Outcomes of stoma for faecal incontinence

AIM: Faecal incontinence is a complex condition with multifactorial aetiology and significant medical, social, psychological and economic implications. Stoma formation is typically considered a last resort, and evidence on outcomes remains limited. This study aimed to evaluate the characteristics, management and outcomes of patients undergoing stoma formation for faecal incontinence. METHOD: A retrospective study was conducted in a tertiary unit, including patients with stoma formation for faecal incontinence between February 2011 and August 2023. Twenty-one patients were identified, of whom 18 participated. Participants completed a 19-item questionnaire, including a Colostomy Impact Score. RESULTS: Eighteen patients participated (15 female and 3 male) with a mean age of 67 years (median 68). All had severe faecal incontinence affecting quality of life. Seventeen patients had a colostomy (6 loop and 10 end) and one had a loop ileostomy. Ten procedures were laparoscopic, four were trephine and four were open. The mean duration of symptoms prior to stoma formation was 100 months. All had failed conservative treatment; additional treatments included sacral neuromodulation, transanal irrigation and anal sphincter repair. Time from specialist consultation to stoma ranged from 1 to 60 months (mean 17 months, median 7.5 months). Parastomal hernia occurred in 15 patients, seven requiring multiple repairs. Overall, 78% reported improved quality of life and 83% wished for earlier surgery. Median Colostomy Impact Score was 11 and Decision Regret Scale was 13. CONCLUSION: Stoma formation for refractory faecal incontinence can significantly improve quality of life. However, stoma-related complications remain common and should be addressed during preoperative counselling and long-term follow-up.