Ostomy Surgery Clinical Practice Guidelines (ASCRS, 2022)

American Society of Colon and Rectal Surgeons (ASCRS)

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

December 08, 2022

Guidelines for ostomy surgery were published in October 2022 by the American Society of Colon and Rectal Surgeons (ASCRS) in Diseases of the Colon and Rectum.[1]

Ostomy Creation

When feasible, ostomy formation via laparoscopy is preferred to ostomy formation via laparotomy.

When indicated, a loop ileostomy or loop colostomy is effective for fecal diversion.

When possible, both ileostomies and colostomies should be fashioned to protrude above the skin surface.

In nonobese patients, routine use of a support rod at the time of loop ileostomy construction is unnecessary.

For prevention of parastomal hernia, routine use of prophylactic mesh at the time of ostomy creation is not recommended. The risk of parastomal hernia may be decreased by extraperitoneal tunneling of an end colostomy.

Ostomy Closure

Early closure of protective ileostomies may be performed in select low-risk patients with a colorectal anastomosis without clinical evidence of anastomotic leak.

Loop ileostomy closure can be performed with either stapled or handsewn technique.

Ostomy-site skin approximation should be performed when feasible, and purse-string skin closure has advantages compared with other techniques.

Minimally invasive Hartmann reversal is a safe alternative to open reversal.

Parastomal Hernia Repair

Parastomal hernia repair should typically utilize mesh reinforcement. Minimally invasive parastomal hernia repair may be performed in selected patients.

For more information, please go to Loop Colostomy, Stomas of the Small and Large Intestine in Children, and Laparoscopic Hartmann Procedure Reversal.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.