Preoperative planning for the potential need for a stoma is critical in improving patients’ postoperative quality of life, reducing postoperative complications, and promoting their independence. This planning includes both preoperative counseling and stoma marking by an ostomy nurse (Figure 7.1). Often times it is helpful for the patient to speak with other willing patients. Support group participation may be very valuable.
Stoma sites should be properly marked by an enterostomal therapist/ostomy nurse. Stoma sites should be modified to avoid scars, skin creases, and other skin disorders. Stoma marking should be done with the patient in the lying, sitting, and standing positions with attention to the beltline and pant height. The site must be checked to ensure skin folds or crevices do not interfere with the appliance fitting. In obese individuals, the stoma usually is placed in the upper abdomen, so it will not be hidden below a large abdominal pannus (Figure 7.2). Stomas should be typically placed through the rectus sheath to reduce the incidence of parastomal hernias.
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