Preface

Gastrointestinal stoma is a therapeutic measure that has been evident for a long time but which retains its validity even among the great and overwhelming advances in clinical practice. Some technical details of the performance of stomas and the frequency of use of the procedure have dramatically reduced but the indications have not changed. Currently, the vast majority of gastrointestinal stomas are temporary. Surgical indications of gastrointestinal stomas in different sites of the digestive tract are based on various pathological conditions. Frequency of the employment of intestinal stomas has varied greatly as time passes, and is linked to evolutions of therapeutic perspectives. Furthermore, the surgical techniques had ameliorative modifications with changes in therapeutic procedures. Most intestinal stomas are temporary, with a program to restore intestinal continuity: emergency ostomy in particular cases of intestinal obstruction, some anastomoses such as coloanal or ileoanal needing temporary diverting ileostomy, and temporary feeding ileostomy. Great care is required in performing and treating ostomy, because the procedure is a fundamental part of the therapeutic program and involves the surgeon, the patient, and the nurse stoma therapist. The therapeutic commitment of ostomy is not limited to local control but involves the evaluation and treatment of general conditions in ostomy feeding and the balance of fluid and electrolyte depletion in cecostomy and diverting ileostomy.

The first section, "Stoma Care," consists of four chapters. The "Introductory Chapter: Role of Colostomy in the Colorectal Pathologies" shows synthetically the current use of colostomy as a complement to colorectal surgery, with the changes that have occurred. The chapter "Stoma Revision on the Flaps in Cases of Abdominal Wall Defect with Digestive Tract Rupture" exposes the very complex topic of incisional hernia with abdominal wall defect, involving intestinal stoma. Resolution of this technical problem comprises various and discussed surgical procedures. The chapter "Intestinal Ostomy Complications and Care" develops completely and clearly the planning of ostomy and the outcomes of intestinal stomas evaluating functional and anatomopathological complications. The chapter "Gastric Microbiota: Between Health and Disease" is very interesting. The chapter introduces the important theme of the change in intestinal microbiota following gastrointestinal stomas. This topic in particular looks at cases of stomas that need enteral feeding.

In the second section, "Stomas Prevention," there are two chapters. The chapter "Full Colonoscopy in Patients under 50 Years Old with Lower Gastrointestinal Bleeding" shows a clinical problem of great social impact: early diagnosis of colonic neoplasm from non-specific signs of gastrointestinal bleeding. This topic looks at the role of full colonoscopy compared with sigmoidoscopy and the usefulness of early diagnosis to prevent the risk of ostomy in the therapeutic program of colorectal cancer. The chapter "Radioimaging Diagnosis of Vaterian Ampulloma: Technique, Semiology, and Differential Diagnosis - Review" shows the complex diagnostic problem of perivaterian pathologies. Correct diagnosis allows the

appropriate therapeutic choice to be made and reduces the risk of complications and intestinal stomas.

> **Vincenzo Neri** University of Foggia, Italy

> > **1**

Section 1

Stoma Care

Section 1 Stoma Care

**3**

**Chapter 1**

Pathologies

temporary exclusion of intestinal transit.

be treated as mucus fistula.

**3. Indications for colostomy**

*Vincenzo Neri*

**1. Introduction**

Introductory Chapter: Role of

Gastrointestinal stomas can be performed during the surgical treatment of various colorectal diseases. The therapeutic indications of colostomy are the

The first subdivision is between temporary and definitive colostomy; this distinction is based on the therapeutic perspective. Following anatomical criterion, the stomas can be divided as terminal and parietal. The parietal colostomies encompass cecostomy and loop colostomy. They are usually temporary, and fecal diversion is often partial; their site can be right iliac fossa (cecostomy) or left iliac fossa (sigmoidostomy) and right paraumbilical site (transverse colonoscopy). Loop colostomy can be stabilized by a stick. Cecostomy usually is completed by the self-retained catheter fixed by the purse-string suture. Technical simplicity and rapid accomplishment are the characteristics of cecostomy. In the past, the parietal colostomies, as transverse colostomy, have been employed with the aim to prevent the leakage or dehiscence of the colorectal anastomosis, but now this role has been denied. In summary cecostomy may be indicated as a means of gas decompression in colonic obstruction, and transverse colostomy can instead ensure fecal diversion which is generally partial. End colostomy allows total fecal diversion. This can be employed in case of resection of diseased segment of the colon, and the immediate, contextual anastomosis is judged to be uncertain and not indicated. End colostomy is recommended rather than loop colostomy as permanent ostomy. In some conditions, such as Hartmann's procedure, there is also the distal end of the colon that can

The purpose of colostomy should be evaluated based on some reflections: clinical frame, functional aim, and temporal perspective of the procedure. The indications for colostomy can occur in the elective or urgent clinical conditions. The elective situation provides the bowel preparation; the patients may be submitted to the surgical procedure in the best general conditions. It will be also possible to

decompression in the treatment of intestinal obstruction or the need of definitive or

Colostomy in the Colorectal

**2. Functional and anatomical characteristics of colostomy**
