The construction of intestinal stomas is a major part of a surgical procedure. A stoma should be formed by a surgeon who is not only technically skilled but also understands the potential metabolic and mechanical problems associated with an ileostomy or colostomy. Because of many of the complications are preventable, careful preoperative planning by the surgeon in conjunction with an enterostomal therapist is important to minimize the incidence of technical complications and to help prepare the patient psychologically for life with a stoma. When a complication does arise, it should be recognized promptly and dealt with appropriately.