This document discusses stoma care for surgeons. It defines a stoma and the main types including colostomy, ileostomy, and urostomy. It covers preparing and counseling patients for stoma surgery, postoperative stoma care including complications, and general stoma care advice. Stoma appliances are also described including types like closed, drainable, one-piece, and two-piece systems. Optimal stoma site selection and factors in stoma care like diet, exercise, and sexual activity are also summarized.

1. Dr.B.Selvaraj MS;MCh;FICS
“ Surgical Educator”
Melaka Malaysia 75150
STOMA CARE
FOR SURGEONS

2. STOMA CARE
Sites: occiput, scapula, ischium, sacrum, heel
 Definition and Types
 Preparation and Counselling of patients for stoma
 Postoperative care for the stoma
 Complications
 Stoma Appliances
 General care and advice

3. STOMA CARE
Sites: occiput, scapula, ischium, sacrum, heel
 A stoma is a surgically created opening in the
body between the skin and a hollow viscus
(stoma has the Greek meaning mouth)
 Abdominal stomas are mainly used to divert
faeces or urine out of the body where it can be
collected in a bag at the skin level.
 There are three common stoma types:
Colostomy, Ileostomy and Urostomy
 It is created in the treatment of Carcinoma,
trauma, sepsis or after surgery

4. STOMA CARE- TYPES
Sites: occiput, scapula, ischium, sacrum, heel
 Two main indications of PEG tube
placement are enteral feeding and stomach
decompression.
 Distal enteral obstruction, severe
uncorrectable coagulopathy and
hemodynamic instability constitute the
main absolute contraindications for PEG
tube placement.
 Jejunostomy is used as an additional
surgical procedure following major
operations when oral feeding is likely to be
delayed for long time.

5. STOMA CARE- TYPES
Sites: occiput, scapula, ischium, sacrum, heel
 Ileostomy— ileum is brought out, and fixed to
the skin of abdominal wall to drain semi-liquid,
faecal matter usually on right lower abdomen.
 Loop Ileostomy: A loop of ileum is brought out
and only the anterior wall of ileum is opened
and posterior wall is intact and it is usually a
temporary procedure
 End Ileostomy: End of ileum is brought out
when the colon and rectum may be removed or
need to be rested to heal.

6. STOMA CARE- TYPES
Sites: occiput, scapula, ischium, sacrum, heel
 Colostomy—Colon at different levels, can be
brought out to the skin as required as
colostomy, to divert faecal matter
 All are end colostomy only. Loop colostomy
done for babies with ano-rectal
malformations
 Temporary end colostomy- Hartman’s
procedure
 Permanent end colostomy- after AP
Resection

7. STOMA CARE
Sites: occiput, scapula, ischium, sacrum, heelUrostomy:
 Nephrostomy: Placement of small flexible rubber
tube through the skin into kidneys
 Pyelostomy: Placement of the same tube into
renal pelvis to drain urine
 Ureterostomy: Surgical establishment of an
external opening into the ureter.
 Vesicostomy: Surgical creation of a stoma
between the anterior bladder wall and the skin of
the lower abdomen.
 Ileal Conduit: a system of urinary drainage which
a surgeon creates using the ileum after removing
the bladder.

8. STOMA CARE
Preparation and Counselling of patients for stoma
 Patient should be explained about the procedure
and should be convinced and consoled about the
stoma.
 Detailed meaning, explanation and after care of
the stoma should be discussed
 Indication for the stoma and consent for the
same should be taken.
 Reassurance about the stoma, its care, and its
position should be diagrammatically explained to
the patient and his/her close relative.
 Proper bowel preparation by bowel wash, gut
irrigation is required before surgery.
 Stoma is usually sited midway between
anterior superior iliac spine and umbilicus.
 It should be away from the belt line, the
scar, creases, and bony points.
 Proper stoma appliances should be decided
after thorough check-up and discussion
with patient and patient’s relative.
 Stoma site should be marked properly
before surgery.
 Ileostomy is usually sited in the right iliac
fossa, colostomy in left iliac fossa.
 The patient should consult a stoma
therapist.

9. STOMA CARE
Selecting Optimal Stomal site

10. STOMA CARE
Sites: occiput, scapula, ischium, sacrum, heelPostoperative care for the Stoma
 Stitches are removed in 6–10 days.
 Dressing should be done first over the stoma
and after placement of appliance, laparotomy
wound is dressed otherwise stoma appliance
will not sit properly.
 Patient should be observed for any
complications.
 Patient should be taught about the stoma care
and its appliances.
 Once wound has healed patient can take bath
by removing the appliances. After bath skin is
dried up and stoma appliances can be fitted
again.
 Care and prevention of skin excoriation due to
leak is also looked into.
 Skin should be absolutely dry prior to placing
the stoma appliances
 Psychotherapy is given for the patient

11. STOMA CARE
Complications
 Skin excoriations
 Mucosal prolapse—common
complication
 Infection either bacterial or
candidial
 Diarrhoea due to irritation.
 Leak due to improper fitting of the
appliances, scar, irregularity of
stoma, prolapse

12. STOMA CARE
Complications
 Mucocutaneous separation
 Retraction
 Stenosis and block.
 Bleeding from the stoma edge
 Para-stomal hernia

13. STOMA CARE
Stoma Appliances
 Stoma appliances are devices, which are used to collect and dispose the effluent materials
which come out of the stoma
 Ideal stoma appliance is:
-Leak proof
™™ -Should not damage the stoma and surrounding skin
™™ -Should prevent odour
™™ -Should be easily available
™™ -Easier to use
 the stoma.

14. STOMA CARE
Stoma Appliances- Types
 Closed type is discarded when full and is
used in patients with well-formed stool.
 Drainable type is used in patients with
loose liquid stool. It can be emptied and
retained and reused.
 One-piece stoma appliance as a bag with
adhesive system attached which adheres
to skin around the stoma.
 Two-piece stoma appliance has got a
flange with adhesive system and a bag
over it, which can be removed and
replaced with a new one without
disturbing the flange underneath.
 Bag can be transparent or opaque

15. STOMA CARE
Stoma Appliances- Types

16. STOMA CARE
General care and advice
 Patient can have normal diet which
regulates the bowel action. Plenty of water is
advisable.
 Patient can go for normal work, exercise like
sports, swimming, tennis. Stoma appliances
suitable for these works are available.
 Antidepressants, anticholinergics might
cause constipation. So these drugs should be
taken carefully.
 Patient can have normal sexual activity.
 Shouldn’t use irritant solutions near stoma
that may lead to dangerous complications
 Patient should have additional stoma bags in
hand so as to use if required urgently
 Patient should be aware of different appliances
available and should be well-versed with its
use. He can take the help of the stoma societies

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