and elective bowel surgery and can be temporary or permanent. They are used in the management of bowel cancer, inflammatory bowel disease, following major trauma and more rarely, in functional bowel disorders. In simple terms all that is required is to bring a loop or end of bowel to the skin surface and suture it there. Loop stomas are sometimes described as defunctioning stomas because they serve temporarily to divert the faecal stream. End stomas are more often permanent in nature. Stomas are usually fashioned at an open or a laparoscopic operation, but can be formed through just the stomal opening (trephine colostomies and ileostomies). The rate of complications following stoma surgery can be high, both in the immediate postoperative period and in subsequent years. Some complications relate to difficulties in other parts of the operation, such as bowel mobilization and vascular division. Others relate to technical issues in the construction of the stoma, such as fixation of the mesentery in ileostomy formation or use of polypropylene mesh to reduce the incidence of parastomal herniation.