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Stoma creation is a surgical procedure to allow a new way for intestinal waste (stool) to leave the body.
A stoma (or ostomy) may be needed to treat many illnesses like cancers, ulcerative colitis, Crohn disease, diverticulitis, trauma, and several urologic and neurologic conditions. Every year, approximately 120 000 stoma procedures are done, and almost 1 million patients have stomas at any given time in North America.
In a stoma procedure, a segment of the intestine is brought outside the body. Depending on the type of illness, different intestine segments may be used to make a stoma. Stomas may be temporary or permanent and are named by the piece of intestine brought outside the body. A colostomy is a stoma created from the colon. An ileostomy is created from a segment of small intestine called the ileum.
Intestinal waste is collected by a special plastic bag (or appliance) hidden under clothing. Stoma appliances come in various types and sizes but usually consist of an adhesive wafer (flange) that seals tightly to the skin and a leakproof collecting pouch. The goal of stoma appliances is to collect stoma drainage, eliminate soiling and odor, and protect the surrounding skin. Usually, the collection pouch has a tight seal that allows the patient to empty the pouch into a toilet. The appliance is normally changed every few days.
Sometimes a temporary or permanent stoma may be necessary for patients. Often, stoma creation may actually improve quality of life for patients with certain illnesses or help to avoid potentially life-threatening situations. Like many things, learning to care for a stoma can be intimidating at first. Education and stoma skills training can lead many patients to live with little to no restrictions.
If possible, patients should meet with their surgeon or stoma care professional before surgery to determine the best location to create a stoma and learn about living with a stoma. Sometimes emergency surgery may not allow time for patients to prepare for stoma creation. Stoma site marking and education before surgery may decrease complications after stoma surgery. Several preoperative stoma educational programs for patients are available for free.
As a patient recovers from stoma creation surgery in the hospital, surgeons, nurses, and stoma care professionals instruct the patient how to care for the stoma. Once a patient goes home, the stoma care team make sure that help and supplies are available at home.
Routine follow-up with specially trained stoma care clinicians can help avoid problems and improve quality of life for patients with stomas. Stoma support groups, both in person and via the internet, are excellent support resources for both new and experienced stoma patients.
American College of Surgeons Ostomy Home Skills Kitwww.facs.org/education/patient-education/skills-programs/ostomy-program/adult-ostomy
American Society of Colon and Rectal Surgeonswww.fascrs.org/patients/disease-condition/ostomy-expanded-version
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr McGee reports coauthorship of the American College of Surgeons Ostomy Home Skills Kit; he received no royalties or payment for authorship.
Sources: American College of Surgeons
Hendren S, Hammond K, Glasgow SC, et al. Clinical practice guidelines for ostomy surgery. Dis Colon Rectum. 2015;58(4):375-387.
Topic: Surgical Procedures
McGee MF. Stomas. JAMA. 2016;315(18):2032. doi:10.1001/jama.2016.0202
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