Is it possible to remove the stoma and restore it? Colostomy removal surgery. These colostomies are installed in the lower part of the left half of the abdominal wall - almost at the very end of the colon, which ensures the release of masses that are very similar in physical and chemical properties.

With a number of intestinal diseases, the passage of stool and its release through natural means is impossible. Then doctors resort to colostomy.

Colostomy - what is it and how to live with it?

A colostomy is a kind of artificial anus that doctors make in the abdominal wall. A hole is made in the peritoneum, and the end of the intestine (usually the colon) is sewn into it. Feces, passing through the intestines, reach the opening and fall into the bag attached to it.

Typically, such an operation is performed when there is a need to bypass the rectal part in the postoperative period, in case of traumatic injuries or tumors, inflammation, etc.

Photo of rectal colostomy

If the lower intestinal tract cannot be restored, a permanent colostomy is performed. Healthy people can easily control bowel movements. This is ensured by the uninterrupted activity of the sphincters.

In patients with colostomy, feces exit through the artificially formed anus in the form of semi-formed or formed masses, without disturbing intestinal activity.

Indications for colostomy

A colostomy can be temporary or permanent. Children most often undergo a temporary stoma.

In general, the indications for colostomy are as follows:

Anorectal incontinence;
Blockage of the intestinal lumen;
colonic walls such as gunshot or mechanical wounds;
Severe cases of colonic pathologies such as ischemic colitis, cancer or peritonitis, and nonspecific ulcerative colitis, abscesses of the intestinal walls with perforation, etc.;
Recurrent cases of cancer processes in and, or;
The presence of severe forms of post-radiation proctitis, this is especially common after cervical canal cancer;
If there are internal to the vagina or bladder;
As a preoperative preparation for the prevention of suture dehiscence and suppuration;
For congenital anomalies such as Hirschsprung's pathology, meconium ileus in newborns or atresia of the anal canal, etc. (if radical intervention is not possible);
With rectosigmoid resection, if after the operation the sutures are ineffective.

Types of stoma

Depending on the location, colostomies are classified into several types: transverse, ascending and descending.

Transverse colostomy.

A transversostomy is formed in the upper abdomen, in the transverse colon.

To avoid nerve damage, the transverse stoma is placed closer to the left splenic flexure.

A transverse colostomy is indicated for intestinal blockage or oncopathologies, traumatic injuries and diverticulitis, and congenital colon anomalies.

Typically, such colostomies are installed temporarily for the duration of treatment. On a permanent basis, transverse stomas are necessary when removing an underlying section of intestine.

Transverse stomas are divided into two types: single-barrel and double-barrel.

Single-barrel or the end stoma is a longitudinal incision of the large intestine, so only one opening is brought to the surface. This technique is usually permanent and is used in radical ectomy of the descending colon.
Double-barreled A colostomy involves removing a loop of intestine and making a transverse incision on it in such a way that 2 intestinal openings are exposed to the peritoneum. Through one passage, feces are excreted, and through the other, medications are usually administered.

The lower intestine may continue to produce mucus, which will be released through the hole created by the cut or the anus, which is normal. Such transversostomies are usually made for a certain period of time.

Ascending colostomy or ascendostomy.

A similar stoma is located on the ascending colon, so it is localized on the right side of the peritoneum. This area is located in the early intestinal part, therefore the excreted contents will be alkaline, liquid and rich in residual digestive enzymes.

Therefore, the colostomy bag needs to be cleaned as often as possible, and the patient is advised to drink more to avoid dehydration, since an ascendostomy is characterized by thirst. An ascending colostomy is usually a temporary therapeutic measure.

Descending and sigmoid colostomy method (descendostomy and sigmostoma).

These types of colostomies are installed on the left side of the peritoneum in its lower part, actually at the end of the colon. Therefore, it produces masses with physical and chemical properties similar to ordinary feces.

A distinctive feature of such colostomies is the patient’s ability to regulate bowel movements. This is explained by the fact that in these parts of the intestine there are nerve endings that allow you to control the process of excretion of feces. Such localization of colostomies allows them to be installed for a long time and even permanently.

