If there is excessive tension, a stoma rod may be used. I prefer short plastic ileostomy rods (Marlen). These have the advantage that they are relatively small, being only several centimeters in length, so that they do not interfere with the stoma appliance, as can larger rods that are meant for use with colostomies. Such rods should be left in place for 5 days after surgery in order to assure adherence of the bowel to the abdominal wall and subcutaneous tissue before removal. In a patient in whom a stoma is constructed under significant tension, these rods can easily cause a partial small-bowel obstruction when they are in place. It is not unusual that, due to this obstructed effect, the patient cannot be advanced beyond a liquid diet until the rod is removed. These rods also have the advantage of having an "eye" on both ends to permit them to be sutured to the skin so they cannot inadvertently "slip out" or be inadvertently removed. If there is difficulty in physically getting the bowel to reach to the skin, in very rare circumstances I have done a lipectomy of the area around the stoma site via the midline incision in order to "thin" the abdominal wall. This approach is used so as not to stretch the ileostomy skin aperture unduly. This is very rarely needed, since fat will almost always compress sufficiently and most obese patients have a fairly soft abdominal wall. One essential in dealing with such patients is, however, to have them seen postoperatively by a skilled enterostomal therapist. These patients will invariably require a convex stoma appliance, Eakin seals, and a stoma belt. There are many different stoma supply manufacturers. Some patients will even require very deep convexities or, appliances with special oval shapes. Without the use of such appliances, ileostomy retraction occurs. This is important, since, if retraction occurs, the stoma will no longer be diverting and the patient then passes a large amount of stool through their J-pouch. This not only causes anal excoriation, but may also impair healing of the distal ileal J-pouch anal anastomosis, the prime purpose of the ileostomy in the first place.
Was this article helpful?
All wart sufferers, this is the day to stop the shame. How I Got Rid Of My Warts Forever and How You Can Get Rid Of Warts Naturally In 3 Days. With No Blisters, No Scars, And No Pain Without medications or expensive procedures. All by applying a simple, very natural and unbelievable FREE substance that can be found in almost every household.