Derivation stomas

·         esofagostoma – is derivation of oesophagus for saliva drainage and prevention of saliva aspiration

·         tracheostoma – ensures airway openness in trauma and cancer

·         ileostoma – the exiting of the terminal part of the small intestine in front of the abdominal wall. It is most often placed in the right lower abdomen. The stoma permanently drains the watery and aggressive contents

·         colostoma – the exiting of the large intestine in front of the abdominal wall. Most often it is formed in the left lower abdomen. Occasionally in the subcostal region for the transverse colon. Stool is formed and less aggressive, it passes irregularly 1 - 3 a day 

- for the colon, stomas are classified according to their position into cecostomies, transversostomies and sigmoideostomies
- in children, they are established temporarily for congenital developmental defects. In adults, we construct stomy on the colon for the following diagnoses:

• acute abdomen (ileus, intestinal perforations) 
• tumours of the intestine
• non-specific intestinal inflammation (Morbus Crohn, proctocolitis)
• hereditary diseases (familial adenomatous polyposis and non-polyposis colorectal cancer)
• diverticulosis 
• injury
• faecal incontinence
• damage to the intestine by radiotherapy
• fistulas

·         urostoma – is the protrusion of the urinary tract in front of the abdominal wall. Urostomy can be continent - the patient empties several times by catheterization, and incontinent - the outlet is not affected - there is no sphincter. Diseases that lead to the establishment of urostomy:
• neurological damage 
• injuries to the head and brain 
• brain and spinal cord tumors
• abdominal and pelvic injuries
• untreated urinary tract infections

Nutritive stoma 

·         Gastrostoma – a catheter is inserted into the stomach to administer special nutrition. The catheter is inserted endoscopically or surgically

·         Jejunostoma – insertion of a catheter into the small intestine. Special partially digested nutrition is administered. The catheter is inserted endoscopically or surgically

-          the pre-operative interview and nurse consultation are important. Also, marking the site of the outlet has been shown to reduce the risk of complications. The patient should be examined lying down, sitting and standing, and in the prone position. The patient should be able to see the stoma. Optimally in the triangle between the anterior superior spina bifida, tuberculum pubicum and umbilicus. Optimal smooth skin diameter is 6 cm. The stoma should pass through. m. rect. abdominis for hernia prevention.

Types of bowel stomas

-          double-barrelled

-          terminal

-          mural

-          protective

-          palliative

-          temporary

-          permanent

Terminal stoma               double-barrelled stoma

Miroslav Zeman, Zdeněk Krška, kol.  Speciální chirurgie. 2014

Complications

Miroslav Zeman, Zdeněk Krška, kol.  Speciální chirurgie. 2014

-           stenosis – arise as a result of ischemia, infection or retraction. Colostomy stenosis can usually be managed conservatively, dilated, irrigated

-           retrakction – as a result of the patient's weight gain after surgery and/or short bowel attachment

-           prolapsus – small prolapse is less common in double-headed transversostomies. The overall incidence is around 10%. The procedure is mostly conservative

-           parastomal hernia – frequent late complications