Complications - Colostomy (sigmoidostomy) creation, double-barreled, laparoscopic

Marked site unusable due to anatomical conditions in situ

• Relocation to a site less accessible or more bothersome for the patient
• Preoperative marking of an alternative site by the stomatherapist

Inability to locate the previously marked excision site

• Marking with a waterproof pen
• Careful preoperative sterile washing of the patient

Injuries to other sections of the intestine

• Locate the injured site and suture

Injuries to vessels

• Avoid tension on the mesentery

Injuries due to trocar positioning

• Trocar insertion under direct vision
• Mini-laparotomy

Thermal damage to the intestine or skin

• Avoidance of monopolar coagulation

Obstruction of stoma placement due to adhesions (also in open technique)

General Complications

• General surgical risks (bleeding, rebleeding, thrombosis, embolism, HIT)
• Subcutaneous emphysema
• Post-laparoscopic shoulder pain syndrome
• Wound healing disorder
• Postoperative ileus
• Adhesions

Specific Complications

Stoma complications are generally common and also result from avoidable technical inadequacies. However, even with proper placement, not all complications can be avoided.

• Circulatory disorders/necrosis of the stoma due to too narrow a stoma channel or vascular injury during extensive mesenteric preparation.
• Mucocutaneous dehiscence due to stoma necrosis, stoma retraction, or an excessively large skin excision. In cases of partial dehiscence, absorbent wound dressings such as calcium alginate, hydrofibers, skin protection powder, or paste are used. Circular dehiscence leads to the formation of circular granulation tissue, which can later result in stoma stenosis. Therefore, surgical correction is often necessary.
• Incorrect positioning with corresponding care problems.
• Peristomal skin irritations with sore skin and redness are most common (18-55%), either due to placement or patient-specific care issues; ranging from mild eczema to ulcerations and severe infections. Conservative therapy through adjustment of care and patient education.
• Parastomal abscess/stoma fistula; when stitching the seromuscular suture (3-point fixation), care should be taken to ensure it is not completely transmural.
• Parastomal hernia → Fascia opening preferably < 25 mm; evaluate prophylactic mesh implantation for permanent stoma placements.
• Stoma prolapse: The irreducible or only temporarily reducible prolapse is only an indication for surgery if it leads to bleeding, incarceration, and obstruction, or if stoma care is no longer ensured.
• Stoma stenosis in too narrow a stoma channel or after circular mucocutaneous dehiscence.
• Stoma retraction (retraction below skin level) can result from insufficient bowel mobilization or as a late complication in inflammation or peritoneal carcinomatosis with retraction of the stoma. Obese patients with a short mesentery are particularly at risk.
• Mucosal bleeding

→ Maximize conservative options to avoid or delay surgical revision

→ For reversible stoma placements, consider the possibility of stoma reversal.

A BMI >30 is an independent risk factor for skin irritations, parastomal hernia, and stoma retraction. The higher the BMI, the higher the risk of complications.