Ostomies and their appliances have evolved considerably and are now part of our daily surgical routine. The first ostomies date back to Antiquity, but little progress was made until the 19th century, when surgical technique was perfected. This paved the way for the appearance and development of commercial stomal appliances in the 20th century. In France, the technique for creation of a stoma is currently based on the 2023 recommendations, but it is important to note that many points are based on expert consensus, and some have not led to recommendations. At the same time, enterostomal therapy and therapeutic patient education have become common practices, and a wide range of appliance choices are now offered to the patient. Despite these advances, several challenges persist, particularly in terms of overall accessibility, economic burden, ecological impact, and optimizing the experience of ostomy patients. Innovation must address these challenges to offer increasingly tailored, personalized, and sustainable solutions, with particular attention paid to the patient experience.