Advantages and disadvantages

The procedure is often vital in nature, providing the patient with a normal life after radical surgical intervention for cancer of the sigmoid or rectum.

This fact is the main indisputable advantage of the artificially created anus.

In addition, modern bandages, colostomy bags and other devices allow you to live comfortably even with a permanent colostomy.

The method certainly has its drawbacks. Perhaps the main one is the psychological factor, which is often the cause of deep depression in the patient. But doctors have learned to deal with this too - they carry out explanatory work with patients, talk about proper stoma care, clarify important nuances, talk about sensations, etc.

For many, smell may seem like another drawback. But the problem is completely solvable, because modern colostomy bags are equipped with magnetic covers, anti-odor filters, and there are also specialized deodorants on sale. Therefore, today such accessories allow us to solve the problem of skin irritation and frequent replacement of the colostomy bag.

Types of colostomy bags

Colostomy bags come in one- and two-component types. Two-component ones are equipped with ostomy bags and a self-adhesive plate, connected by a special flange. But such colostomy bags are inconvenient because they can cause skin irritation. Therefore, when using them, it is allowed to replace the plate every 2-4 days, and the bag - daily.

If there is a feeling of itching and discomfort, it is recommended to immediately peel off the plate. An undoubted advantage is that the colostomy bag is equipped with a special filter that eliminates gases and odors.

Unlike a two-component one, a one-component colostomy bag must be changed every 7-8 hours. Two-component ones involve replacing only the bag, and the plate is changed only once every 3-4 days.

The drainage bag must be emptied when it is 1/3 full; to do this, bend over the toilet a little and open the drainage hole, after which the feces bag must be washed and dried. Before reusing the bag, check the drainage hole to ensure it is closed.

How to care for your stoma at home?

A colostomy requires very careful care, which begins from the first day after surgery. First, the patient is taught by a nurse who changes colostomy bags and cleanses the stoma. In the future, the patient independently changes fecal bags and treats the stoma opening.

The whole process takes place in several algorithms:

First, the feces are removed;
Then the outlet hole is washed with boiled warm water, the skin around it is thoroughly washed, and then dried with gauze napkins;
Treat the skin surface with Lassara paste or Stomagesiv ointment, after which gauze soaked in Vaseline is applied around the stoma and covered with a sterile bandage and cotton wool. Cover the treatment area with a gauze bandage, which is changed every 4 hours.
When the stoma heals and is completely formed, you can use colostomy bags. The final formation and healing is indicated by the mouth not protruding above the skin and the absence of inflammatory infiltrate. Only with such a clinical picture is the use of a colostomy bag allowed.
It is recommended to change fecal bags in the evenings or in the morning. First, carefully remove the used feces receptacle, then remove any remaining feces and wash the stoma. Then the mouth and the skin around it are treated with ointment or paste, and then the colostomy bag is fixed again.

Typically, Coloplast paste containing a small amount of alcohol is used to glue the receiver. The product does not cause irritation even to skin damaged by trauma and inflammation, and also improves the fixation of the device.

Some patients, before gluing the colostomy bag, treat the skin with a special protective film, which protects the skin from inflammation and irritation.

Nutrition

There is no special specialized diet for colostomy patients, so after surgery, significant changes in the patient’s diet are not expected.

With a colostomy, the only thing that needs to be taken into account is the effect of each product on the digestive processes.

It is recommended to limit foods that contribute to gas formation, which include eggs and beer, carbonated drinks and cabbage, mushrooms and legumes, onions and chocolate, for obvious reasons.
Foods such as garlic and eggs, spices and fish, onions and cheese significantly enhance the smell of intestinal gases.
Lettuce and yogurt, lingonberries and spinach, parsley, etc. have the opposite effect.

With the right combination of products, many unpleasant situations can be avoided. In addition, it is recommended to chew food with special care, eat more often and little by little.

To prevent unwanted gas escape, you can lightly press on the stoma. Colostomy patients should also monitor the consumption of laxatives and constipation foods to avoid problems such as diarrhea or constipation.

Types of operations

The location of the colostomy is determined by the doctor, taking into account the specific clinical picture of each patient.

