Stoma Retraction Management
Stoma retraction should be managed initially with specialized pouching techniques including convex appliances, ostomy belts, paste, and barrier rings to bolster stoma height, with surgical revision reserved for cases where conservative management fails or complications develop that prevent adequate stoma care. 1
Initial Conservative Management
The first-line approach focuses on optimizing the pouching system to compensate for the retracted stoma:
- Use convex appliances to create pressure that pushes the retracted stoma outward and improves the seal between the appliance and peristomal skin 1
- Apply an ostomy belt in conjunction with the convex appliance to maintain consistent pressure and prevent leakage 1
- Utilize paste or barrier rings around the stoma base to fill in gaps and create a level surface for appliance adhesion 1
- Heat the appliance with a hair dryer before application and lie flat for several minutes after application to improve adhesion 1
- Ensure the peristomal skin is completely dry before applying any pouching system 1
- Apply a fine dusting of stomal powder followed by skin sealant on any damaged peristomal skin before appliance placement 1
Monitoring and Ongoing Assessment
- Measure stoma size at each appliance change for the first 8 weeks as the stoma continues to change during this period 1
- Cut the appliance opening one-eighth inch larger than the stoma to prevent mucosal irritation while minimizing skin exposure to effluent 1
- Monitor for secondary complications including peristomal skin breakdown from leakage, which can cause significant excoriation, pain, and pouching difficulties 1
Indications for Surgical Intervention
Surgical revision becomes necessary when conservative measures fail:
- Inability to maintain adequate stoma care despite optimized pouching techniques 2
- Development of complications such as bowel obstruction, bleeding, or incarceration 2
- Severe peristomal skin ulceration that cannot be managed with conservative care 2
- Persistent leakage causing significant financial hardship from frequent appliance changes and skin damage 1
Surgical Options
When surgery is required, the approach depends on patient factors:
- Local stomaplasty can be performed without full laparotomy in select cases, particularly in obese patients where panniculectomy with skin excision may address the retraction without formal stoma revision 3
- Transabdominal stoma revision involves mobilizing the bowel and recreating the stoma with adequate length, ensuring placement through the rectus muscle 2
- Avoid moving the stoma to a new location during revision, as this creates significant risk of complications at the new site 1
Prevention Strategies
The most effective management is prevention through proper surgical technique:
- Preoperative marking by a wound ostomy and continence (WOC) specialist significantly reduces the risk of retraction and improves quality of life 1, 4
- Adequate mobilization of the bowel at initial surgery to avoid excess tension 3
- Placement through the rectus muscle rather than lateral to it 1
- Avoid using stoma rods/bridges, as they do not reduce retraction risk and may cause additional complications including edema, necrosis, and peristomal skin damage 5