Intestinal Stomas

  • Laurence R. Sands
  • Floriano Marchetti


Intestinal stomas have long been used by surgeons for fecal diversion and remain an important tool for both the general and colon and rectal surgeon. They are considered a vital ­element as either a permanent means for stool evacuation or as a temporary bridge in order to treat complicated abdominal problems or to heal more distal anastomoses. The surgeon must always regard fecal diversion as a means to salvage patients from abdominal catastrophy and should never consider stoma creation as a defeat even though many patients may regard it as such.



This chapter was written by Bruce Orkin, Peter Cataldo, Neil Hyman, and Richard Nelson, in two ­separate chapters in the previous version of this textbook.


  1. 1.
    Bryant TA. Case excision of a stricture of the descending colon through an incision made for a left lumbar colostomy: with remarks. Proc R Med Chir Soc. 1882;9:149–53.Google Scholar
  2. 2.
    Cheselden W. Colostomy for strangulated umbilical hernia. In Anatomy of the Human Body. 5th ed. London: ­William ­Bowyer; 1740.Google Scholar
  3. 3.
    Brown JY. The value of complete physiologic rest of the large bowel in the treatment of certain ulcerative and obstructive lesions of this organ. Surg Gynecol Obstet. 1913;16:610–3.Google Scholar
  4. 4.
    Miller GG, Gardner CMcG, Ripstein CB. Primary resection of the colon in UC. Can Med Assoc J. 1949;60:584–5.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Brooke BN. The management of an ileostomy including its complications. Lancet. 1952;2:102–4.PubMedGoogle Scholar
  6. 6.
    Hawley PR, Ritchie JK. Complications of ileostomy and colostomy following excisional surgery. Clin Gastroenterol. 1979;8:403–14.PubMedGoogle Scholar
  7. 7.
    Grogan JE, Smith MC. The economic cost of UC: a national estimate for 1968. Inquiry. 1973;10:61–8.PubMedGoogle Scholar
  8. 8.
    Paranby CN, Jenkins JT, Weston V, et al. Defunctioning stomas in patients with locally advanced rectal cancer prior to preoperative chemoradiotherapy. Colorectal Dis. 2009;11(1):26–31.Google Scholar
  9. 9.
    Rowbatham J. Stomal care. New Eng J Med. 1981;279:90–2.Google Scholar
  10. 10.
    Fazio VW. Invited commentary: loop ileostomy. World J Surg. 1984;8:405–7.Google Scholar
  11. 11.
    Edwards DP, Leppington-Clarke A, Sexton R, et al. Stoma-related complications are more frequent after transverse colostomy than loop ilesotomy: a prospective randomized clinical trial. Br J Surg. 2001;88(3):360–3.PubMedGoogle Scholar
  12. 12.
    Gazzard BG, Saunders B, Dawson AM. Diets and stoma function. Br J Surg. 1978;65(9):642–4.PubMedGoogle Scholar
  13. 13.
    Hill GL. Physiology of conventional ileostomy. In: Dozois RR, editor. Alternatives to conventional ileostomy. Chicago: Yearbook Medical Publishers; 1985. p. 31–5.Google Scholar
  14. 14.
    Turnbull Jr RB. Intestinal stomas. Surg Clin North Am. 1958;38:1361.PubMedGoogle Scholar
  15. 15.
    Crawford N, Broooke BN. Ileostomy chemistry. Lancet. 1957;1:864–7.Google Scholar
  16. 16.
    Smiddy FG, Gregory SD, Smith IB, et al. Faecal loss of fluid, electrolytes and nitrogen in colitis before and after ileostomy. Lancet. 1960;1:14–9.PubMedGoogle Scholar
  17. 17.
    Kramer P, Kearney MM, Ingelfinger FJ. The effect of specific foods and water loading on the ileal excreta of ileostomized human subjects. Gastroenterology. 1962;42:535–46.PubMedGoogle Scholar
  18. 18.