The presence of hems or scars can significantly complicate the installation of a stoma on the intestine, since it is necessary to take into account the condition of the fatty tissue and muscle layer, which, when folds form, can displace the colostomy over time.

Patients may require surgery to create or close a colostomy, as well as surgical intervention for reconstructive purposes. Each intervention has its own individual characteristics, requiring a different approach to the patient.

Overlay

The colostomy procedure is performed under general anesthesia in a sterile operating room.

First, the surgeon cuts off a rounded area of subcutaneous tissue and skin at the site of the intended location of the stoma.
In the second stage of the operation, the muscles are separated in the direction of the fibers. To avoid compression on the intestine, the hole is made large enough. In addition, the likelihood that the patient will gain excess weight is taken into account in advance if the stoma is applied for a long time.
Then the intestine is brought out through a loop and the necessary incision is made on it.
The intestine is sutured to the muscle tissue of the peritoneum, and its edges are attached to the skin.

Unfortunately, it has not yet been possible to invent drainage means into the stomal mouth, since the immune system includes protective functions and actively resists foreign materials, provoking tissue degeneration and inflammation.

Only surgical suturing of the intestinal edge to the skin heals favorably, although it would be much easier to use special tubes coming from the intestinal lumen and brought out.

Closing

Surgery to close a stoma in the intestine is called a colostomy.

A temporary colostomy is usually closed 2-6 months after placement. This operation is the elimination of an artificially created anus.

A prerequisite for closing the operation is the absence of obstructions in the lower parts of the intestine to the anus.

About a centimeter from the edge of the stoma, the surgeon makes a tissue dissection, slowly separating the elements. Then the intestine is brought out and the edge with the hole is excised. Then both ends of the intestine are sutured and returned back to the peritoneum. Then, using contrast, the seam is checked for leaks, after which the wound is sutured layer-by-layer.

Reconstructive surgery

Typically, such interventions are prescribed to patients with temporary colostomies imposed while the underlying sections of the intestine are being treated. Many patients believe that after stomal closure, intestinal functions are completely restored, which is not entirely true.

Even if the restorative surgical intervention is completely successful, the absence of a certain area in the intestine cannot but affect its further functionality.

The most optimal period for stromal closure is the first 3-12 months after surgery. This is the only way to count on successful healing of intestinal tissues without consequences for the body. In fact, reconstructive surgery is the closure of a stoma or colostomy, the description of which is presented above.

Diet after surgery

After reconstructive surgery or closure of the stoma, you must follow a strict diet so that the digestive processes quickly recover.

The diet comes down to excluding foods like:

Hot seasonings or spices like curry, chili pepper, etc.;
Excessive amounts of soda, kvass or beer;
Gas-forming products such as beans, garlic or cabbage, etc.;
Fatty foods;
Foods that cause irritation of intestinal tissues, such as currants or raspberries, grapes or citrus fruits.

If necessary, the doctor prescribes individual restrictive dietary instructions for the patient.

Complications

Colostomy is a serious surgical procedure that can cause many complications.

Specific secretions. This mucus is produced by intestinal tissues as a lubricant to facilitate the passage of stool. Normally, the consistency of the discharge may be sticky or similar to egg white. If there are purulent or bloody impurities in the mucus, this may indicate the development of an infectious process or damage to the intestinal tissue.
Blocking the stoma orifice. Typically, this phenomenon is the result of the adhesion of food particles and is accompanied by watery stools, swelling of the stoma, flatulence or nausea and vomiting symptoms. If you suspect the development of such a complication, it is recommended to exclude solid foods, periodically massage the abdominal area near the mouth of the stoma, increase the volume of fluid consumed, and take hot baths more often, which helps to relax the abdominal muscles.
Paracolostomy hernia. This complication involves protrusion of the intestine through the muscles of the peritoneum, and a clear subcutaneous bulge is observed near the mouth of the stoma. Special support bandages, weight control and avoidance of lifting and dragging heavy objects will help you avoid this. Usually hernias are eliminated using conservative methods, but sometimes it cannot be done without. Unfortunately, there is always a possibility of re-formation of the hernia process.

