Abstract:
A stoma extender includes a first end for insertion into a stoma for diverting stomal effluent into the stoma extender before the effluent exits the stoma; a second end for remaining external of the stoma, for providing a discharge exit for stomal effluent; and a conduit portion coupled between the first and second ends for communicating stomal effluent through the stoma extender, wherein the length of the conduit portion is adjustable stably, to permit adaptation of the stoma extender to an individual&#39;s stoma.

Description:
[0001]    The present invention relates to the field of ostomy appliances for fitting and sealing within and around an ostomate&#39;s stoma to direct effluent output. Other aspects of the invention relate to the ability to adjust to the varying distance between the fascia and the skin and the ability to “self-inflate” via fluidic actuation. The term “ostomy” is intended to cover at least colostomy, ileostomy and urostomy. 
       BACKGROUND TO THE INVENTION 
       [0002]    Effectively directing or otherwise controlling effluent output is central to ostomy devices designed to protect skin adjacent to the discharge area. Creating a seal around a person&#39;s stoma, such that the seal is dependable, comfortable and conducive to body tissue, is important for the function of ostomy appliances. Once this seal has been made, the appliance may use one or more of a variety of techniques for managing stomal discharge. The formation of such a seal remains an area of continuous improvement and development, since the performance and comfort of the seal is fundamental to customer acceptance. The protection of the external peristomal tissue where the normal skin and stoma tissue meet is an essential characteristic of such an ostomy device. Peristomal tissue can be extremely sensitive. Irritation can result if the peristomal tissue is exposed to body waste, or to repeated application and removal of adhesive or other sealants. 
         [0003]    Ideally, the stoma should protrude from the abdominal surface of the ostomate by a distance ranging from 0.5 cm to 2.5 cm. This protrusion forms a spout, from which effluent can discharge directly into the pouch. However, in many cases, the stoma protrudes by a lesser amount or not at all. For example, a “flush stoma” is a condition when the stoma reaches only as far as the surface of the abdomen; a “recessed stoma” is a condition when the stoma does not even reach the surface of the abdomen, and the peristomal skin is drawn into a funnel shaped mouth between the stoma and the abdominal surface. There are many potential causes for these conditions. These can include improper formation of the stoma by the surgeon; and post-operative weight gain by the ostomate. Post-operative weight gain causes the ostomate&#39;s abdominal region to expand in girth while the length of the intestine attached to the abdomen remains fixed, thereby resulting in the stoma being pulled toward and ultimately below the surface of the abdomen. 
         [0004]    Flush and recessed stomas can be difficult to manage, because some effluent discharged from the stoma can tend to pool around the stoma, instead of the effluent discharging completely into the pouch. Stool retained in this manner can attack the interface between the adhesive body fitment and the ostomate&#39;s peristomal skin. Such attack reduces the adhesion of the body fitment to the skin, thereby reducing the effectiveness and the usable life of the appliance. The stool can also cause irritation and degradation of the peristomal skin itself. Stool exiting the stoma may contain digestive juices from the body, and such juices can attack the peristomal skin resulting in excoriation. It is hitherto not known for a single device to accommodate varying distances between the stoma and skin level. 
         [0005]    Some known devices use a single expandable balloon or member inside the stoma to form a seal against the inside wall of the opening, and a fixed stop or surface against the outside of the body. However, such devices have to be designed carefully to avoid the risk of damage to the sensitive internal tissue. In such designs, a relatively high concentration of force may be placed on the tissue underneath the stoma, effecting blood circulation in the area under pressure, thereby over time leading to tissue necrosis. 
         [0006]    By way of example, U.S. Publication No. 2003/0220621 describes a valved ostomy device including a hollow discharge tube and anchoring means for anchoring the tube in the stoma. The anchoring means comprises an inflatable balloon cuff inserted in the stoma to anchor the tube against the stomal wall, and a screw threaded clamp as an outer stop surface. Although the screw threaded clamp has a conformable pad, the anchoring means bears the entire weight of the ostomy appliance and any collection device attached to it. Thus, the strength of the attachment has to be offset against limitations on the clamping force which can be applied through the peristomal tissue without causing discomfort and tissue damage, and the inflation pressure of the balloon cuff without causing internal tissue damage to the stoma lumen. Additionally, the device has very little or no range of adjustment to the varying distance between the underside of the fascia and the skin, limiting the use to individuals whose fascia-skin distance is within the range of the device. Also, the means of inflating the device requires a secondary mechanism such as a syringe or pump to inflate it. To have the user carry around an extra component is inconvenient, and the inflation mechanism may not have a means to control the amount of fluid to be pumped into the device, which brings associated risks of under or over-inflation of the device. 
         [0007]    EP 0168967, EP 1346711 and U.S. Pat. No. 4,950,223 describe ostomy ports comprising a single inflatable balloon inserted into the stoma, and an external adhesive wafer for securing the appliance to the skin around the stoma. Such designs are concerned primarily with the formation of a seal inside the stoma lumen. The peristomal tissue is either unprotected or is protected by the adhesive wafer, leaving the possibility that the peristomal tissue may be vulnerable to the conventional problem of irritation and pain resulting from exposure to stool or repeated applications and removals of adhesive. As in the previous referenced device, there are also no significant accommodations for the variation in fascia-skin distance or the fact that a secondary component is required for inflation. 
       SUMMARY OF THE INVENTION 
       [0008]    The present invention is generally directed to a stoma extender having a first end for insertion into a stoma for diverting stomal effluent into the stoma extender before the effluent exits the stoma, a second end for remaining external of the stoma, for providing a discharge exit for stomal effluent, and a tubular portion or conduit portion coupled between the first and second ends for communicating stomal effluent through the stoma extender. 