    Kanaghinis T, Lubran M, Coghill NF. The composition of ileostomy fluid. Gut. 1963;4:322.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hill GL, Millward SF, King RFGJ. Normal ileostomy output: close relation to body size. Br Med J. 1979;2:831–2.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Soper NJ, Orkin BA, Kelly KA, et al. Gastrointestinal transit after proctocolectomy with ileal pouch-anal anastomosis or ileostomy. J Surg Res. 1989;46:300.PubMedGoogle Scholar
  21. 21.
    Robertson MD, Mathers JC. Gastric emptying rate of solids is reduced in a group of ileostomy patients. Dig Dis Sci. 2000;45(7):1285–92.PubMedGoogle Scholar
  22. 22.
    Newton CR. Effect of codeine phosphate, Lomotil and Isogel on ileostomy function. Gut. 1978;19:377–83.PubMedPubMedCentralGoogle Scholar
  23. 23.
    King RFGJ, Norton T, Hill GL. A double-blind cross-over study or the effect of loperimide hydrochloride and codeine phosphate on ileostomy output. Aust NZ J Surg. 1982;52(2):121–4.Google Scholar
  24. 24.
    Gallagher ND, Harrison DD, Skyring AP. Fluid and electrolyte disturbances in patients with long established ileostomies. Gut. 1962;3:219–23.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Bambach CP, Robertson WG, Peacock M, et al. Effect of intestinal surgery on the risk of urinary stone formation. Gut. 1981;22:257–63.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Clarke AM, Chirnside A, Hill GL, et al. Chronic dehydration and salt depletion in patients with established ileostomies. Lancet. 1967;2:740–3.PubMedGoogle Scholar
  27. 27.
    Hill GL, Goligher JC, Smith AH, et al. Long term changes in total body water, total exchangeable sodium and total body potassium before and after ileostomy. Br J Surg. 1975;62:524–7.PubMedGoogle Scholar
  28. 28.
    Cooper JC, Laughland A, Gunning EJ, Burkinshaw L, Williams NS. Body composition in ileostomy patients with and without ileal resection. Gut. 1986;27(6):680–5.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Holgate AM, Read NW. Relationship between small bowel transit time and absorption of a solid meal: influence of metachlopromide, magnesium sulfate, and lactulose. Dig Dis Sci. 1983;28:812.PubMedGoogle Scholar
  30. 30.
    Vince A, O’Grady F, Dawson AM. The development of ileostomy flora. J Infect Dis. 1971;128:638–41.Google Scholar
  31. 31.
    Finegold SM, Sutter VL, Boyle JD, Shimada K. The normal flora of ileostomy and transverse colostomy effluents. J Infect Dis. 1970;122(5):376–81.PubMedGoogle Scholar
  32. 32.
    Gorbach SL, Nahas L, Wenstein L. Studies of intestinal microflora: IV. The microflora of ileostomy effluent: a unique microbial ecology. Gastroent. 1967;53:874–80.Google Scholar
  33. 33.
    Percy-Robb IW, Jalan KN, McManus JP, et al. Effect of ileal resection on the bile salt metabolism in patients with ileostomy following proctocolectomy. Clin Sci. 1971;41:371–82.PubMedGoogle Scholar
  34. 34.
    Gorbach SL, Tabaqchali S. Bacteria, bile and the small bowel. Gut. 1969;10:963–72.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Hulten L, Kewenter J, Persson E, et al. Vitamin B12 absorption in ileostomy patients after operation for ulcerative colitis. Scan J Gastroent. 1970;5:113–5.Google Scholar
  36. 36.
    Dotevall G, Kock NG. Absorption studies in regional enteritis. Scan J Gastroent. 1968;3:293–8.Google Scholar
  37. 37.
    Modlin M. Urinary calculi and ulcerative colitis. Br Med J. 1972;3(821):292.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Fukushima T, Sugita A, Masuzawa S, Yamazaki Y, Takemura H, Tsuchiya S. Prevention of uric acid stone formation by sodiumbicarbonate in an ileostomy patient: a case report. Jap J Surg. 1988;18:465–8.Google Scholar