Also, with a colostomy, other complications may develop, such as fistulas, prolapse or retraction of the stoma, stenosis or ischemia of the colostomy, leakage of digestive waste into the abdominal cavity or onto the skin surface, stricture or evagination, and necrosis, purulent processes, etc.

You can avoid such troubles, the main thing is to strictly follow medical recommendations, especially the diet and hygienic requirements for caring for a colostomy.

Videos about how to care for a colostomy:

Any patient perceives the closure of a colostomy with joy, because he has a chance, although not immediately, to send his needs through the anus, located at the end of the rectum, and not on the stomach, and to do this at his own request. However, to achieve the long-awaited normalization of stool, you need to go a long way to restore the functioning of the large intestine. How is the operation to close a colostomy performed and when will the period of life associated with many inconveniences, called life after a colostomy, end?

Unlike an ileostomy, a colostomy is an opening for removing feces from the large intestine.

A colostomy has some advantages over an ileostomy:

Although uncontrollable, the urge to defecate is an opportunity to mentally prepare in a few minutes.
The feces are practically formed - the skin around the stoma is subject to less irritation.
The course of the operation to apply a colostomy, just like the course of the operation to close it, consists of fewer stages.
The diet is not so strict.
The recovery period takes 2-3 times less time than if a stoma for the small intestine is closed.

The course of the operation to close a colostomy consists of the following stages:

With a double-barreled stoma, an incision is made between two holes, and with a single-barrel stoma, the length of the incision depends on the length of the longitudinal incision of the colon, which was made before the colostomy.
The section of intestine where the ostomy was performed is removed.
With double-barrel, the holes are sutured, and with single-barrel, the functioning ends of the intestine are connected. As a rule, the closure of an end stoma (single-barrel type) is carried out with the removal of a section of the intestine that was cut longitudinally, plus 10-15% beyond this length, and this is already a resection of the intestine, that is, the intestine will not function as before the ostomy. The consequences are expressed in rapid bowel movements from 15 minutes to 2 hours after eating. Accordingly, in order to increase the absorption of nutrients, you need to either eat several times more, or switch to high-calorie and frequent meals 5 times a day or more. Therefore, the procedure for closing a double-barreled stoma is easier for the surgeon and the patient than the operation for closing a single-hole stoma.
The muscle tissue is carefully sewn together and the top suture is applied. Sutures are applied with self-absorbing threads such as catgut.
The degree of tightness of the intestinal section is checked.

The operation may include additional steps, such as transplanting a section of the rectum or another section of the large intestine if a suitable donor is available.

The operation to remove a colostomy lasts on average 100-120 minutes, and in some cases up to 3 hours. Despite the fact that reconstructive surgery is entrusted only to professionals, due to the physiological characteristics of the body of some patients, for example, heart problems, colostomy and stoma elimination, it can be carried out in 2 stages with a break of several days. If the patient cannot withstand the effects of general anesthesia, the colostomy is not closed until the heart can cope with the required load.

It is possible to completely restore the former functionality of the intestines in 40% of cases. Often, after closing a colostomy, complications may arise both in the area of the stoma where the surgical actions were performed, and in the functioning of the intestine after a long period. The main complications arise when removing a single-barrel (end colostomy, since this type is not temporary.)

When removing both single-barrel and double-barrel stoma, the following complications may occur:

Perforation or rupture of the intestine in the stoma area.
Rectal prolapse.
Suppuration or inflammation in the area of the former stoma.
The occurrence of obstruction in the ostomy area due to the accumulation of feces in the area of the sutures.

You cannot do a colostomy:

if the sphincter muscles have atrophied or been damaged;
after a long course of chemotherapy;
if the villous epithelium is atrophied or damaged by more than 50%, fecal stagnation with subsequent sepsis is possible;
if during the stoma more than 30% of the intestinal tract was removed, except for the output from the rectum.

Recovery

As a rule, the complications described above arise when restorative procedures are not properly performed in the postoperative period, which can last from several weeks to several months.

The end date of the postoperative rehabilitation complex can only be announced by the attending physician after diagnosing the intestinal condition.

Postoperative rehabilitation includes an appropriate diet and a strict daily routine.

