Clinics in Colon and Rectal Surgery 2019; 32(03): 171-175
DOI: 10.1055/s-0038-1677004
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diverting Ostomy: For Whom, When, What, Where, and Why

Alexis Plasencia
1  Jackson Memorial Hospital, University of Miami, Miami, Florida
,
Heidi Bahna
2  Division of Colon and Rectal Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
3  University of Miami at JFK Medical Center, Atlantis, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
02 April 2019 (eFirst)

Abstract

Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.