Surgical Ostomy - Types, Causes, Procedure, and Complications

Introduction:

An ostomy is a type of surgery done when the intestine cannot continue its function of eliminating waste. An artificial opening is created in the gastrointestinal tract segment and directed to the skin. The segment of the bowel that sticks out at the opening is called a stoma; it has no nerve endings. Hence, it's not painful. A bag/pouch is attached to this stoma, from where the fecal matter is collected, called an ostomy bag/pouch. An ostomy can be permanent or temporary, depending on the condition.

What Are the Types of Ostomy?

Based on the segment of the gastrointestinal tract used to create an ostomy, there are two types:

• Ileostomy: In this, the ileum (the last part of the small intestine, whose function is to absorb water and nutrients from food) is directed to the opening in the anterior abdominal wall. Depending on the condition, the surgeon will carry out this procedure after removing some or all of the colon and rectum. The stoma is created on the right side of the abdomen and can be temporary or permanent. This type of ileostomy is mostly temporary (3 to 6 months). The stool collected from this part is looser and watery.

• Colostomy: In this, the colon (the last part of the gastrointestinal tract, where remaining food and nutrients are absorbed and help to form stool) is directed to the opening in the anterior abdominal wall. Depending on the condition, the stoma can be on the right or left side. The stools are softer and firmer because the colon is further down than the ileum, and more water and nutrients get absorbed.

The types of colostomy are based on the part of the intestine where the stoma is created, i.e., transverse, sigmoid, ascending, or descending colostomy.

What Are the Causes of Surgical Ostomy?

Temporary Causes:

• Colorectal cancer (colon/rectal cancer) which are the parts of the large intestine.

• Inflammatory bowel disease (inflammation of the gastrointestinal tract).

• Diverticulitis (inflammation of small pouches that bulge into the intestine).

• Blockage of the bowel.

• Injury.

Permanent Causes:

• Gastrointestinal malignancies.

• Anal cancer/rectal cancer.

• Crohn's disease.

• Familial adenomatous polyposis (FAP) is an inherited condition where polyps form in the large intestine.

• In ulcerative colitis, the colon and rectum inflamed and develop an ulcer.

• Colonic dysmotility.

• Colon obstruction.

• Bowel incontinence.

• Traumatic disruption of the intestinal tract.

What Is the Procedure of Surgical Ostomy?

The procedure for both ileostomy and colostomy are similar except for the site.

• Before the procedure, the patient should refrain from drinking or eating to empty the bowels.

• The location of the stoma is marked, and general anesthesia is given.

• The surgeon will remove a circle of the skin 2.5 to 3 cm in diameter from the abdomen.

• An incision is made, and areas are identified.

• Depending on the condition, part of the ileum/colon is attached to the abdominal wall, and the surgeon will sew around the stoma.

• Depending on the condition, the surgeon may remove the colon or sew it so it can heal and later be reattached.

• According to the manner of surgical construction, it can be a loop, end, or reservoir.

What Is the Recovery Procedure After Surgical Ostomy?

• After the ostomy, the patient should stay in the hospital for 1 to 2 weeks until complete recovery and receive pain medication.

• Diet instructions are provided; patients are fed through veins/ intravenously.

• Regular check-ups for post-operative complications.

• Avoid extreme physical exercise for three months and driving or heavy lifting for 2 to 3 weeks.

What is an Ostomy Bag/Pouch?

A plastic bag/pouch collects fecal matter from the digestive tract through the stoma. The pouch system may have one component (a sticky back that adheres to the skin) or two components (a sticky ring/flange that fits around the stoma, and the person connects the pouch to the ring/flange). The pouch comes in a variety of styles and sizes. It can be a reusable or single-use bag. It can be large or small. One can use paste, powder, or belts to keep the bag in place.

Features of the Bag: Odor-resistant, easy to put on, hard or impossible to see under clothes, gentle on skin, leakproof. One can use ostomy accessories such as rings and sealants, ostomy paste and skin protectants, adhesive removers, barrier strips, and odor eliminators.

People can use skin-safe powder, charcoal-filtered pouches (to eliminate gas), mints (to eliminate odors), or a small interior bag inside the pouch and discard the bag after it's filled. It has to be changed when it is one-third or one-half filled.

What Are the Complications of Surgical Ostomy?

• The skin around the stoma can be red, itchy, or uncomfortable.

• Pouchitis, an infection, can cause irritation and inflammation of the intestinal lining and should be treated with antibiotics.

• A person is likely to have strong gas in the first two months.

• Bleeding from the stoma.

• No input of stool.

• Diarrhea.

• Nausea.

• Vomiting.

• A person should seek emergency care if the stoma changes its color (blue/dark); it indicates that insufficient oxygen supply.

What Are the Changes in Lifestyle After Surgical Ostomy?

• A person should care regularly.

• Changes in diet and a low-fiber diet should be involved.

• Drink a lot of water.

• Restricting foods that contain causes of gas, such as cabbage, broccoli, etc.

• Avoid chewing gum.

• Chew food thoroughly.

• Eat small meals at regular intervals.

• Extreme exercises should be avoided.

• While taking a bath, the skin around the ostomy site should be cleaned and dried properly.

• People may not have any control over their bowels, so they must wear them continuously.

• This does not affect physical relations, and patients can resume sexual activity.

Conclusion:

Ostomy procedures can be life-saving. However, certain lifestyle changes must be made; caring is of utmost importance. Though it can be a life-changing procedure, one can resume their normal life routine after some months. One has to be mentally and emotionally prepared and talk to their caregivers if any problems occur.