An ileostomy is a procedure done when the lumen of the ileum is carried via the abdominal wall surgical opening, which the surgeon develops during the surgery. The ileostomy procedure can be transient or permanent, an end procedure, or a loop procedure. This procedure aims to vacate the body through the ileum rather than the typical pathway via the anus. The outcome of this procedure includes a loose stool, even with that predicted to move via the ileum. The big bowel causes stool to be solid and conditional upon moisture absorption. The outcome of this procedure can alter but generally varies from two hundred to seven hundred milliliters per day, and an Ileostomy is usually initiated on the right abdominal flank.
What Are the Anatomical and Physiological Considerations in Loop Ileostomy?
An ileostomy originates from a portion of the ileum, a portion of the small intestine. The small intestine starts at the pylorus part of the stomach. It comprises three adjacent units: the proximal region is called the duodenum, the middle part jejunum, and the distal ileum. The ileum and jejunum are intraperitoneal arrangements. Thus, the duodenum has a retroperitoneal element to it.
The jejunum and duodenum are connected to the ileum mesentery. They are peritoneal folds, including vessels, lymphatic channels, and nerves. The small intestine is six to seven meters long with a variable diameter of the lumen that is three and five centimeters. It has many procedures involving the digestion of food, enzyme production, and absorbing proteins and nutrients: the intestinal wall, the subserosa, and the serosa. The ileum ends at the junction of the ileocaecal at the top part of the caecum valve before forming the upward colon. Therefore, the caecum can be recognized at that end of the bowel.
The front abdominal wall anatomy is essential to know the location of the trephine incision, which is done in the ileostomy. The discovered layers are the skin, subcutaneous layer of fat, Scarpa's fascia and Camper's, front rectus sheath, muscle, back rectus sheath, and the peritoneum.
The muscles include the outer and inner obliques, the transverse abdominis, and the rectus abdominis. The abdominis, which are obliques and transverse, will connect in different levels to the inferior ribs and the iliac crests. In contrast, the rectus abdominis originates from the costal border and xiphoid process before advancing inferiorly to the symphysis pubis.
The abdomen muscles are covered in fascia but have thick tendons known as aponeuroses that consolidate at the midline to create the linea alba. We should obtain this procedure via the muscle of the rectum and sheath to decrease the hazard of the later-parastomal appearance of the hernia, which arises when the incision produces the constituents of the abdomen force via the defect.
What Are the Indications of Loop Ileostomy?
There are various indications for creating an ileostomy. A loop ileostomy is done if a distal part of the ileum is taken out to the skin with two lumens emptying into the sac of the stoma and is typically utilized as a temporary stool diversion to shield an anastomosis distally like a colonic anastomosis in fractional resection of the colon.
The basis for protecting the anastomosis's distal position is to decrease the hazard of anastomosis leakage during the passage of stool by joining the two bowel endings. If the anastomosis distally has recovered, two limbs of the loop ileostomy can be merged jointly, correcting the gastrointestinal tract continuity and permitting the passage of the stool via the colon.
In this procedure, the limb of the proximal part departs out of the stool, and the distal limb shows a mucous fistula, emptying the discharges created within the lining of the mucosa lining beginning from the lumen into the caecum.
Nevertheless, the distal limb of a distal part would not empty secretions of the colon. The ileocaecal valve is capable and does not relax the colon. It is significant to mention if there is a colonic obstacle, as the patient would be at risk of perforation due to the obstruction in the big bowel.
It is because the colon is incapable of decompressing may be in the proximal or distal direction to the obstructing origin, generating discharges and flatus to create tension in an effectively sealed bowel loop. Subsequently, this temporary ileostomy can be repaired and reconnected in three and six months to provide continuity of the bowel.
How Is Loop Ileostomy Performed?
The limb of the distal part is unfurled transversely for its diameter in a place of about midway up from the skin. Bleeding in the submucosa can be handled with bipolar cautery. Interrupted absorbable sutures are positioned at the three, nine, and twelve o'clock positions, carrying seromuscular bites at the top portion of the lumen in the limbs and four cm inferior to the loop before bearing a subcuticular piece of the skin at the trephine skin border.
The locations are far from the supplying mesentery. A Langenbeck retractor is utilized to support the lumen. The interrupted stitches are then secured in the area by using square knots. The limb away from the midline is everted likewise. Thus, they are small and squirted as there is a small bump of the limb distally beyond the skin. Interrupted absorbable stitches are roughly used in a circular pattern on two limbs without eliminating the blood supply of the mesentery.
What Are the Complications of Loop Ileostomy?
The complication of the loop ileostomy includes - Stenosis, bleeding, recurrence, renal impairment, loss of balance in the electrolytes, obstacle or fistula appearance, allergy to the skin, infection in the chest, formation of blood clots, and difficulty in passing urine.
The appearance of an ileostomy if in an immediate urgent or elective environment. It can be regarded as a life-saving procedure. It is achieved in the patient's appeals to enhance their life grade. An ileostomy procedure is accomplished by a surgeon, a children's surgeon, or a surgeon of the colorectum, and a stoma nurse provides the care. This condition can occur in an urgent situation or as elective surgery. This procedure includes the operator accountable for approving the patient concerning components of the method and the postoperative period concerned.