**2. Ostomy planning**

### **2.1 Counseling**

The multiple aspects involved in rehabilitation of patients with an ostomy including the medical and nursing care must be initiated at the moment of the indication and extended until a complete adaptation of the patient with the new situation occurs.

Preoperative preparation prior to planned ostomy creation includes stoma site selection, emotional support, and patient education, as well as early planning for subsequent discharge, ongoing rehabilitation care for the patient and family, and outpatient follow-up.

Patients who require an ostomy for fecal diversion often experience physical, psychological, and emotional stress related to misconceptions and fears regarding social acceptance, sexuality, and economic burden. To allay these fears, preoperative education, counseling, and ostomy site selection should be undertaken, whenever possible, from a skilled ostomy nurse specialist. Several aspects going from the initial patient's approach with clarification of doubts about diagnosis, familiar history, intestinal habit, medicines, social activities, emotional state, psychomotor skills, and schooling to skin conditions' evaluation are important to provide a proper knowledge about the medical condition and adequately educate the patient. To achieve the autonomy about the ostomy care, the patient should be oriented toward maintaining a well-recognized standard of care, with decrease of complications. In addition to improved overall quality of life, preoperative counseling is associated with decreased stoma-related postoperative complications, improved postoperative patient stoma proficiency, and earlier discharge from the hospital [2, 3].

### **2.2 Site selection and marking**

Proper site selection is essential for minimizing postoperative complications and achieving a good postoperative quality of life. A poor site selection is more likely in patients undergoing emergency surgery compared with elective surgery. Obesity, scars, type of surgery (emergency or elective), underlying disease,

**35**

*Intestinal Ostomy Complications and Care DOI: http://dx.doi.org/10.5772/intechopen.85633*

(**Figure 1A** and **B**).

**Figure 1.**

adjustments [5].

location

paste and powder)

order to prevent complications (**Figure 1C**).

**3. Intestinal ostomies: routine care**

**3.1 Protecting the peristomal skin**

abdominal wall contour (sitting and standing), prior abdominal incisions, bony prominences, occupation, clothing style, and physical activity impairment can be cited as factors which difficult the adequate site of an abdominal stoma [4]

*Stoma site demarcation. This is an important step to achieve a technically good result after ostomy confection allowing adequate pouch adaptation, especially in obese patients with skin folds (A), permitting the natural* 

*wear of belts and cloths (B). The ideal appearance of an ostomy is depicted at C.*

Once selected the ostomy site, laparoscopic approach is a safe and effective alternative to laparotomy for creating a loop ostomy. The advantages of the laparoscopic approach are that it provides an excellent view of the abdominal cavity and minimizes the risks and complications of an open procedure. Whatever surgical approach is used, the goal is to obtain a stoma technically in good conditions in

Many pouching systems are available, as either one- or two-piece systems. The main functions of ostomy pouches are to contain the ostomy effluent, contain odor, and protect the peristomal skin. The patient should be taught strategies that can help promote pouch adherence to the skin and minimize leakage. Occasional leakage is common and is nothing to be concerned about. However, if the leak is constant, a double check of the stoma bag is advisable. A stoma leakage usually results from a stoma bag that has not been fitted correctly leaving gaps in the wafer and the hole does not fit snugly around the stoma. If this happens an ostomate nurse should be contacted for advice and eventual

The protection of peristomal skin is better achieved with simple measures such as:

1.Selecting a bag system that conforms to the abdominal contour at the stoma

2.Sizing the opening of the barrier ring to minimize the amount of exposed skin

agents, Skin Prep) and to prevent irritation and injury of the skin (skin barrier

3.Using adjunctive products to improve the fixation of the pouch (adhesive

**Figure 1.**

*Gastrointestinal Stomas*

adaptation [1].

**2.1 Counseling**

situation occurs.

outpatient follow-up.

from the hospital [2, 3].

**2.2 Site selection and marking**

**2. Ostomy planning**

patients or those with extensive adhesions.

pathologic conditions, including congenital anomalies, colon obstruction, inflammatory bowel disease, traumatic disruption of the intestinal tract, or gastrointestinal malignancy, when restoration of intestinal continuity is contraindicated or not immediately feasible given the patient's clinical condition. End ostomy is the name indicative of a hollow viscera pull to the skin as a terminal opening. In this way only one open lumen is viewed. The majority of ostomies today are created as a temporary measure, although the ostomies with a permanent intention are not rare. Construction of an ostomy should always be performed using a segment of healthy, well-vascularized bowel. Expected difficulties arise in morbidly obese

This chapter will discuss ostomies brought to the surface of the body, focusing primarily on ileostomy and colostomy complications with the proposed treatment approach. Even when the stoma is technically adequate, alterations on the corporal image, lifestyle, and sexuality, as well as the need for auto care may occur leading to social and psychological disturbances which difficult the individual social

The multiple aspects involved in rehabilitation of patients with an ostomy including the medical and nursing care must be initiated at the moment of the indication and extended until a complete adaptation of the patient with the new

Preoperative preparation prior to planned ostomy creation includes stoma site selection, emotional support, and patient education, as well as early planning for subsequent discharge, ongoing rehabilitation care for the patient and family, and

Patients who require an ostomy for fecal diversion often experience physical, psychological, and emotional stress related to misconceptions and fears regarding social acceptance, sexuality, and economic burden. To allay these fears, preoperative education, counseling, and ostomy site selection should be undertaken, whenever possible, from a skilled ostomy nurse specialist. Several aspects going from the initial patient's approach with clarification of doubts about diagnosis, familiar history, intestinal habit, medicines, social activities, emotional state, psychomotor skills, and schooling to skin conditions' evaluation are important to provide a proper knowledge about the medical condition and adequately educate the patient. To achieve the autonomy about the ostomy care, the patient should be oriented toward maintaining a well-recognized standard of care, with decrease of complications. In addition to improved overall quality of life, preoperative counseling is associated with decreased stoma-related postoperative complications, improved postoperative patient stoma proficiency, and earlier discharge

Proper site selection is essential for minimizing postoperative complications and achieving a good postoperative quality of life. A poor site selection is more likely in patients undergoing emergency surgery compared with elective surgery. Obesity, scars, type of surgery (emergency or elective), underlying disease,

**34**

*Stoma site demarcation. This is an important step to achieve a technically good result after ostomy confection allowing adequate pouch adaptation, especially in obese patients with skin folds (A), permitting the natural wear of belts and cloths (B). The ideal appearance of an ostomy is depicted at C.*

abdominal wall contour (sitting and standing), prior abdominal incisions, bony prominences, occupation, clothing style, and physical activity impairment can be cited as factors which difficult the adequate site of an abdominal stoma [4] (**Figure 1A** and **B**).

Once selected the ostomy site, laparoscopic approach is a safe and effective alternative to laparotomy for creating a loop ostomy. The advantages of the laparoscopic approach are that it provides an excellent view of the abdominal cavity and minimizes the risks and complications of an open procedure. Whatever surgical approach is used, the goal is to obtain a stoma technically in good conditions in order to prevent complications (**Figure 1C**).
