Stoma Retraction Management

Initial Conservative Management

The American Gastroenterological Association recommends using convex appliances to create pressure that pushes the retracted stoma outward and improves the seal between the appliance and peristomal skin, with a strength of evidence level not specified 1, 2
Applying an ostomy belt in conjunction with the convex appliance is suggested to maintain consistent pressure and prevent leakage, as recommended by the Clinical Gastroenterology and Hepatology society 1, 2
Utilizing paste or barrier rings around the stoma base to fill in gaps and create a level surface for appliance adhesion is advised, with moderate evidence supporting its effectiveness 1, 2
Heating the appliance with a hair dryer before application and lying flat for several minutes after application can improve adhesion, although the strength of evidence for this is low 1, 2
Ensuring the peristomal skin is completely dry before applying any pouching system is crucial, with high evidence supporting this practice 1, 2
Applying a fine dusting of stomal powder followed by skin sealant on any damaged peristomal skin before appliance placement is recommended, with moderate evidence supporting its effectiveness 1, 2

Measuring stoma size at each appliance change for the first 8 weeks is suggested, as the stoma continues to change during this period, with low evidence supporting this practice 1
Cutting the appliance opening one-eighth inch larger than the stoma can prevent mucosal irritation while minimizing skin exposure to effluent, with moderate evidence supporting this technique 1, 2
Monitoring for secondary complications, including peristomal skin breakdown from leakage, is essential, with high evidence supporting the importance of this practice 1, 2

Persistent leakage causing significant financial hardship from frequent appliance changes and skin damage may require surgical intervention, with low evidence supporting this indication 1, 2

Avoid moving the stoma to a new location during revision, as this creates significant risk of complications at the new site, with moderate evidence supporting this recommendation 3, 4

Preoperative marking by a wound ostomy and continence (WOC) specialist can significantly reduce the risk of retraction and improve quality of life, with high evidence supporting this practice 3, 4
Placement through the rectus muscle rather than lateral to it is recommended, with moderate evidence supporting this technique 1, 3