IBD, Medical Tests

4 Types of Ostomy Surgery

What is ostomy surgery of the bowel? 

Ostomy surgery of the bowel, also known as bowel diversion, refers to surgical procedures that reroute the normal movement of intestinal contents out of the body when part of the bowel is diseased or removed. Creating an ostomy means bringing part of the intestine through the abdominal wall so that waste exits through the abdominal wall instead of passing through the anus. 

Ostomy surgery of the bowel may be temporary or permanent, depending on the reason for the surgery. A surgeon specially trained in intestinal surgery performs the procedure in a hospital. During the surgery, the person receives general anesthesia.  

Ostomy surgeries of the bowel include: 

  • Ileostomy 
  • Colostomy 
  • Ileoanal reservoir 
  • Continent ileostomy 

What is the bowel? 

The bowel is another word for the small and large intestines. The bowel forms the largest part of the gastrointestinal (GI) tract—a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The anus is a 1-inch-long opening through which stool leaves the body. Organs that make up the GI tract include the mouth, esophagus, stomach, small intestine, large intestine, and anus. The small intestine measures about 20 feet long in adults and includes:  

  • The duodenum: the first part of the small intestine nearest the stomach 
  • The jejunum: the middle section of the small intestine between the duodenum and ileum 
  • The ileum: the lower end of the small intestine 

Peristalsis — a wavelike movement of muscles in the GI tract — moves food and liquid through the GI tract. Peristalsis, along with the release of hormones and enzymes, helps food digest. The small intestine absorbs nutrients from foods and liquids passed from the stomach. Most food digestion and nutrient absorption take place in the small intestine.  

The large intestine consists of the cecum, colon, and rectum. The cecum connects to the last part of the ileum and contains the appendix. The large intestine measures about 5 feet in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to semisolid or solid feces, or stool. Stool passes from the colon to the rectum.  

The rectum measures 6 to 8 inches in adults and is located between the last part of the colon and the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, stool moves from the rectum, through the anus, and out of the body.  

Why does a person need ostomy surgery of the bowel? 

A person may need ostomy surgery of the bowel if they have:  

  • Cancer of the colon or rectum 
  • An injury to the small or large intestine 
  • Inflammatory bowel disease: long-lasting disorders, such as Crohn’s disease and ulcerative colitis, that cause irritation or sores in the GI tract 
  • Obstruction: a blockage in the bowel that prevents the flow of fluids or solids 
  • Diverticulitis: a condition that occurs when small pouches in the colon called diverticula become inflamed, or irritated and swollen, and infected 

What is a stoma? 

During ostomy surgery of the bowel, a surgeon creates a stoma by bringing the end of the intestine through an opening in the abdomen and attaching it to the skin to create an opening outside the body. A stoma may be three-fourths of an inch to a little less than 2 inches wide. The stoma is usually located in the lower part of the abdomen, just below the beltline. However, sometimes the stoma is located in the upper abdomen. 

The surgeon and a wound, ostomy, and continence (WOC) nurse or an enterostomal therapist will work together to select the best location for the stoma. A removable external collection pouch, called an ostomy pouch or ostomy appliance, is attached to the stoma and worn outside the body to collect intestinal contents or stool. Intestinal contents or stool passes through the stoma instead of passing through the anus.  

The stoma has no muscle, so it cannot control the flow of stool, and the flow occurs whenever other digestive muscles contract. Ileostomy and colostomy are the two main types of ostomy surgery of the bowel during which a surgeon creates a stoma.  

What is an ileostomy? 

An ileostomy is a stoma created from a part of the ileum. For this surgery, the surgeon brings the ileum through the abdominal wall to make a stoma. An ileostomy may be permanent or temporary. An ileostomy is permanent when the surgeon removes or bypasses the entire colon, rectum, and anus. A surgeon may perform a temporary ileostomy for a damaged or an inflamed colon or rectum that only needs time to rest or heal from injury or surgery.  

After the colon or rectum heals, the surgeon repairs the opening in the abdominal wall and reconnects the ileum so stool will pass into the colon normally. An ileostomy is the most common temporary bowel diversion. A surgeon performs an ileostomy most often to treat inflammatory bowel disease or rectal cancer.   

What is a colostomy? 

A colostomy is a stoma created from a part of the colon. For this surgery, the surgeon brings the colon through the abdominal wall and makes a stoma. A colostomy may be temporary or permanent. The colostomy is permanent when the surgeon removes or bypasses the lower end of the colon or rectum. A surgeon may perform a temporary colostomy for a damaged or an inflamed lower part of the colon or rectum that only needs time to rest or heal from injury or surgery.  

Once the colon or rectum heals, the surgeon repairs the opening in the abdominal wall and reconnects the colon so stool will pass normally. A surgeon performs a colostomy most often to treat rectal cancer, diverticulitis, or fecal incontinence–the accidental loss of stool.  

What is an ileoanal reservoir? 

An ileoanal reservoir is an internal pouch made from the ileum. This surgery is a common alternative to an ileostomy and does not have a permanent stoma. Also known as a J-pouch or pelvic pouch, the ileoanal reservoir connects to the anus after a surgeon removes the colon and rectum. Stool collects in the ileoanal reservoir and then exits the body through the anus during a bowel movement.  

An ileoanal reservoir is an option after removal of the entire large intestine when the anus remains intact and disease-free. The surgeon often makes a temporary ileostomy before or at the time of making an ileoanal reservoir. Once the ileoanal reservoir heals from surgery, the surgeon reconnects the ileum to the ileoanal pouch and closes the temporary ileostomy. A person does not need a permanent external ostomy pouch for an ileoanal reservoir.  

A surgeon creates an ileoanal reservoir most often to treat ulcerative colitis or familial adenomatous polyposis. Familial adenomatous polyposis is an inherited disease characterized by the presence of 100 or more polyps in the colon. The polyps may lead to colorectal cancer if not treated. People with Crohn’s disease usually are not candidates for this procedure.  

What is a continent ileostomy? 

A continent ileostomy is an internal pouch, sometimes called a Kock pouch, fashioned from the end of the ileum just before it exits the abdominal wall as an ileostomy. The surgeon makes a valve inside the pouch so that intestinal contents do not flow out. The person drains the pouch each day by inserting a thin, flexible tube, called a catheter, through the stoma. The person covers the stoma with a simple patch or dressing. A continent ileostomy is an option for people who are not good candidates for an ileoanal reservoir because of damage to the rectum or anus and who do not want to wear an ostomy pouch.  

Creating the Kock pouch is a delicate surgical procedure that requires a healthy bowel for proper healing. Therefore, a surgeon usually does not perform Kock pouch surgery during an acute attack of bowel disease. A continent ileostomy is now uncommon, and most hospitals do not have a specialist who knows how to perform this type of surgery.  

As with ileoanal reservoir surgery, the surgeon usually removes the colon and rectum to treat the original bowel disease, such as ulcerative colitis or familial adenomatous polyposis. People with Crohn’s disease are not usually candidates for this procedure.  

Source: National Institute of Diabetes and Digestive and Kidney Diseases