ASCRS Ch54 - Intestinal Stomas

Fifty-fourth chapter of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (McGee MF, Cataldo PA). Book pages 907–946 (PDF pages 897–936 of raw/ASCRS Textbook 4th Ed.pdf, offset +10 — one higher than Ch53's +9, confirmed via the "© Springer Nature Switzerland AG 2022 <page>" copyright-line cross-check (see log.md's offset-correction note — this was previously mislogged as "+9, unchanged from Ch53"); Ch54 begins immediately at PDF page 897 with no intervening blank page). By far the longest chapter ingested to date (40 PDF pages vs. the typical ~13) and heavily figure-driven (38 numbered figures covering technique), but the underlying text is comprehensive rather than padded. No prior wiki page existed for stomas at all, so this chapter created an entirely new procedure page rather than reconciling existing content.

Key concepts (chapter's own summary box)

• Preoperative stoma site marking and patient education improve stoma-related clinical outcomes, patient quality of life and experience, while decreasing healthcare resource utilization.
• The finished stoma should protrude from the skin, improving the seal between the appliance and peristomal skin and decreasing complications.
• Optimal ostomy care includes preoperative and postoperative care by an ostomy nurse specialist (e.g. WOCN-certified).
• Early stoma-related complications (leakage, peristomal dermatitis, dehydration) can often be remedied with stoma care and patient education.
• Loop ileostomy is preferred over transverse loop colostomy for temporary fecal diversion in most circumstances.
• Stapled and hand-sutured techniques are both acceptable for loop ileostomy closure.

Filing

• Intestinal Stomas — entirely new procedure page. Covers configuration/indications (colostomy, ileostomy, jejunostomy — end vs. loop), physiology by stoma type, preoperative siting/education, full technical creation detail (small bowel end/loop, end/loop colostomy, ICG perfusion assessment), postoperative care and appliances, the full complications spectrum (ischemia, peristomal skin disorders, pyoderma gangrenosum, peristomal varices, prolapse, abscess, high output stomas), stoma reversal (preparation, timing, technique, complications, loop-ileostomy-vs- colostomy comparison), and special considerations (the difficult/obese-patient stoma, genitourinary stomas, the Turnbull blowhole colostomy, ileostomy/foodstuff bolus obstruction). Cross-referenced into Diverticulitis, Crohn Disease, Ulcerative Colitis, Ileal Pouch-Anal Anastomosis (IPAA), Radiation Colitis (Proctitis), Infectious Colitis, and Short Bowel Syndrome.

Relevance

Unlike Ch52/Ch53, this chapter is not particularly trial-rich for its most consequential claims — most of the high-value content (siting technique, perfusion assessment, complication management algorithms) is expert-consensus/technique detail rather than RCT-driven. The exceptions worth noting for potential independent ingestion: a Scandinavian RCT on early (8–13 days) vs. late (12 weeks) loop ileostomy closure timing (genuinely practice-relevant given ongoing debate), the HASTA multicenter trial comparing stapled vs. handsewn loop ileostomy closure, and a 2019 meta-analysis on stoma rods (found increased necrosis/dermatitis with rod use — a finding that cuts against common practice). None reach the bar of the six Ch53 studies for independent ingestion priority given the wiki's current backlog, but worth a Research Priorities.md mention if stoma-specific research questions arise.

Parastomal hernia repair technique itself is explicitly deferred by the source textbook to the next chapter (Ch55, "Abdominal Wall Reconstruction and Parastomal Hernia Repair") — this chapter only supplies the parastomal hernia incidence range (0–40%) as part of its general complications table.

Open items / gaps

• All content is textbook-level/secondary. 128 references total; only a handful (noted above) are individually load-bearing enough to flag for future independent ingestion.
• Chapter 55 ("Abdominal Wall Reconstruction and Parastomal Hernia Repair," Petro CC, Prabhu A, Rosen MJ) begins immediately at PDF page 937 with no offset shift — next in the sequential ingest.