The value of a well-placed stoma.

PURPOSE: The author describes the purpose, procedure, and practice of stoma-site marking. Patient anxiety and other emotional implications of ostomy surgery are explored, and expenses related to supplies and reimbursement issues are discussed. OVERVIEW: Patients with specific advanced colorectal, bladder, ovarian, or endometrial cancers sometimes require surgery that controls malignancies but necessitates ostomy creation. Despite a well-placed and well-constructed stoma, adjustment to an ostomy is difficult and lengthy. Maladaptive behaviors are exacerbated when an ostomy is constructed poorly and positioned poorly on the abdominal wall. Additional expenses are incurred when this stoma requires a customized and complex pouching system. CLINICAL IMPLICATIONS: Malformed ostomies, leaking ostomy pouches, or skin irritations impact negatively on the patient and family members and may result in treatment delays. The patient's body structure, fat stores, occupation, and clothing style must be considered when determining the appropriate stoma site. Attention also must be paid to psychosocial support so that both emotional and physical healing occur.