[The complicated stoma--late complications, conservative and surgical management].

Creation of a stoma is related with up to 50% complications. Two main causes are recognised: stomacare and positioning of the stoma. During the first few weeks the diameter of the stoma may shrink by 1/3. In this phase without the professional aid by a stomatherapist the risk of skin problems increases with time. Late complications as prolapse, parastomal hernia and stenosis are often the result of a too lateral positioning of the stoma or of early complications as necrosis, dehiscence, retraction and parastomal abscess. If conservative treatment does not solve the problem surgical procedures are warranted. Beside local corrections replacement of the stoma may be needed. However this is a major operation. Therefore, replacement should be the last option to resolve stoma complications.