Stomas

Stoma is the term given to a surgically created opening in the bowel, to allow the diversion of faecal matter.

They may involve the small bowel (ileostomy) or large bowel (colostomy). They may be temporary or permanent, and they may consist of 1 (end) or 2 (loop) openings onto the skin.

Ileostomy

Ileostomies are usually placed in the lower right hand side of the abdomen. They are commonly created as a temporary measure to divert the faecal stream from a bowel join (anastamosis) closer to the anus. These types of ileostomies (loop ileostomy) typically remain in place for at least 6 weeks , but maybe longer depending on

  • Your recovery time from surgery
  • In the case of surgery for cancer, whether any chemotherapy or radiotherapy is needed
  • The integrity of the join that the stoma is ‘bypassing’.

Ileostomies are often ‘spouted’ to improve the ease of fitting a stoma bag. The construction of a good stoma will make the care and ease of your stoma much easier. An ileostomy typically produces between 500-900ml per day.

The closure of a loop ileostomy is a relatively small operation. In most cases there is no incision apart from around the stoma. Prior to closing or reversing the stoma a gastrograffin enema is often done. This is a dye test to test the bowel anastamosis.

Colostomy

A colostomy is usually placed on the left side of the abdomen, and look quite different to an ileostomy. The faecal matter is much more solid in a colostomy, and therefore may only need to be emptied every 2-3 days.

The most common type of colostomy that may be reversed, is a stoma formed during a Hartmann’s procedure. A Hartmann’s is typically performed to treat a perforated colon following diverticulitis, but can also be done for cancer. Reversal or closure of a colostomy is a significant surgical undertaking, and requires either a laparoscopic (keyhole) or open operation. Depending on the level of the large bowel anastamosis, occasionally a temporary loop ileostomy follows a closure of colostomy, but this is uncommon.

Stomal hernia

A stomal hernia (parastomal hernia) is a complication that can significantly affect the quality of life of patients with a stoma. Hernias occur for many reasons that may relate to

  • Patient factors:  co-morbidities, smoking, previous hernias, steroid use
  • Surgical factors:  emergency surgery, bowel obstruction, location of stoma
  • Stoma factors:  small or large bowel stoma, end or loop

Parastomal hernias can present as an emergency with signs and symptoms of bowel obstruction, irreducible hernia, fistula or ischaemia.  Hernias may also present as a gradually enlarging mass or lump deep to the stoma. It can make the fixation of the bag extremely difficult to achieve because of the change in the shape of the abdominal wall, leading to bag leakages and stomal erosions.

Laparoscopic parastomal hernia repair has the advantage of avoiding large incisions, but has the disadvantage of mesh being placed within the abdomen.

Deciding whether an open or a laparoscopic repair is best suited for you is a discussion that you must have with your surgeon.