         [0009]    Optional aspects of the invention include (i) the length of the conduit portion being adjustable stably to enable the stoma extender to be adapted to an individual&#39;s stoma; (ii) a seal for the first end, the seal including a plurality of resilient fingers and elastic webbing extending at least between portions of the fingers; (iii) a seal for the first end, the seal comprising a material configured to expand when contacted by moisture; (iv) a collapsed configuration of the first end and, optionally, a portion of the tubular member or conduit portion, the collapsed configuration being retained by a water-soluble and/or water-dispersible glue or coating, such as gelatin; (v) an inflation fluid reservoir integrated in the stoma extender for inflating a seal at the first end, thereby avoiding the user having to carry additional inflation equipment; and/or (vi) a collar slidable on the tubular member and retained selectively by a selective engagement device. The selective engagement device may be manually operable, or it may be directionally responsive. 
         [0010]    These ideas may be used independently, or any two or more of the above ideas may be used in combination. The invention explicitly envisages all such possible combinations and permutations. 
         [0011]    There are several embodiments of the invention. These illustrate the above and other aspects of: a means of sealing against the intestinal wall; an ability to adjust to the varying fascia-skin distances and provide an elastic range to accommodate movement; a means of insertion and removal from the stoma; and a feature of “self-inflation” by means of internally containing the fluidic pressure to actuate and/or deploy the device. Each embodiment may incorporate one or more of these aspects. 
         [0012]    Additional features usable in combination with this invention are described in co-pending applications U.S. Application Nos. 60/891,120 and 60/891,127, the contents of which are hereby incorporated by reference. 
         [0013]    Other aspects of the present invention, and additional features usable in combination with the foregoing, include: 
         [0014]    (a) The seal may comprise an inflatable chamber portion for sealing against the internal wall of the stoma. The inflatable chamber is toroidal in shape and is sealed to or continuous with a tubular straight, tapered or “trumpet-shape” central channel constructed of a thin elastic material. 
         [0015]    (b) The seal may comprise a first inflatable chamber portion for sealing against the internal wall of the stoma, and a second inflatable chamber portion for sealing externally of the stoma. 
         [0016]    (c) The seal may be positioned in the aperture of an adhesive member. The seal may include an inflatable chamber portion and a support. The support may provide a backbone for the inflatable chamber portion. The inflatable chamber portion may allow the support to float somewhat with respect to the adhesive member. 
         [0017]    (d) The seal may include an inflatable chamber portion that is located in the aperture of an adhesive member, and is configured to seal externally of the stoma, without substantially occluding the stoma. A tubular member or passage may optionally extend through the external inflatable chamber portion for discharge of body waste. The inflatable seal may allow the discharge of body waste without removal of the inflatable seal from the stoma. 
         [0018]    (e) The seal comprising the internal portion for sealing against the internal wall of the stoma may be constructed of a non-inflatable toroidal member, i.e., an O-ring. This member is attached and/or bonded to or is of a continuously formed shape with a generally tubular elastic member that extends through the stoma opening creating a passageway out of the body. 
         [0019]    (f) The seal comprising the internal portion for sealing against the internal wall of the stoma may be constructed, in the deployed state, of a non-inflatable funnel-shaped member possessing finger-like protrusions, roughly like the supporting members of an umbrella, but in the opposite direction of deployment. These protrusions are continuous with a ringed feature at their base that provides a support to maintain a central opening, in particular, if there is a radial force to effect closing of the fingers. This funnel-shaped member is constructed of flexible and/or elastic material such that it is rigid enough to maintain shape but flexible and soft enough to easily close the fingers to affect a somewhat cylindrical shape. The end of the fingers curve inward with a radius so as to prevent the concentration of force at the finger ends when contacting the intestinal wall. Over this funnel-shaped member is attached/bonded or otherwise constructed continually a thin highly elastic covering, so as to create webbing between the fingers and a sealed central tubular passageway from the end of the supporting ringed feature. The central tubular passageway extends through the stoma opening and out of the body. The central tubular passageway may be of a tubular straight, tapered or “trumpet” shape. Another embodiment may have the supporting ringed feature extend through the stoma and out of the body. A tubular shaped insertion tool may be used to engage the curved ends of the fingers in the closed state. Once the distal end of the device in place inside the stoma the tool is removed and the shape memory of the funnel-shaped member deploys the device. It may be that the highly elastic covering is an over-molding where the fingers, formed originally in a pre-loaded state, are held in tension during the over-molding process so that when the completed device is deployed the highly elastic covering retains a stretched condition to maintain the seal to the intestinal wall. 
         [0020]    (g) The seal comprising the internally inflated chamber portion may be constructed of a single chamber or dual interconnecting chambers attached and/or bonded to, or constructed of one formed shape, with a tubular, more firm or rigid central member. The proximal end of this assembly or component may be attached to another more elastic tubular member, or the central member itself continues outside the body, so as to provide a passageway through the device. With embodiments having the other more elastic tubular member, the shape may be tubular straight, tapered or “trumpet-like”. The assembly/component comprising the single or dual chambers, and the more firm central tubular member, are to be inserted fully behind the fascia and inflated, while the proximal end of the central member or the more elastic straight, tapered or “trumpet” shaped tubular member remains external to the stoma. This assembly configuration may allow for easy insertion into the stoma opening without the need for an insertion device. 