  39. 39.
    Christl SU, Scheppach W. Metabolic consequences of total colectomy. Scand J Gastroenterol Suppl. 1997;222:20–4.PubMedGoogle Scholar
  40. 40.
    Raza SD, Portin BA, Bernhoft WH. Umbilical colostomy: a better intestinal stoma. Dis Colon Rectum. 1977;20(3):223–30.PubMedGoogle Scholar
  41. 41.
    Fitzgerald PG, Lau GY, Cameron GS. Use of the umbilical site for temporary ostomy: review of 47 cases. J Pediatr Surg. 1989;24(10):973.PubMedGoogle Scholar
  42. 42.
    Simmons KL, Smith JA, Bobb KA, et al. Adjustment to colostomy; stoma acceptance, stoma care self efficacy and interpersonal relationships. J Adv Nurs. 2007;60(6):627–35.PubMedGoogle Scholar
  43. 43.
    Chaudhri S, Brown L, Hassan I, et al. Preoperative intensive, community-based vs. traditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48(3):504–9.PubMedGoogle Scholar
  44. 44.
    Bloemen JG, Visschers RG, Truin RGJ, et al. Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum. 2009;52(7):1251–8.PubMedGoogle Scholar
  45. 45.
    Ross L, Abild-Nielsen AG, Thomsen BL, et al. Quality of life of Danish colorectal cancer patients with and without a stoma. Support Care Cancer. 2007;15(5):505–13.PubMedGoogle Scholar
  46. 46.
    Silva MA, Ratnayake G, Deen KI. Quality of life of stoma patients: temporary ileostomy versus colostomy. World J Surg. 2003;27(4):421–4.PubMedGoogle Scholar
  47. 47.
    Siassi M, Hohenberger W, Losel F, et al. Quality of life and patient’s expectations after closure of a temporary stoma. Int J Colorectal Dis. 2008;23(12):1207–12.PubMedGoogle Scholar
  48. 48.
    Goligher JC. Extraperitoneal colostomy or ileostomy. Br J Surg. 1958;46:97–103.PubMedGoogle Scholar
  49. 49.
    Hellinger M, Martinez S, Parra-Davilla E, et al. Gasless laparoscopic assisted intestinal stoma creation through a single incision. Dis Colon Rectum. 1999;42(7):1228–31.PubMedGoogle Scholar
  50. 50.
    Sakai T, Yamshita Y, Maekawa T, et al. Techniques for determining the ideal stoma site in laparoscopic colostomy. Int Surg. 1999;84(3):239–40.PubMedGoogle Scholar
  51. 51.
    Scheidbach H, Ptok H, Schubert D, et al. Palliatve stoma creation: comparison of laparoscopic vs. conventional procedures. Lagenbecks Arch Surg. 2009;394(2):371–4.Google Scholar
  52. 52.
    Oliveira L, Reissman P, Nogueras JJ, et al. Laparoscopic creation of stomas. Surg Endosc. 1997;11:19–23.PubMedGoogle Scholar
  53. 53.
    Liu J, Bruch HP, Farke S, et al. Stoma formation for fecal diversion: a plea for the laparoscopic approach. Tech Coloproctol. 2005;9(1):9–14.PubMedGoogle Scholar
  54. 54.
    Fazio VW. Loop ileostoym and loop-end ileostomy. In: Dudley H, Pories W, Carter D, editors. Rob and Smiths operative surgery. 4th ed. London: Butterworth; 1983. p. 54–64.Google Scholar
  55. 55.
    Meagher AP, Owen G, Gett R. Multimedia article. An improved technique for end stoma creation in obese patients. Dis Colon Rectum. 2009;52(3):531–3.PubMedGoogle Scholar
  56. 56.
    Huser N, Michalski CW, Erkan M, et al. Systemic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248(1):52–60.PubMedGoogle Scholar
  57. 57.
    Pappalardo G, Spoletini D, Proposito D, et al. Protective stoma in anterior resection of the rectum: when, how, and why? Surg Oncol. 2007;16 Suppl 1:S105–8.PubMedGoogle Scholar
  58. 58.
    Lefebure B, Tuech JJ, Bridoux V, et al. Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer. Int J Colorectal Dis. 2008;23(3):283–8.PubMedGoogle Scholar
