Challenges of Temporary Stoma Creation- An Observational Study from a Tertiary Care Centre in Mumbai, India

Aims: To identify the challenges that are faced with the creation of temporary stomas.

Study Design: Observational Study.

Place and Duration of Study: This study was undertaken in Topiwala National Medical College (TNMC) and BYL Nair Charitable Hospital, Mumbai, over a 4-year period between 2018 and 2022.

Methodology: Institutional Ethics Committee clearance was first obtained. Based on their diagnosis, and clinical and radiological findings, patients above the age of 18yrs who were planned for temporary enterostomies were identified. The details of the procedure and the intra-operative findings were documented for the sample population that was calculated to be 150. The exclusion criteria included patients with permanent stomas, urinary conduits and enterocutaneous fistulae. Patients were followed up until stoma closure or death.

Results: The highest incidence of stoma creation was seen in the 51-60yr age group - 25.3%. Our study identified that 104 patients were men (69.3%). Emergency stoma creation was done in 100 patients and 50, in the elective setting. Colorectal Carcinoma was the most common indication for stoma creation (42.7%). Stomas were least commonly performed for Carcinoma Cervix, Sigmoid perforation and Sigmoid Volvulus. Loop ileostomy was the most commonly performed procedure, accounting for 45.3% of enterostomies. Out of the sample population, 47 suffered from stoma-related complications. Peristomal skin excoriation accounted for the maximum number of cases, 25 patients (53.1%). Majority of patients who developed complications were managed conservatively (78.7%).

Conclusions: In emergency settings, as life-saving surgeries require the least intra-operative time, stoma creation is one of the most widely used strategies. It is imperative that proper techniques of stoma creation are employed to minimise the complications associated with their creation. Most complications can be treated conservatively while few may require surgical intervention.