STOMA CONSTRUCTION AND THE OBESE PATIENT: Using a Visual Model to Explain and Demonstrate Flush and Retracted Stomas in the Obese Population

Unfortunately flat, retracted, or problematic stomas are the reality for many ostomy patients. Unfortunately, when patients realize their stomas are unlike those shown in medical literature or what they had expected pre-surgery, surgeons are often blamed for these problems when, in fact, other pre-existing physical conditions such as obesity are the culprit. To avert the inevitable blame game and enhance learning and successive ostomy autonomy for your patients, one of the major conditions that MUST be addressed during your instruction session is how the degree of obesity, the thickness of the fatty omentum, and the structure of the mesentery directly affect the surgical formation of a stoma and it’s management after surgery. However, by using the words “fat” or “obese” when providing patient education you may be encouraging serious consequences: your patient’s body image concerns could be injured wounding already fragile feelings, and an innocent discussion about your patient’s belly fat could unintentionally derail your teaching session causing important information regarding how obesity can negatively affect a physician’s surgical technique while building a stoma to be missed. By using a visual model such as the Anatomical Apron with an attachable Adipose Pad you can easily demonstrate and explain how the thickness of the abdominal wall directly affects the physician’s formation of the stoma, how excessive adipose tissue causes tension and subsequent stomal problems such as flatness, retraction, and appliance integrity issues, and how abdominal thickness and mesentery structure intensify stoma retraction and functionality post-surgery. The Anatomical Apron with the attached Adipose Pad allows you and your patient to focus on the role of adipose tissue in the abdomen and the subsequent complications it can cause a surgeon while trying to construct a budded stoma without evoking hurt feelings, derailing your patient teaching, or encouraging your patient to lay blame anywhere.