Stoma Considerations Following Exenteration

The majority of patients who undergo exenterative surgery for urological, gynecological, or colorectal cancer will require urinary and/ or fecal diversion. The decision-making and formation of a stoma can be complex, with major impact on the quality of life (QoL) of patients. Patients needing pelvic exenteration have a QoL heavily influenced by morbidity relating to stoma complications. This chapter describes various possible urinary and/or combined fecal diversion methods. Accumulation of urine in continent urinary reservoirs can result in metabolic acidosis by reabsorption of ammonia, chloride, and hydrogen and secretion of bicarbonate and sodium. Uretero-ileocecal appendicostomy could be considered as a modification of the Penn pouch, using a detubularized colonic segment folded into a U-shape. Orthotopic neobladder is well known for reconstruction after cystectomy. Comparative studies on continent and incontinent urinary diversion techniques are scarce. Urological leaks can be demonstrated by contrast extravasation on radiological imaging such as computer tomography scans or conduitograms.