Ostomy Surgery

Publication Date: May 24, 2022
Last Updated: January 2, 2023

Recommendations

OSTOMY CREATION

When feasible, laparoscopic ostomy formation is preferred to ostomy formation via laparotomy. (1C)
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Loop ileostomy is preferred over transverse loop colostomy for temporary fecal diversion in most cases. (2B)
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Whenever possible, both ileostomies and colostomies should be fashioned to protrude above the skin surface. (1C)
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When using a support rod for a loop ostomy, a flexible or rigid ostomy rod may be used. (2C)
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Use of antiadhesion materials may be considered to decrease adhesions at temporary ostomy sites. (2B)
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Lightweight polypropylene mesh may be placed at the time of permanent ostomy creation to decrease parastomal hernia rates. (1B)
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Extraperitoneal tunneling of end colostomies may decrease parastomal hernia rates. (2C)
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For patients with a new ileostomy, postoperative care pathways may prevent hospital readmission for dehydration. (1C)
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OSTOMY CLOSURE

Stapled and hand-sutured techniques are both acceptable for loop ileostomy closure. (1B)
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Ostomy-site skin reapproximation should be performed when feasible, and pursestring skin closure may have advantages compared with other techniques. (1B)
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Laparoscopic Hartmann reversal is a safe alternative to open reversal in experienced hands. (1C)
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OSTOMY COMPLICATIONS

Parastomal hernia repair should typically be performed by using mesh reinforcement or by relocating the stoma. (1C)
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Prosthetic mesh may be used during parastomal hernia repair with low short-term risk of intestinal erosion or mesh infection. (1C)
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Bioprosthetic material may be used as an alternative to synthetic mesh for repair of parastomal hernias. (2C)
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Laparoscopic parastomal hernia repair with mesh may be a safe alternative to open mesh repair.

(1C)
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EVIDENCE FOR THE VALUE OF AN OSTOMY NURSE

Ostomy education should have a preoperative and postoperative component, and should involve a specialized provider, such as a WOCN nurse when possible. (1B)
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Preoperative ostomy site marking should be performed by a trained provider whenever possible. (1C)
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Follow-up care for ostomy teaching, care, and support should be available to all patients. (1C)
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Recommendation Grading

Overview

Title

Ostomy Surgery

Authoring Organization

American Society of Colon and Rectal Surgeons

Publication Month/Year

May 24, 2022

Last Updated Month/Year

September 30, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Give guidance to surgeons and other health care providers in an effort to improve the quality of care and outcomes for patients undergoing ostomy surgery.

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Emergency care, Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management, Prevention

Diseases/Conditions (MeSH)

D003107 - Colorectal Surgery, D010030 - Ostomy

Keywords

parastomal hernia, ostomy surgery

Source Citation

Davis BR, Valente MA, Goldberg JE, Lightner AL, Feingold DL, Paquette IM; Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum. 2022 Oct 1;65(10):1173-1190. doi: 10.1097/DCR.0000000000002498. Epub 2022 May 24. PMID: 35616386.

Methodology

Number of Source Documents
205
Literature Search Start Date
January 1, 2014
Literature Search End Date
December 1, 2021