Indications and Outcome of Stomas in Patients with Intestinal Diseases

Introduction: Stomas provide fecal diversion in emergent and elective settings. There are several factors that should be considered when selecting which type of stoma should be created for a particular patient and condition. These include the indication for the stoma (fecal diversion, intestinal decompression), the site of intestinal pathology, available stoma sites, ease of caring for the stoma, and difficulty of subsequent stoma reversal. The aim of this study is to evaluate our clinical experience with stomas. Methods: The medical charts and computer-based data of all patients with stomas operated in our clinic between January 2008 and May 2016 were documented retrospectively. Demographics, indications for stoma placement, the type of stomas, stoma related complications, and the timing of stoma closure were recorded. Overall morbidities and the survival of patients were also evaluated. The mean follow-up period was 60 months (range 2-96). Results: A total of 204 patients (123 male and 81 female) were operated and the mean age was 54 (range, 18–92). Type of stomas created were jejunostomy (n= 14, 6.8 %), ileostomy (n=105, 51.4 %;), colostomy (n=81, 39.7 %), and ileostomy+colostomy (n=4, 1.9 %). The number of emergent conditions (n=119, 58.3 %) pulled ahead of the elective cases (n=85, 41.6%). The primary reason of ostomy placement was malignancies (n=140, 68.6%). While mostly preferred type of stoma for cancer surgery was colostomy and loop/end ileostomy (n=60, 74 %, n=90, 85.7 %, respectively); jejunostomy was seen to be obligatory for mesenteric ischemia (n=12, 85.7 %), exposing these patients to short bowel syndrome (n=10, 83 %). Overall complication rate was 14.7 % (n=30). Parastomal hernia, stenosis and necrosis were equally seen complications (n=9, 4.4 % each, respectively). Prolapsus was seen in only 3 patients (1.4 %). The average time for closure was 280 days (range 14-1436). In over 1/3 of patients (n=79, 38.7%); the ostomies could not be closed due to ongoing chemo/radiotherapy (n=32, 40 %), Miles operation (n=24, 30 %), failed intestinal function due to short bowel syndrome (n=9, 11 %), early mortality (n=8, 10 %), and other reasons (n=6, 7 %). The mortality was seen mostly in jejunostomy-created patients (n=7, 50 %). Conclusion: Colorectal carcinomas and short bowel syndrome are the main reasons for permanent stomas. Even in attentive surgical approach in creation of stomas, complication rates and morbidity are relatively high. References: 1. Strong SA. The Difficult Stoma: Challenges and Strategies. Clin Colon Rectal Surg. 2016;29:152–9. 2. Öistämö E, Hjern F, Blomqvist L, Falkén Y, Pekkari K, Abraham-Nordling M. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol. 2016;14(1):232.