The very first stoma changes after an operation should be performed on the third postoperative day. If the stoma bandage leaks, this must be changed earlier. The change should be carried out by a stoma nurse/nurse while the patient is in the supine position. The stoma is observed for possible infection, necrotizing mucosa or abdominal wall, loosening of sutures, and for leakage of air and bowel content. Bag inflation is a signs of bowel activity. It is appropriate to use a colorless, drainable bag in the first period since the bowel content is thinner in the beginning. If a bag with a filter is used, the filter should be covered.
As soon as the patient is ready for it, the patient is trained for stoma changing/cleaning. Training should occur daily until the patient has mastered it.
Transverse colostomies and ileostomies can be closed after about six weeks. For closing of ileostomy, there is a higher chance of postoperative ileus and possibly also for bowel leakage than with colostomy.
For Hartmann's operation, the goal in some instances is to perform a re-anastomosis of the bowels and to avoid permanent stoma.
Complications of stoma
- Infection in the subcutaneous tissues occurs relatively often and more commonly with obesity.
- Necrotizing of mucosa or the entire abdominal wall occurs more frequently in patients with a thick subcutaneous fat layer.
- Loosening of eversion sutures along the edge occurs relatively frequently.
- Retraction of stoma to the skin level or under occurs relatively rarely, but more frequently for loop colostomy. Retraction can cause overflow to the disconnected bowel. This is especially unfortunate in fistula relief.
- Colo-cutaneous/ileo-cutaneous fistulas occur rarely.
- Peristomal hernia is a complication where the stoma bulges out like lump on the skin. This can make attachment of the stoma bag more difficult and the stoma may have to be moved.
- Stenosis in the stoma opening occurs relatively rarely. It occurs if the bowel opening is not adequately inverted or if the tip of the stoma necrotizes down to or under the skin level.
- Retraction of the stoma down to or under the skin level occurs relatively rarely.
- Prolapse of stoma is a relatively rare complication where the bowel turns itself 10 cm or more out through the stoma opening. This happens most often in transverse colostomy stomas. The herniation can cause increased pressure to the bowel vessels through the abdominal wall and possible cause bowel necrosis. This complication can be treated conservatively but may relapse.