Risk Factors of Ostomy Leakage: A Scoping Review

For people with diseases such as colorectal, bladder, or gynecological cancers, as well as inflammatory bowel disease and diverticulitis, ostomy surgery is a common and often lifesaving intervention. This surgery creates an artificial opening on the abdomen through which feces, gas, or urine exit the body. Therefore, an ostomy appliance is required to collect the effluent. This appliance consists of an ostomy baseplate adhering to the peristomal skin and connected to a collection bag. However, achieving a perfect fit between the appliance and the stoma is not always possible. Leakage occurs when the skin barrier fails to create an adequate seal, allowing effluent to come into contact with the peristomal skin or escape onto clothing. Currently, there is no standardized definition of ostomy leakage. In 2015, Claessens defined leakage as "leakage or seepage under the adhesive: output comes in contact with the skin and/or clothing." In 2017, Fellows et al. defined pouch seal leakage as "stomal effluent seeping between the skin and the wafer of the ostomy pouching system." In 2018, Nafees et al., through qualitative interviews, defined leakage as "leakage under the baseplate" or "leakage outside the baseplate (onto clothing, onto bed)." A multicenter cross-sectional survey with a large sample size showed that most ostomy patients (89%–90%) and stoma care nurses (93%–98%) considered it as leakage when effluent reached outside the edges of the baseplate. Due to the varying definitions of leakage across studies, the reported incidence of leakage also differs substantially. According to the literature, the incidence of ostomy leakage ranges from 17% to 87% and appears to persist over time. Furthermore, due to varying understandings of what constitutes leakage, patient-reported leakage may be underestimated. To minimize the risk of leakage episodes, patients often resort to using ostomy accessory products such as seals/rings, paste, tape, or belts to maintain baseplate adhesion and function, thereby increasing healthcare costs. The emotional burden of leakage and its impact has also been reported as significant. The literature indicates that 92% of the ostomats worried to some degree about leakage, and the emotional impact of experiencing leakage onto clothes appeared to last up to 1 year after the last leakage incidence. Meanwhile, both leakage onto clothing and peristomal skin complications contribute significantly to diminished quality of life. Given this, leakage is a well-known challenge challenge that affects patients' physical, psychological, and daily life. Altogether, leakage problems remain challenging for many patients, and identifying individual reasons for leakage is the first step toward prevention. Previous studies have identified several risk factors associated with ostomy leakage, including female gender, use of one‑piece equipment [21], absence of preoperative siting [22], ostomy type (ileostomy vs. colostomy), stoma morphology (height, shape, and location), peristomal body profile changes, the presence of superficial creases and deep peristomal folds, age, receive preoperative instruction, the underlying reason for surgery. However, due to heterogeneity in study designs, definitions, and measurement methods, the existing evidence remains fragmented. Therefore, the purpose of this scoping review is to establish current knowledge about the risk factors of leakage in ostomy patients, thereby providing a reference for leakage reduction and the development of nursing intervention programs.