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.
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Cite this: Ostomy Surgery Clinical Practice Guidelines (ASCRS, 2022) - Medscape - Dec 08, 2022.
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