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Reasons For Relocation
Moving a colostomy, ileostomy or urostomy may seem a strange or bizarre procedure, but it can be quite necessary and improve a patient's quality of life when appropriately and prop-erly performed. Understanding the indications for this surgical procedure requires an understanding of how a stoma is opti-mally created and managed. When a stoma functions so poorly that it compromises the quality of a patient's everyday life, it needs to be fixed. Sometimes fixing a stoma requires moving the stoma to another site on the abdomen.
The need for a stoma relocation can be determined under a variety of circumstances. Ideally, this should be an elective (meaning scheduled in advance) procedure performed with the understanding of the patient. Counseling by a qualified WOCN (wound ostomy and continence nurse) and preopera-tive marking of the patient's body for placement of stoma sites are essential to success.
Ideally, the stoma should be located below and to one side of the belly button, away from bone, skin creases and scars. (Figure 1 ) There should be a smooth, flat area of skin surround-ing the stoma upon which to fix the appliance. Properly func-tioning stomas should be fairly easy to pouch. A patient should be able to see the stoma and care for it easily. If this is not the case, the cost and time to care for a poorly functioning stoma may justify a surgical procedure to correct the problem. Proper stomas should be pouchable with one appliance without change for 3-5 days and should not leak under routine activi-ties and conditions.
Improper Construction
First, the patient may not have been marked or counseled prior to the surgery. This can occur because some surgeons do not feel it is important to counsel or mark their patients prior to the creation of a stoma. The stoma may have been created during an emergency procedure when there was insufficient time to mark or counsel the patient or the surgeon may not have anticipated the need for a stoma before starting the operation. all these situations can lead to improper placement.
Second, the patient's disease process can stretch the abdo-men so that it is impossible to properly mark the site. Finally, sometimes stomas simply cannot be created properly. Critically...