When performing surgery for digestive tract endometriosis, it is necessary to take into consideration the possibility of placing a temporary stoma (artificial anus).
The purpose of a stoma is to divert stool upstream from the surgical site to allow for better healing. The stoma can be performed at the outset, during endometriosis surgery, when the surgeons (gynecologist and digestive surgeon) estimate that there is a significant risk of incomplete healing of the digestive suture, which can lead to digestive fistula. Digestive fistula is one of the most severe complications of digestive surgery (17) and is due to the opening of digestive suture, with release of stool into the abdomen (leading to peritonitis) or into the vagina (when an excision of the vagina has been performed). When a stoma is not performed immediately, the occurrence of a fistula requires emergency surgery and placement of a temporary stoma. The stoma is maintained for about 2 months. Its closure by a new surgical intervention is performed once complete healing of the digestive tract suture is certain. In the case of digestive fistula, the stoma may be maintained for several months until complete healing of the fistula (17). One or more additional surgeries may also be required to achieve permanent closure of the fistula (17).
Placing a stoma does not prevent all risks of digestive fistula, but reduces the risk of complications following the appearance of the fistula (peritonitis, complete opening of the digestive suture, etc). Performing a stoma however, presents risks of its own. These specific complications require surgical repair in about 8% of cases (24).
Consequently whether a stoma should be perfomed or not requires detailed discussion with the gynecologic and digestive surgeon before surgery, so as to find the best balance between expected risks and benefits.