  59. 59.
    Kong AP, Kim J, Holt A, et al. Selective treatment of rectal cancer with single- stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality. Int J Colorectal Dis. 2007;22(8):897–901.PubMedGoogle Scholar
  60. 60.
    Gastinger I, Marusch F, Steinart R, et al. Protective ­defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92(9):1137–42.PubMedGoogle Scholar
  61. 61.
    Vlot EA, Zeebregts CJ, Gerritsen JJ, et al. Anterior resection of rectal cancer without bowel preparation and diverting stoma. Surg Today. 2005;35(8):629–33.PubMedGoogle Scholar
  62. 62.
    Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis. 2008;10(8):785–8.PubMedGoogle Scholar
  63. 63.
    Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96(5):462–72.PubMedGoogle Scholar
  64. 64.
    Ulrich AB, Seiler C, Rahbari N, et al. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52(3):412–8.PubMedGoogle Scholar
  65. 65.
    Park JJ, del Pino A, Orsay CP, Nelson RL, et al. Stoma complications. Dis Colon Rectum. 1999;42:1575–80.PubMedGoogle Scholar
  66. 66.
    Cartmell MT, Jones OM, Moran BJ, et al. A defunctioning stoma significantly prolongs the length of stay in laparoscopic colon resections. Surg Endosc. 2008;22(12):2643–7.PubMedGoogle Scholar
  67. 67.
    Caricato M, Ausania F, Ripetti V, et al. Retrospective analysis of long term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007;9(6):559–61.PubMedGoogle Scholar
  68. 68.
    Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients. Dis Colon Rectum. 1999;42:1569–74.PubMedGoogle Scholar
  69. 69.
    Pilgrim CH, McIntyre R, Bailey M. Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum. 2010;53(1):71–6.PubMedGoogle Scholar
  70. 70.
    Vijayasekar C, Marimuthu K, Jadhav V, et al. Parastomal hernia: is prevention better than cure? Use of a polypropylene mesh at the time of stoma formation. Tech Coloproctol. 2008;12(4):309–13.PubMedGoogle Scholar
  71. 71.
    Janes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to prevent parastomal hernia. Br J Surg. 2004;91:280–2.PubMedGoogle Scholar
  72. 72.
    Guzman-Valdivia G. Incisional hernia at the site of a stoma. Hernia. 2008;12(5):471–4.PubMedGoogle Scholar
  73. 73.
    De Raet J, Delvaux G, Haentjens P, et al. Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum. 2008;51(12):106–9.Google Scholar
  74. 74.
    Pastor DM, Pauli EM, Koltun WA, et al. Parastomal hernia repair: a single center experience. JSLS. 2009;13(2):170–5.PubMedPubMedCentralGoogle Scholar
  75. 75.
    Tang CL, Yunos A, Leong AP, et al. Ileostomy output in the early postoperative period. Br J Surg. 1995;82:607.PubMedGoogle Scholar
  76. 76.
    Cooper JC, Williams NS, King RFGJ, et al. Effects of a long-acting somatostatin analogue in patients with severe ileostomy diarrhea. Br J Surg. 1986;73:128–31.PubMedGoogle Scholar
  77. 77.
    Maratka Z, Nedbal J. Urolithiasis as a complication of the surgical treatment of UC. Gut. 1964;5:214–7.PubMedPubMedCentralGoogle Scholar
  78. 78.
    Kennedy HJ, Lee EGS, Claridge G, et al. Urinary stones in subjects with a permanent ileostomy. Q J Med. 1982;203:341–57.Google Scholar
  79. 79.
    Darren JJ, Parish JG, Lewitt MF, et al. Nephrolithiasis as a complication of UC and regional enteritis. Ann Intern Med. 1962;56:843–53.Google Scholar
  80. 80.
    Prien EL, Prien Jr EL. Composition and structure of urinary stones. Am J Med. 1968;45:654–72.PubMedGoogle Scholar
  81. 81.
    Christie PM, Knight GS, Hill GL. Comparison of relative risks of urinary stone formation after surgery for ulcerative colitis: conventional ileostomy vs. J-pouch. A comparative study. Dis Colon Rectum. 1996;39:50–4.PubMedGoogle Scholar
  82. 82.
    Christie PM, Knight GS, Hill GL. Metabolism of body water and electrolytes after surgery for ulcerative colitis conventional ileostomy versus J-pouch. Br J Surg. 1990;77:149–51.PubMedGoogle Scholar
  83. 83.
    Cohen S, Kaplan M, Gottlieb C, et al. Liver disease and gall-stones in regional enteritis. Gastroenterology. 1971;60:237–45.PubMedGoogle Scholar
  84. 84.
    Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998;41:1562–72.PubMedGoogle Scholar
  85. 85.
    Maeda K, Maruta M, Utsumi T, et al. Pathophysiology and prevention of loop stomal prolapse in the transverse colon. Tech Coloproctol. 2003;7(2):108–11.PubMedGoogle Scholar
  86. 86.
    Tepetes K, Spyridakis M, Hatzitheofilou C. Local treatment of a loop colostomy prolapse with a linear stapler. Tech Coloproctol. 2005;9(2):156–8.PubMedGoogle Scholar
  87. 87.
    Leong AF, Yunos AB. Stoma management in a tropical country: colostomy irrigation versus natural evacuation. Ostomy wound manage. 1999;45(11):52–6.PubMedGoogle Scholar
  88. 88.
    Terranova O, Sandei F, Rebuffat C, et al. Irrigation versus natural evacuation of left colostomy. Dis Colon Rectum. 1979;22:32–4.Google Scholar
  89. 89.
    Kock NG. Intra-abdominal “reservoir” in patients with permanent ileostomy. Preliminary observations on a procedure resulting in fecal “continence” in five ileostomy patients. Arch Surg. 1969;99(2):223–31.PubMedGoogle Scholar
  90. 90.
    Castellan MA, Gosalbez R, Labbie A, et al. Outcomes of continent catheterizable stomas for urinary and fecal incontinence: comparison among different tissue options. BJU Int. 2005;95(7): 1053–7.PubMedGoogle Scholar
  91. 91.
    Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6, 107 cases. Int J Colorectal Dis. 2009;24(6):711–23.PubMedGoogle Scholar
  92. 92.
    Mansfield SD, Jensen C, Phair AS, et al. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg. 2008;32(9):2101–6.PubMedGoogle Scholar
  93. 93.
    MacLeod I, Watson AJ, Hampton J, et al. Colonic pouchography is not routinely required prior to stoma closure. Colorectal Dis. 2004;6(3):162–4.PubMedGoogle Scholar
  94. 94.
    Salem L, Anaya DA, Roberts KE, et al. Hartmann’s colectomy and reversal in diverticulitis: a population-level assessment. Dis Colon Rectum. 2005;48(5):988–95.PubMedGoogle Scholar
  95. 95.
    Mazeh H, Greenstein AJ, Swedish K, et al. Laparoscopic and open reversal of Hartmann’s procedure – a comparative retrospective analysis. Surg Endosc. 2009;23(3):496–502.PubMedGoogle Scholar
  96. 96.
    Chouillard E, Pierard T, Campbell R, et al. Laparoscopically assisted Hartman’s reversal is an efficacious and efficient procedure: a case control study. Minerva Chir. 2009;64(1):1–8.PubMedGoogle Scholar
  97. 97.
    Riansuwan W, Hull TL, Millan MM, et al. Nonreversal of Hartmann’s procedure for diverticulitis: derivation of a scoring system to predict nonreversal. Dis Colon Rectum. 2009;52(8):1400–8.PubMedGoogle Scholar

Copyright information

© ASCRS (American Society of Colon and Rectal Surgeons) 2011

Authors and Affiliations

  • Laurence R. Sands
    • 1
  • Floriano Marchetti
    • 2
  1. 1.Division of Colon and Rectal Surgery, Department of SurgeryUniversity of Miami, Miller School of MedicineMiamiUSA
  2. 2.Department of SurgeryUniversity of Miami Miller School of MedicineMiamiUSA

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