The topic at hand is about managing persistent leaks from a stoma that lies on its side, particularly on a small abdomen. This situation can be quite challenging because the output tends to flow beneath the wafer instead of into the pouch, leading to frequent leaks. The person dealing with this issue is currently using a two-piece system with an Ostoform flange but still needs to change the appliance multiple times a day. Here are some suggestions and insights that might help:

1. Consider switching to a convex system:
- Try using convex wafers or a convex single pouch to help push the stoma outward, directing the output into the bag. This might be a temporary or partial fix, especially if the stoma is recessed or side-directed.

2. Evaluate the possibility of stoma revision surgery:
- Sometimes, recessed or side-shooting stomas may need surgical revision. Once corrected, the wear time of the appliance can typically extend to 4–5 days.
- This procedure can be simple and done on an outpatient basis if the bowel can be brought forward. More extensive surgery might be needed if there are complications.
- It’s a good idea to consult with an experienced colorectal surgeon and a stoma nurse team.

3. Improve skin preparation and application technique:
- Make sure to remove all residual adhesive with an adhesive remover.
- Wash the skin around the stoma with oil-free soap and rinse thoroughly.
- Ensure the skin is completely dry before applying the wafer, and avoid using lotions or oily products that might interfere with adhesion.
- Cut the wafer opening to the correct size and use a mirror to ensure even placement.

4. Add barrier rings or seals:
- Applying a barrier ring around the stoma opening on the wafer can enhance the seal and absorb minor moisture.

5. Continue product trials before opting for surgery:
- Stomas can change over time, so experimenting with different systems might lead to a workable solution.
- Some examples to try include various one-piece pouches and two-piece systems, keeping a “less is more” approach in mind.

6. Seek professional guidance:
- Arrange an appointment with a certified stoma nurse for a hands-on assessment of supplies, fit, and stoma condition.
- A specialist can provide samples of convex products, barrier rings, and additional fitting tips.

7. Try a barrier ring and convex wafer combination:
- Using a combination of a convex wafer with a barrier ring can significantly extend wear time and reduce leaks until a more permanent solution is found.