         [0021]    (h) The member comprising the seal external to the stoma may be constructed of a thicker toroidal-shaped elastic material or O-ring such that when the internal member is deployed within the stoma the external member may be manually “rolled up” by the user, utilizing the circumferential detent of the toroidal shape and the elastic rebound of the interconnecting tubular member or passage, so as to accommodate the varying fascia-skin distance. The interconnecting tubular member may comprise the range of characteristics from thin and highly elastic to being constructed of more rigid material, and may be of a tubular tapered or “trumpet” shape. 
         [0022]    (i) The member comprising the seal external to the stoma may not only be constructed of a thicker toroidal-shaped elastic material or O-ring for a manual circumferential detent adjustment to the fascia-skin distance, but may also contain a pressurized chamber, i.e., an inflatable O-ring. This chamber is to be pressurized with fluid at manufacture or at some time previous to use, such that the pressure contained, when released, can be utilized to transfer, via elastic action, the fluidic component through interconnecting passageways into the internal chamber so the internal chamber may be deployed while within the body, thereby eliminating the need of a secondary component for inflating the device. An orifice or other fluid restriction, or valve may be used at the entrance, exit or along the interconnecting passageways to delay device deployment to allow the user sufficient time for device insertion. The internal chamber may be constrained, e.g., folded, rolled and/or twisted, into a thin, long shape to ease insertion into the stoma prior to device deployment without the need for an insertion tool. Gelatine or other coating on the constrained internal chamber may facilitate insertion by maintaining the constraint until the gelatine contacts or is within the moist interior of the stoma. The addition of a cap over the internal chamber may also aid in maintaining the chamber in a constrained condition before use. 
         [0023]    (j) The member external to the stoma may not comprise an external seal but may only rest or attach and have “vents” allowing fluid escape in the event the internal seal to the intestine is compromised. The effluent venting may prevent occlusion of the stoma opening in the event of seal failure. The effluent venting may also be an indicator that the device is in need of replacement. 
         [0024]    (k) The member external to the stoma, with embodiments that have amore firm central tubular member, may be comprised of a more rigid material, effectively a collar, and may possesses features along the contacting surface with the central member such that the collar may be manually placed over and easily slid down the central member but will meet more resistance moving up the central member. This may be accomplished via angled, bendable protrusions with sharp ends extending radially inward and contacting the central member so that movement in one direction (downward or distally) is facilitated but opposite movement (upward or proximally) is restrained. The restrained movement in the proximal direction of the collar may not be full but measured so as to prevent tissue damage in the event of excessive or unexpected body movement. Another embodiment may involve a locking feature within the collar whereas once the collar is in place over the central tubular member a second component of the collar interacts to squeeze the central tubular member sufficiently so as to hold the collar in its position on the member. 
         [0025]    (l) Successfully packaging the device embodiments possessing the pressurized external chamber or inflatable O-ring (ref. ‘i’ above) may be accomplished by utilizing a container pressurized with the same fluid and to the same pressure as the device in the non-deployed state. This may alleviate the problem of the device depressurizing over time due to the permeability of the device materials. The package container may be constructed of barrier films or may be a hard polymer or an aluminum (e.g., like a soda can) or other container that will hold the fluidic pressure over time until the contained device is needed. 
         [0026]    (m) The seal comprising the internal portion for sealing against the internal wall of the stoma may be constructed of a rigid tubular member with a semi-spherical bulge at the distal end. The proximal end of the tubular member comprises a generally flange-shaped feature exterior to the body so as to be clear of the stoma and attach to an external wafer or component. Through the bulge are a series of holes. Over the exterior of the tubular member is placed a covering of expandable foam material, which may be generally thicker over the bulge at the distal end. This foam material expands significantly in the presence of moisture. When the device is inserted the moisture and liquid effluent in the stoma pass through the holes in the bulge and over the surface of the foam causing the foam to expand and create a seal against the intestinal wall. 
         [0027]    As used herein, the term “inflatable” means a chamber portion that is configured to be expanded by inflating the chamber with a positive inflation pressure (e.g., a pressure of inflation fluid greater than the external pressure). 
         [0028]    Features and advantages of the invention may include: providing an ostomy seal that is comfortable and effective without creating high concentrations of pressure internally or externally, and which can produce a comfortable peristomal seal; the ability to adjust to the varying fascia-skin distances and provide an elastic range to accommodate movement; the means of insertion and removal from the stoma; and the feature of “self-inflation” by means of internally containing the fluidic pressure to actuate and/or deploy the device. 
         [0029]    Although certain features have been highlighted above and in the appended claims, the Applicant may seek claim protection for any inventive feature and/or idea described and/or illustrated herein whether or not emphasis has been placed thereon. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0030]      FIG. 1  is a schematic perspective view of a first embodiment of the invention in an “unrolled” condition possessing features described in “e” and “h” above. 
           [0031]      FIG. 2  is a schematic perspective view of a second embodiment of the invention in an “unrolled” condition possessing features described in “e” and “h” above. 
           [0032]      FIG. 3  is a schematic sectional view showing the first embodiment of the invention in an “unrolled” condition. 
           [0033]      FIG. 4  is a schematic perspective view of the first embodiment of the invention in an “unrolled” condition illustrating the removal string of the device. 
           [0034]      FIG. 5  is a schematic sectional view showing a third embodiment of the invention in an “unrolled” and deployed condition possessing features described in “f” and “h” above. 
           [0035]      FIG. 6  is a schematic sectional view showing a fourth embodiment of the invention possessing features described in “m” above. 
           [0036]      FIG. 7   a  is a schematic perspective view showing a fifth embodiment of the invention in an “unrolled” and inflated condition possessing features described in “g” and “h” above. 
           [0037]      FIG. 7   b  is complementary schematic perspective views to  FIG. 7   a  showing a fifth embodiment of the invention in an “unrolled” and inflated condition possessing features described in “g” and “h” above. 
           [0038]      FIG. 8  is a schematic sectional view showing the fifth embodiment of the invention in an “unrolled” and inflated condition. 
           [0039]      FIG. 9  is a schematic sectional view a sixth embodiment of the invention in an inflated condition possessing features described in “b” and “g” above. 
           [0040]      FIG. 10  is a schematic perspective view showing a seventh embodiment of the invention in an inflated condition possessing features described in “g”, “j” and “k” above. 
           [0041]      FIG. 11  is a schematic perspective view showing an eighth embodiment of the invention in an inflated condition possessing features described in “g”, “j” and “k” above. 
           [0042]      FIG. 12   a  is a schematic perspective view showing an ninth embodiment of the invention in an “unrolled” and inflated condition possessing features described in “a” and “h” above. 
           [0043]      FIG. 12   b  is a complementary schematic perspective view to  FIG. 12   a  showing an ninth embodiment of the invention in an “unrolled” and inflated condition possessing features described in “a” and “h” above. 
           [0044]      FIG. 13  is a schematic sectional view showing the ninth embodiment of the invention in an “unrolled” and inflated condition. 
           [0045]      FIG. 14   a  is a schematic perspective views showing a tenth embodiment of the invention in an un-deployed condition possessing features described in “a” and “i” above (but cannot be rolled). 
           [0046]      FIG. 14   b  is a complementary schematic perspective view to  FIG. 14   a  showing a tenth embodiment of the invention in an un-deployed condition possessing features described in “a” and “i” above (but cannot be rolled). 
           [0047]      FIG. 15  is a schematic perspective view showing the tenth embodiment of the invention having the constraining cap removed. 
           [0048]      FIG. 16  is a schematic perspective view showing the tenth embodiment of the invention being inserted into the stoma through a two piece ostomy wafer. 
           [0049]      FIG. 17  is a schematic perspective view showing the tenth embodiment of the invention inserted in the stoma through a two piece ostomy wafer but not yet deployed. 
           [0050]      FIG. 18  is a schematic sectional view showing the tenth embodiment of the invention inserted in the stoma through a two piece ostomy wafer but not yet deployed. 
           [0051]      FIG. 19  is a schematic sectional view showing the tenth embodiment of the invention inserted in the stoma through a two piece ostomy wafer and deployed. 
           [0052]      FIG. 20  is a schematic front perspective view showing the tenth embodiment of the invention inserted in the stoma through a two piece ostomy wafer and deployed. 
           [0053]      FIG. 21  is a schematic perspective view showing an eleventh embodiment of the invention in an “unrolled” and inflated condition possessing features described in “a” and “i” above (can be rolled). 
           [0054]      FIG. 22  is a schematic sectional view showing the eleventh embodiment of the invention in an “unrolled” and inflated condition. 
           [0055]      FIG. 23  is a schematic perspective view showing an example dip-molding tool for creating the eleventh embodiment of the invention. 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0056]    Referring to  FIGS. 1-4 , depicting the first and second embodiments, in which an ostomy appliance  10  may include a seal for sealing around a stoma. The seal may generally comprise an O-ring or similar portion  11  for insertion into the stoma and sealing against the internal wall of the stoma lumen, and a second O-ring or similar portion  12  for sealing and/or restraining against external tissue (skin) or an adhesive component around the stoma. The two O-rings are attached or continuous with a conduit portion or tubular member  13  so as to create a central channel  14  for stoma effluent to pass. The internal O-ring  11  is inserted into the stoma via an insertion tool (not shown) and placed just beyond the abdominal wall (fascia). The external O-ring  12  is then grasped and gently tugged outward to seat the internal O-ring  11  against the fascia. The second external O-ring  12  is then manually “rolled” or twisted using the fingers to roll up the excess length of the tubular member  13  so as to adjust to the specific distance between the fascia and skin. The rolling action occurs in increments utilizing the natural circumferential detent of the O-ring  12 . Once sufficient length has been taken up the resistance of the circumferential detent acts to maintain the position of the rolled up length. Additionally, the elastic rebound of the tubular member  13  provides an elastic range to accommodate body movement when the ostomy appliance  10  is worn. The addition of an adhesive on the skin or the adhesive component where the O-ring  12  contacts the skin may aid in securing the ostomy appliance  10 . In the first embodiment ( FIGS. 1 ,  3  and  4 ), the shape of the tubular member  13  is designed to exactly accommodate the diameter reduction resulting from the accumulation of material during the roll up adjustment, resulting in a slightly tapered shape to the tubular member  13  and a somewhat large diameter reduction near the distal end. This will allow for a wide range of fascia-skin adjustment and material elasticity. 
         [0057]    In the second embodiment ( FIG. 2 ), the shape of the tubular member  13  is more “trumpet” shaped. This design reduces bunching of the tubular member  13  material in the stoma but will add a radial force to the external O-ring  12  when rolled so the fascia-skin adjustment range may be reduced. This may be compensated for by increasing the external O-ring  12  rigidity and/or decreasing the O-ring  12  diameter and/or increasing the elasticity of the tubular member  13  material. Refinement of this shape will depend on the applicable range of fascia-skin distance for a given ostomy appliance  10  size. Once the ostomy appliance  10  is in place, stoma effluent passes through the central channel  14  and out of the body. If a two piece ostomy pouch system is used in conjunction with the ostomy appliance  10 , the chance of effluent leakage should be significantly reduced. 
         [0058]    To effect easy removal of the ostomy appliance  10  a removal string  15  is attached in a specific way to the internal O-ring  11  ( FIG. 4 ). The removal string  15 , comprising of nylon, silk or other suitable material, is driven through and attached to the O-ring  11  from the front (distal side) and exits the back. The removal string  15  is then looped around and run through the central channel  14  where it is suitably adhered to the skin or ostomy wafer above the opening of the central channel  14  by way of an attached adhesive strip  16 . When the user wishes to remove the ostomy appliance  10  the removal string  15  is gently pulled. This twists the internal O-ring  11  in a manner that collapses the O-ring shape and allows the O-ring  11  to more easily pass through the stoma opening and out of the body and discarded. 
         [0059]    In a third embodiment of the ostomy appliance  10 , referring to  FIG. 5 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of a funnel-shaped member  18  possessing finger-like protrusions  17 . These protrusions  17  are continuous with a ringed feature  19  at their base that provides support to maintain the opening of the central channel  14  through the funnel-shaped member  18 . The dimensions of the protrusions  17  in conjunction with the flexible and/or elastic material properties of the funnel-shaped member  18  are designed so that the member  18  is rigid enough to maintain shape, but flexible and soft enough to bend the protrusions  17  together to achieve a cylindrical shape for the member  18 . The ends  20  of the protrusions  17  curve inward with a radius so as to prevent the concentration of force at the ends  20  when contacting the intestinal wall. Over the outside of the funnel-shaped member  18  is formed a thin, continuous, highly elastic covering  21  so as to create a collapsible and stretchable webbing between the protrusions  17  and a sealed central channel  14  from the end of the ringed feature  19 . This elastic covering  21  is bonded to or otherwise attached to the funnel-shaped member  18 . It may be that the elastic covering  21  is an over-molding, where the protrusions  17  are formed prior to the over-molding in a pre-loaded state, such that during the over-molding process the protrusions  17  are held in tension so that when the completed ostomy appliance  10  is deployed in situ, the webbing portion of the elastic covering  21  retains a stretched condition to maintain the seal to the intestinal wall. The elastic covering  21  which forms the central channel  14  extends through the stoma opening and out of the body when the ostomy appliance  10  is in place. The shape of the elastic covering  21 , which forms the central channel  14 , is similar to the proximal portion of the tubular member  13  of the second embodiment above ( FIG. 2 ), where the shape of the elastic covering  21  is “trumpet-shaped” and attached to an external O-ring  12 , so as to function similarly as an adjustment to the various fascia-skin distances. 
         [0060]    In another embodiment the shape of the elastic covering  21 , which forms the central channel  14  may also be of a tubular tapered shape attached to an external O-ring  12  as in the first embodiment above ( FIGS. 1 ,  3  and  4 ). 
         [0061]    Still another embodiment may have the supporting ringed feature  19  extend in a tubular straight shape through the stoma passageway and out of the body. 
         [0062]    The means of inserting the ostomy appliance  10  into the stoma may involve the use of a tubular shaped insertion tool (not shown). The tool is placed through the central channel  14  from the proximal end of the ostomy appliance  10 , passes through the ringed feature  19 , and the tool end engages the curved ends of the protrusions  17  when they are bent together into a cylindrical shape. The tool may be held in place by adhesive and/or engaging features at the tool end. The protrusions  17  may also possess adhesive and/or engaging features. The tool may also be held in place via a feature that maintains a fit with the ringed feature  19  and/or the proximal end of the tool and ostomy appliance  10 . The insertion tool may be fixed in place at manufacture and packaged to facilitate user insertion. 
         [0063]    The third embodiment of the ostomy appliance  10  is inserted into the stoma opening via the insertion tool and the tool is then disengaged and removed, allowing the shape memory of the funnel-shaped member  18  to deploy the ostomy appliance  10  and create a seal against the intestinal wall. As with the first and second embodiments the external O-ring  12  is then grasped and manually “rolled” or twisted using the fingers to roll up the excess length of the elastic covering  21 , which forms the central channel  14 , so as to adjust to the specific distance between the fascia and skin. The elastic rebound of the elastic covering  21 , which forms the central channel  14 , also provides an elastic range to accommodate body movement when the ostomy appliance  10  is worn. The addition of an adhesive on the skin or on an adhesive component where the external O-ring  12  contacts, may aid in securing the ostomy appliance  10 . 
         [0064]    The shape memory of the funnel-shaped member  18  is measured so that the force required to simply pull the ostomy appliance  10  out of the stoma is such that it does not inflict tissue damage and is comfortable to the user. 
         [0065]    In a fourth embodiment of the ostomy appliance  10 , referring to  FIG. 6 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of an expandable foam material  22 . This foam material  22  covers the exterior of a more rigid central support  23  that is of a generally tubular shape, but having a semi-spherical bulge  24  at the distal end and flange-like feature  25  at the proximal end. The foam material  22  may have varying thicknesses over different portions of the central support  23 , e.g., it may be thicker over the semi-spherical bulge  24 . The foam material  22  expands significantly in the presence of moisture. Over the exterior of the foam material  22  may be a coating or covering of very thin, elastic sealing film  27 . The flange-like feature  25  remains exterior to the body when the ostomy appliance  10  is in place so as to be clear of the stoma, and may attach to the skin, an external wafer or other component. The flange-like feature  25  may be shaped generally flat, convex, concave or a combination of these. Through the semi-spherical bulge  24  are a series of holes  26  for allowing moisture to pass through the central support  23 . There may be additional holes  26  at other points along the central support  23 . 
         [0066]    The ostomy appliance  10  may be manually inserted through the aperture of a two-piece ostomy wafer and into the stoma and the flange-like feature  25  may then attach to the wafer. The moisture and liquid effluent in the stoma pass into the central channel  14  and through the holes  26  in the central support  23  and into the foam material  22  causing the foam material  22  to expand, stretching the sealing film  27  and creating a seal against the intestinal wall. 
         [0067]    The ostomy appliance  10  is removed manually by detaching the ostomy appliance  10  from the ostomy wafer and pulling it out of the stoma and discarded. 
         [0068]    In a fifth embodiment of the ostomy appliance  10 , referring to  FIGS. 7 and 8 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of an internally inflated chamber portion  28  that may be constructed of dual interconnecting chambers  29  attached and/or bonded to, or constructed of one formed shape, with a tubular more firm or rigid central member  30 . The inflated chamber portion  28  may be attached to another more elastic tubular member  31  similar to the proximal portion of the tubular member  13  of the second embodiment above ( FIG. 2 ), where the shape of the elastic tubular member  31  is “trumpet-shaped” and attached to an external O-ring  12 , so as to function similarly as an adjustment to the various fascia-skin distances. In another embodiment the shape of the elastic tubular member  31 , which also forms part of the central channel  14 , may also be of a tubular tapered shape attached to an external O-ring  12  as in the first embodiment above ( FIGS. 1 ,  3  an  4 ). 
         [0069]    The inflated chamber portion  28  of the fifth embodiment of the ostomy appliance  10  is inserted fully behind the fascia. The proximal end of the ostomy appliance  10 , which includes a portion of the elastic tubular member  31  and the attached O-ring  12 , remains external to the stoma. The dual interconnecting chambers  29  are then inflated via an inflation tube  32  that has a check valve, and an inflation device such as a syringe. Once inflated, as with previous embodiments, the external O-ring  12  is then grasped and gently tugged outward to seat the most proximal of the dual interconnecting chambers  29  against the fascia. The external O-ring  12  is then manually rolled so as to adjust to the specific distance between the fascia and skin. The firmness of the external O-ring  12  acts to maintain the position of the rolled up length and the elastic rebound of the tubular member  31  provides an elastic range to accommodate body movement when the ostomy appliance  10  is worn. Also, as with previous embodiments, the addition of an adhesive on the skin or the adhesive component  33  where the O-ring  12  contacts may aid in securing the ostomy appliance  10 . This assembly configuration may allow for easy insertion into the stoma opening without the need for an insertion device. 
         [0070]    The ostomy appliance  10  is removed by deflating the interconnecting chambers  29  and pulling the ostomy appliance  10  out of the body and discarded. 
         [0071]    In a sixth embodiment of the ostomy appliance  10 , referring to  FIG. 9 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of an internal inflated chamber  34  and an external portion for restraining against external tissue consisting of an external inflated chamber  35  that may be fluidically interconnected and attached and/or bonded to, or constructed of one formed shape, with a tubular more firm or rigid central member  36 . 
         [0072]    The internal chamber  34  and the portion of the central member  36 , up to just before the external chamber  35 , of the ostomy appliance  10  is inserted into the stoma. The interconnected chambers,  34 ,  35 , are then inflated via an inflation tube  32  that has a check valve, and an inflation device. 
         [0073]    The ostomy appliance  10  is removed by deflating the interconnected chambers,  34 ,  35  and pulling the ostomy appliance  10  out of the body and discarded. 
         [0074]    In a seventh embodiment of the ostomy appliance  10 , referring to  FIG. 10 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of a internal inflated chamber  34  attached and/or bonded to, or constructed of one formed shape, with a tubular more firm or rigid central member  36 . The central member  36  continues outside the body, so as to provide a passageway through the ostomy appliance  10 . The member external to the stoma may be comprised of a more rigid material, effectively a collar  37 , and may possess features along the contacting surface with the central member  36  such that the collar  37  may be manually placed over and easily slid down the central member  36  but will meet more resistance moving up the central member  36 . This may be accomplished via angled, bendable protrusions  38  with sharp ends extending radially inward and contacting the central member  36  so that movement in one direction (downward or distally) is facilitated but opposite movement (upward or proximally) is restrained. The restrained movement in the proximal direction of the collar  37  may not be a rigid stop but measured so as to prevent tissue damage in the event of excessive or unexpected body movement. Another embodiment may involve a locking feature (not shown) within the collar  37  whereas once the collar  37  is in place over the central member  36  a second component of the collar  37  interacts to squeeze the central member  36  sufficiently so as to hold the collar  37  in its position on the central member  36 . The collar  37  shape is such as to be clear of the stoma, and may attach to the skin, an external wafer or other component. The collar  37  may be shaped generally flat, convex, concave or a combination of these. The collar  37  may not comprise an external seal but may only rest or attach and have “vents” allowing fluid escape in the event the internal seal to the intestine is compromised. The effluent venting may prevent occlusion of the stoma opening in the event of seal failure. The effluent venting may also be an indicator that the device is in need of replacement. 
         [0075]    The internal chamber  34  and the portion of the central member  36  of the ostomy appliance  10  is inserted into the stoma and fully behind the fascia and inflated via an inflation tube  32  that has a check valve, and an inflation device. The central member  36  is then gently tugged in the proximal direction to seat the internal chamber  34  against the fascia. The collar  37  is then placed over the central member  36  and slid down to rest against the skin, an external wafer or other component, then if needed locked in place. The central member  36  may have excess length trimmed to reduce the profile of the ostomy appliance  10 . 
         [0076]    The ostomy appliance  10  is removed by deflating the internal chamber  34  and pulling the ostomy appliance  10  out of the body and discarded. 
         [0077]    The eighth embodiment of the ostomy appliance  10 , referring to  FIG. 11 , has the same features and function as the seventh except there are dual interconnecting chambers  29  similar to the fifth embodiment. 
         [0078]    In a ninth embodiment of the ostomy appliance  10 , referring to  FIGS. 12 and 13 , an ostomy appliance  10  may include a seal for sealing around a stoma such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of an inflatable chamber  39  toroidal in shape and sealed to or continuous with a tubular tapered or “trumpet-shape” central channel  40  constructed of a thin elastic material. The tapered channel  40  may be attached to another elastic tubular member  31  similar to the proximal portion of the tubular member  13  of the second embodiment above ( FIG. 2 ), where the shape of the elastic tubular member  31  is “trumpet-shaped” and attached to an external O-ring  12 , so as to function similarly as an adjustment to the various fascia-skin distances. In another embodiment the shape of the elastic tubular member  31 , which also forms part of the central channel  14 , may also be of a tubular tapered shape attached to an external O-ring  12  as in the first embodiment above ( FIGS. 1 ,  3  and  4 ). The distal end of the ostomy appliance  10 , including the inflatable chamber  39 , the distal end of the inflation tube  32  and the tapered channel  40  with a portion of the elastic tubular member  31  may be constrained, e.g., folded, rolled and/or twisted, into a thin, long shape to ease insertion into the stoma without the need for an insertion tool. Gelatine or other coating on the constrained members may facilitate insertion by maintaining the constraint until the gelatine contacts or is within the moist interior of the stoma. The addition of a cap over the internal chamber may also aid in maintaining the chamber in a constrained condition before use. 
         [0079]    The constrained distal end of the ninth embodiment of the ostomy appliance  10  is inserted fully into the stoma, so as the end is behind the fascia. The proximal end of the ostomy appliance  10  which includes a portion of the elastic tubular member  31  and the attached O-ring  12  remain external to the stoma. After the constraining coating has dissolved, the inflatable chamber  39  is then inflated via an inflation tube  32  that has a check valve, and an inflation device such as a syringe. Once inflated, as with previous embodiments, the external O-ring  12  is then grasped and gently tugged outward (proximally) to seat the inflatable chamber  39  against the fascia. The external O-ring  12  is then manually rolled so as to adjust to the specific distance between the fascia and skin. The firmness of the external O-ring  12  acts to maintain the position of the rolled up length, and the elastic rebound of the tubular member  31  and the tapered channel  40  provides an elastic range to accommodate body movement when the ostomy appliance  10  is worn. Also, as with previous embodiments, the addition of an adhesive on the skin or the adhesive component where the O-ring  12  contacts may aid in securing the ostomy appliance  10 . 
         [0080]    The ostomy appliance  10  is removed by deflating the inflatable chamber  39  and pulling the ostomy appliance  10  out of the body and discarded. 
         [0081]    In a tenth embodiment of the ostomy appliance  10 , referring to  FIGS. 14 ,  15 ,  16 ,  17 ,  18 ,  19  and  20 , an ostomy appliance  10  may include a seal for sealing around a stoma  41  such that the seal comprising the internal portion for sealing against the internal wall of the stoma lumen consists of an internal inflatable chamber  39  toroidal in shape and sealed to or continuous with a tubular tapered or “trumpet-shape” central channel  40  constructed of a thin elastic material. The tapered channel  40  may also be continuous with another external inflatable chamber  42  having thicker and/or stronger (less soft) elastic material. There are interconnecting fluid passageways  43  between the internal chamber  39  and the external chamber  42 . At the entrance, exit or along the fluid passageways  43  there may be an orifice or other fluid restriction, or valve to delay and/or control the initiation of the fluid transfer from the external chamber  42  to the internal chamber  39 . The external chamber  42  is to be pressurized with fluid at manufacture or at some time previous to use, such that the pressure contained, when released, can be utilized to transfer, via elastic action, the fluidic component from the external chamber  42  through the fluid passageways  43  into the internal chamber  39  so the internal chamber  39  may deploy within the body without the need of a secondary component for inflating the ostomy appliance  10 . The internal chamber  39  and the tapered channel  40  may be constrained, e.g., folded, rolled and/or twisted, into a thin, long shape to ease insertion into the stoma  41  without the need for an insertion tool. Gelatine or other coating  50  on the constrained members may facilitate insertion by maintaining the constraint until the gelatine contacts or is within the moist interior of the stoma  41 . The addition of a cap  46  over the internal chamber  39  and constrained members may also aid in maintaining the internal chamber  39  in a constrained condition before use. Constraining the internal chamber  39  may also prevent premature fluid transfer from the pressurized external chamber  42 . Attached to the external chamber  42  is an attachment cover member  44 . The function of the cover member  44  is to provide a means of easily handling, attaching/removing and deflating the ostomy appliance  10  and is constructed of a relatively rigid polymer material. On the underside of the cover member  44  along the outer flange is a ring-shaped area  48  that once the ostomy appliance  10  is deployed will contact the surface around the stoma  41  on a two-piece ostomy wafer  47 . The ring-shaped area  48  has alternating shallow vents  51  or spaced clearances around the perimeter to allow effluent and/or gas escape from around the back side of the internal seal in the event of seal failure. This ring-shaped area  48  may be coated with an adhesive between the vents  51  and/or the ostomy wafer  47  may have an adhesive for attaching the ostomy appliance  10 . Additionally, within the cover member  44  is a deflation tear-away tab  45  used to deflate the ostomy appliance  10 . The deflation tab  45  is a break-away feature of the cover member  44  in that the attachment or bonding of the material of the external chamber  42  to the attachment member  44  overlaps the perforation of the deflation tab  45  such that when the deflation tab  45  is broken, the seal to the external chamber  42  is compromised, deflating the ostomy appliance  10 . Successfully packaging the ostomy appliance  10  may be accomplished by utilizing a container pressurized with the same fluid and to the same pressure as the external chamber  42  in the non-deployed state. This may alleviate the problem of the ostomy appliance  10  depressurizing over time due to the permeability of the ostomy appliance  10  materials. The package container may be constructed of barrier films or may be a hard polymer or an aluminum (e.g., like a soda can) or other container that will hold the fluidic pressure over time until the contained ostomy appliance  10  is needed. 
         [0082]    The tenth embodiment of the ostomy appliance  10  is removed from its container, the cap  46  is removed ( FIG. 15 ), and the ostomy appliance  10  is inserted fully into the stoma  41  ( FIGS. 16 ,  17  and  18 ), so as the end of the constrained portion is behind the fascia  49 . The constraining coating  50  dissolves and the transfer of fluid from the external chamber  42  to the internal chamber  39  initiates. Applying a manual downward pressure to the cover member  44  may also initiate and/or accelerate the transfer of fluid. The internal chamber  39  is then inflated, and the external chamber  42  deflated which allows the ring-shaped area  48  to contact the surface of the ostomy wafer  47  and attach the ostomy appliance  10 . Stoma effluent is then free to flow through the ostomy appliance  10  and out into a pouch without contacting other tissue. 
         [0083]    The ostomy appliance  10  is removed by pulling the deflation tab  45  out, deflating the ostomy appliance  10 , then pulling the ostomy appliance  10  away from the ostomy wafer  47  and out of the body and discarded. 
         [0084]    The eleventh embodiment of the ostomy appliance  10 , referring to  FIGS. 21 and 22 , has the same features and functionality as the tenth except does not possess an attachment cover member  44  but instead relies on the external inflatable chamber  42  for providing a means of easily handling, attaching/removing and deflating the ostomy appliance  10 . As with the tenth embodiment there are interconnecting fluid passageways  43  between the internal chamber  39  and the external chamber  42  that contains an orifice  52  or other fluid restriction, or valve to delay and/or control the initiation of the fluid transfer from the external chamber  42  to the internal chamber  39 . As with the tenth embodiment, the external chamber  42  is to be pressurized with fluid at manufacture or at some time previous to use. The contained pressurized fluid, when released, may transfer, via elastic action, the fluid from the external chamber  42  through the orifice(s)  52  and fluid passageways  43  into the internal chamber  39  so the internal chamber  39  may deploy within the body without the need of a separate inflation device. The internal chamber  39  and the tapered channel  40  may also be constrained and held via a coating  50 , as with the tenth embodiment, into a thin, long shape to ease insertion into the stoma  41 . A cap may be placed over the internal chamber  39  and constrained members. Additionally, once the ostomy appliance  10  is in place and the external chamber  42  has transferred the fluid into the internal chamber  39  to deploy the ostomy appliance  10 , the deflated external chamber  42  may then be used, being now similar to the external O-ring  12  in the ninth embodiment ( FIGS. 12  and&amp;  13 ), to function as an adjustment to the various fascia-skin distances via a circumferential roll up of the tapered channel  40 . Successfully packaging the ostomy appliance  10  may be accomplished similar to the tenth embodiment, by utilizing a container pressurized with the same fluid and to the same pressure as the external chamber  42  in the non-deployed state. 
         [0085]    The ostomy appliance  10  may be fabricated in part by means of a dip molding process.  FIG. 23  demonstrates an example of a possible dip-mold mandrel tool. First the tool may be dipped in an appropriate material component up to the A-A line and allowed to cure so as to form a thin, soft, highly elastic film for the formation of the internal chamber  39  and tapered channel  40 . This defines the first dipping area  53 . 
         [0086]    Then the tool may be dipped in an appropriate material component up to the B-B line and allowed to cure so as to form a thick, strong, elastic film for the formation of the external chamber  42 . This defines the second dipping area  54 . The second dipping area  54  may require subsequent dips to achieve the desired thickness. After curing of the dip-mold materials additional assembly steps will be needed to complete the ostomy appliance  10 . 
         [0087]    The eleventh embodiment of the ostomy appliance  10 , very similar to the tenth, is removed from its container, the cap over the constrained members is removed, and the ostomy appliance  10  is inserted fully into the stoma  41 , so as the end of the constrained portion is behind the fascia  49 . The constraining coating dissolves and the transfer of fluid from the external chamber  42  to the internal chamber  39  initiates. The internal chamber  39  is then inflated, and the external chamber  42  deflated which allows the deflated external chamber  42  to be used as the external O-ring  12  as in previous embodiments. The external chamber  42  is grasped and gently tugged outward (proximally) to seat the inflatable chamber  39  against the fascia  49 . The external chamber  42  is then manually rolled so as to adjust to the specific distance between the fascia and skin. The firmness of the deflated external chamber  42  acts to maintain the position of the rolled up length, and the elastic rebound of the tapered channel  40  provides an elastic range to accommodate body movement when the ostomy appliance  10  is worn. Adhesive on the surface of the ostomy wafer  47  contacting the underside of the external chamber  42  assists in attaching the ostomy appliance  10 . Stoma effluent is then free to flow through the ostomy appliance  10  and out into a pouch without contacting other tissue. 
         [0088]    The ostomy appliance  10  is removed by pulling the deflation pull-out  51 , deflating the ostomy appliance  10 , then pulling the ostomy appliance  10  away from the ostomy wafer  47  and out of the body and discarded. 
         [0089]    It will be appreciated that the foregoing description contains preferred forms of the invention, and that many modifications, improvements and equivalents are within the scope of the claimed invention.