Outcomes of stoma for faecal incontinence.

AIM: Faecal incontinence is a complex condition with multifactorial aetiology and significant medical, social, psychological and economic implications. Stoma formation is typically considered a last resort, and evidence on outcomes remains limited. This study aimed to evaluate the characteristics, management and outcomes of patients undergoing stoma formation for faecal incontinence.

METHOD: A retrospective study was conducted in a tertiary unit, including patients with stoma formation for faecal incontinence between February 2011 and August 2023. Twenty-one patients were identified, of whom 18 participated. Participants completed a 19-item questionnaire, including a Colostomy Impact Score.

RESULTS

Eighteen patients participated (15 female and 3 male) with a mean age of 67 years (median 68). All had severe faecal incontinence affecting quality of life. Seventeen patients had a colostomy (6 loop and 10 end) and one had a loop ileostomy. Ten procedures were laparoscopic, four were trephine and four were open. The mean duration of symptoms prior to stoma formation was 100 months. All had failed conservative treatment; additional treatments included sacral neuromodulation, transanal irrigation and anal sphincter repair. Time from specialist consultation to stoma ranged from 1 to 60 months (mean 17 months, median 7.5 months). Parastomal hernia occurred in 15 patients, seven requiring multiple repairs. Overall, 78% reported improved quality of life and 83% wished for earlier surgery. Median Colostomy Impact Score was 11 and Decision Regret Scale was 13.

CONCLUSION

Stoma formation for refractory faecal incontinence can significantly improve quality of life. However, stoma-related complications remain common and should be addressed during preoperative counselling and long-term follow-up.