title: Revising the troublesome stoma: combined abdominal wall recontouring and revision of stomas.
abstract: OBJECTIVE
  Despite preoperative siting and maturation of stomas, some patients may have poor stoma function because of redundant pannus, scars, creases, and parastomal or incisional hernias. In these patients, a combined abdominoplasty and stoma revision may be helpful. The object of this manuscript is to report our preliminary results.
  
  
  METHODS
  Eight patients (mean age, 48 years; female/male ratio, 7/1) undergoing this procedure are reported. Five patients had inflammatory bowel disease, two had malignancies, and one had multiple sclerosis with bladder and bowel involvement. Patients were contacted at two months to two years follow-up to assess functional outcome and satisfaction with the procedure.
  
  
  RESULTS
  Indications for surgery were difficulty maintaining an appliance (n = 7), frequent stool leakage (n = 6), and skin irritation (n = 4). Multiple surgeries (n = 4), skin creases (n = 3), scarring (n = 2), large weight loss (n = 4), and hernias (n = 5) were contributing factors. At surgery five patients had hernias repaired (3 parastomal, 2 incisional), three had stomas resited, and three underwent resections for Crohn's disease. One patient developed a seroma postoperatively. At follow-up six patients were able to maintain an appliance for at least four days, whereas one changed the appliance every three days because of personal preference. None experience stool leakage. All reported a dramatic improvement in body image.
  
  
  CONCLUSIONS
  Combined stoma revision and abdominoplasty can be performed safely and leads to improved functional results and outcome.
authors.affiliation: Division of General Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Evans
authors.forename: M H
authors.initials: MH
authors.lastname: Brown
authors.forename: G H
authors.initials: GH
authors.lastname: Wilkes
authors.forename: Z
authors.initials: Z
authors.lastname: Cohen
authors.forename: R S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D003125:Colostomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas