Intestinal Stomas; Basics, Complications and Controversy: Systematic review

Introduction Intestinal stomas, including ileostomies and colostomies, are surgically created openings in the abdominal wall to divert bowel contents for treating various benign and malignant conditions. Stomas, which can be temporary or permanent, play a critical role in decompressing the bowel, diverting contents, or protecting surgical anastomoses. Despite their benefits, stoma-related complications occur in 10%-70% of cases and significantly affect patients’ quality of life, including social and psychological well-being. Objectives: This systematic review categorizes stomas by presentation, fate, anatomical site, and construction, reviews complications, and examines nutritional, psychological, and social impacts, management controversies, and cost-reduction strategies. Methods We reviewed clinical studies, guidelines, and expert recommendations on stoma types, complications, and management challenges. Results Stomas are classified by presentation (emergency/elective), fate (temporary/permanent), anatomical site (ileostomy/colostomy), and construction (loop/divided). Complications (10%-70%) include skin irritation, stenosis, hernias, prolapse, and retraction. Nutritional support, particularly tailored diets for high-output stomas, is crucial. Stomas have considerable social and psychological impacts, but these can be improved through support groups and specialized care. Management controversies include timing of stoma closure, indications for diverting stomas, and approaches to leaks. The financial burden, including costs of managing complications, can be reduced by enhancing patient support and healthcare resources. Conclusions Optimal stoma care requires a multidisciplinary, patient-centered approach to improve physical and mental health outcomes. Despite ongoing management controversies, patient autonomy and well-being remain central. Strengthening support systems and healthcare resources is essential for better clinical and financial outcomes for stoma patients.