Colostomy

ALSO KNOWN AS: Ostomy surgery

DEFINITION: Colostomy is the surgical rerouting of the colon through a new opening (ostomy) in the abdomen, forming a stoma. A colostomy is described by the part of the colon involved (ascending, transverse, descending, or sigmoid). The type of stoma constructed (end-type or loop-type), and the type of ostomy (temporary or permanent).

Cancers diagnosed or treated: Colon cancer, rectal cancer, advanced anal cancer

Why performed: Colostomy is performed to reroute the waste in the colon, either as a temporary diversion or as a permanent new path for waste to leave the body. Temporary diversion may be needed so that newly connected tissues in the lower bowel can heal, to stage an operation for a patient who has a partial obstruction or is too frail to undergo extensive surgery, or in an emergency to relieve an obstructing tumor or to allow an infection to clear before removing diseased tissue. Later, the temporary ostomy may be reversed to restore normal bowel function. A permanent colostomy is needed when the anal sphincter is removed, when the rectum and part or all of the colon are removed, and it is not possible or optimal to connect the remaining ends, or when an obstructing tumor cannot be bypassed, or an unremovable tumor is likely to obstruct.

Patient preparation: A series of medical tests are completed to plan treatment and to evaluate the patient’s fitness for this surgery. A specialist (ostomy nurse or enterostomal therapist) counsels the patient and helps choose the location for the stoma. Certain patient medications may need to be stopped for the procedure, the patient’s bowel must be cleaned, and the patient’s stomach must be empty. In an emergency, patient evaluation and preparation may be limited.

Steps of the procedure: Colostomy is performed in a hospital as part of or as the first stage of a larger operation. Sensors are placed to monitor the patient’s condition. An intravenous (IV) line is started, and an antibiotic is infused. General anesthesia is administered, and a breathing tube is placed. The patient is positioned, a urinary catheter is inserted, and the incision sites are prepared.

Most commonly, a colostomy constructs either an end-type or a loop-type stoma. Details for each procedure vary with the larger operation needed, the parts of the bowel involved, and the surgical approach chosen (open or laparoscopic).

With an end-type stoma, this procedure temporarily or permanently connects the upper end of the colon to an opening in the abdomen. First, an ostomy opening is made in the abdomen. The colon is freed from attachments and divided. The upper end is passed through the ostomy opening, the colon segment is sized to an appropriate length, and the edge of the cut end is folded back and stitched to the abdomen, forming an end stoma. The lower end may be totally removed, permanently sealed, temporarily sealed, or temporarily formed into a mucous fistula by connecting it to a second abdominal opening.

With loop-type stoma, this procedure temporarily opens a loop of the colon onto the abdomen and constructs either one stoma (end-loop) or two stomas (double-barrel). First, an ostomy opening is made in the abdomen. A loop of the colon is freed from attachments and brought through the ostomy opening. Then, either an end-loop stoma or a double-barrel stoma is constructed. The loop is divided to create an end-loop stoma. The lower end is sealed and anchored with one stitch near the ostomy opening, and the cut edge of the upper end is folded back and stitched to the abdomen, forming one stoma. To construct a double-barrel stoma, the loop is slit lengthwise. A small bridge is placed underneath the loop, bisecting the slit and raising the middle of the loop. The edges of the split are stitched to the abdomen on both sides of the bridge, forming two stomas.

After the procedure: After the surgery, anesthesia is stopped, and the breathing tube is removed. The urinary catheter and the IV line are kept. A clear collection pouch is fitted over the stoma. The patient is transferred to the recovery room and then to a hospital room. Medications are given to control pain and infection. The ostomy is closely monitored. Once it starts functioning, the patient learns how to care for the stoma, empty and change pouches, and manage bowel function. At home, the patient follows the physician’s instructions for medications, activities, and diet.

Risks: Colostomy is relatively safe. Stomal side effects are very common, but most are not serious. Early side effects are irritation and leakage. Later side effects are hernia, prolapse, fistula, obstruction, ischemia, necrosis, retraction, separation, and narrowing. When an ostomy is temporary, overall risk includes that of reversing the colostomy.

Results: After colostomy, waste previously collected in the rectum and pushed through the anus now flows through the ostomy into a flat plastic pouch (ostomy appliance) that fits securely over the stoma. Depending on the type of colostomy and patient-specific factors, many types and sizes of ostomy appliances are available. Some patients benefit from minor changes in diet and alterations in clothing. Patients can consult with a wound, ostomy, and continence Nurse (WOCN) or an ostomy management specialist (OMS) for expert advice. Colostomy patients’ quality of life has dramatically improved as advances in ostomy management and stomal care benefit from evolving technology.

Bibliography

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