The indication for colostomy placement is made in approximately 70% of cases due to malignant tumors of the colon, rectum, anus, or bladder. The placement is either protective (e.g., to spare a vulnerable anastomosis or in planned neoadjuvant radiochemotherapy, as well as to protect wound healing, e.g., in pressure ulcers) or definitive (e.g., in inoperable rectal carcinoma). The placement can be performed conventionally open (usually as part of the treatment of the underlying disease) or laparoscopically (especially before definitive operations).
Indications include:
- Rectal carcinoma
- Anal carcinoma
- Sigmoid diverticulitis
- Crohn's disease, ulcerative colitis
- Anal fistulas, anal abscesses
- Injuries (e.g., impalement injuries, pelvic fractures, iatrogenic)
- Anal atresia
- Pressure ulcer
- Neurological diseases
- Fecal incontinence
- Decompression stoma
- Protective stoma
- Rectovaginal-vesical fistula
- Anastomotic insufficiency
For a colonic stoma, any part of the colon can be used in principle, with the transverse colon and sigmoid colon being most commonly advanced.
Optimal is the transrectal placement in the lower abdomen above the arcuate line. The superior muscular and fascial support at this site is intended to prevent the development of a parastomal hernia or prolapse.
Due to anatomical proximity, the placement of a transverse colostomy is recommended in the upper abdomen, and for ileostomy and sigmoidostomy, placement in the lower abdomen is recommended.
Special situation of protective stoma in colorectal carcinoma:
In low anterior resection with TME, a protective stoma is generally indicated, with an ileostomy being preferable to a colostomy. An ileostomy is easier and less complicated to reverse. Parastomal hernias and stoma prolapses occur less frequently. However, fluid loss syndrome occurs much less frequently with a colostomy, and obstruction problems after reversal are also less common.
