The topic at hand is about a person who has had a permanent ileostomy for 45 years without any issues. Recently, they noticed that the stoma's opening has shifted from the center to the top edge and is now almost level with the skin. They are concerned about what might happen if the opening goes below the skin surface and are considering whether a surgical revision is necessary.

Here are some helpful insights and advice:

1. The main concern is whether the stoma retracting below the skin surface could lead to functional or health problems.

2. The person is a nurse with experience in ostomy care and has seen many irregular stomas in patients, but is understandably worried about their own situation.

3. If the stoma continues to work well without causing obstruction, excessive leakage, or skin damage, most surgeons and experienced ostomates suggest avoiding revision surgery.

4. It's common for stomas to change shape, size, and position over time due to factors like aging muscles, weight changes, pregnancies, or tightening of peristaltic muscles. These changes are often harmless.

5. For temporary blockages caused by muscle tightening around the stoma, using a dilator gently and practicing relaxation techniques can help restore flow without needing surgery.

6. Even if there are more leaks as the stoma retracts, non-surgical management, such as adjusting appliances, is generally preferred. This is especially true for older patients who want to avoid the risks associated with surgery.