The diet looks like this:

the first 3-5 days after surgery - droppers with the necessary substances;
5-12 days – liquid porridge with sugar;
12-21 days – foods, except raw vegetables and fruits, are gradually introduced into the diet;
raw cabbage, apple peels, fried and spicy foods, as well as legumes and corn should not be consumed for 90 days or longer after surgery.

Many patients look forward to operations to close a colostomy, because then a person has the opportunity to live a normal life again and relieve his needs with the help of an anus located not on the stomach, but in the right place. But from the closure of the colostomy to the normalization of stool elimination processes, a long rehabilitation period will have to go through, and the functionality of the large intestine will be established.

What to expect from such an operation and when the recovery period will end can be found in the article below.

How does surgery to close a colostomy work?

A colostomy is an artificially created opening in the large intestine that allows stool to pass out. It is applied in various cases: for problems with the lower intestines, for malignant neoplasms and other factors. Colostomy can be either temporary or permanent.

The operation to close a temporary colostomy is called reconstructive surgery and is the elimination of a previously created stoma.

The operation is performed by a qualified and experienced surgeon and takes place within one hundred to one hundred and twenty minutes. In some cases, the operation lasted up to three hours. Sometimes the elimination of a colostomy occurs in two stages, the interval between which is several days. This operation is performed under general anesthesia, and if the patient’s heart is not able to cope with general anesthesia, then the colostomy is not closed until his heart can cope with such a load.

This method of surgical intervention consists of several stages.

If a double-barreled stoma was applied, then an incision is made between the holes; with a previously applied single-barrel colostomy, the length of the incision directly depends on the longitudinal incision of the colon.

After the incision, the section of the intestine where the ostomy was performed is removed.

With a single-barrel colostomy, the two ends of the intestine are connected, and with a double-barrel colostomy, the holes are simply sutured. When closing an end stoma, it is most often accompanied by the removal of that section of the intestine that was cut longitudinally. It turns out that the intestines will no longer function as before. The most striking consequence of this is rapid bowel movement, which lasts from fifteen minutes to two hours from the moment of eating. Therefore, to increase the digestibility of foods, you need to eat several times more, but for these purposes, the method of fractional meals is most often used. That is, they eat often, but in small portions. Thus, the operation to close a double-barreled stoma is easier for both the patient and the surgeon who performs it than the closure of an end stoma with a single opening.

Then the muscle tissue is sewn together, and then the upper sutures are applied using self-absorbing threads. Lastly, the intestines are checked for leaks. Such an operation may also contain additional stages when, for example, a rectal lobe transplant is required.

Contraindications and possible complications when closing a colostomy

It is possible to restore intestinal function to the previous level only in forty percent of all cases. After such an operation, some complications are possible, which affect both the area where the colostomy was previously placed and the functioning of the intestine, which has not functioned for a long period of time. The most severe complications arise after the elimination of a terminal single-barreled colostomy, since such a stoma is considered permanent and is placed for the rest of life.

When closing any type of colostomy, the following complications arise:

prolapse of the rectum from the anus;
intestinal perforation or rupture in the area of the operation;
intestinal obstruction in the operated area associated with the accumulation of large amounts of feces;
infectious-inflammatory or purulent processes in the place where the colostomy was previously located.

Colostomy has a certain number of contraindications:

atrophy or damage to the sphincter muscles;
removal of more than thirty percent of the intestine when applying a stoma, in addition to removal from the rectum;
long course of chemotherapy for cancer;
atrophy or more than fifty percent damage to the villous epithelium, since this may result in fecal stagnation, which often leads to sepsis.

Recovery in the postoperative period

The rehabilitation period after surgery to close a colostomy is usually several months. And all possible complications often arise when at this moment the patient does not follow all the doctor’s recommendations, or are not followed in full.

When the recovery and rehabilitation period ends is decided only by the attending physician based on diagnostic studies of the intestines.

The most important thing in the postoperative period is to follow a diet and maintain a healthy lifestyle with a strict daily routine.

The diet program during the recovery period looks something like this:

3-5 days after surgery only drips with the necessary medications;
from the fifth to the twelfth day you can only eat liquid porridge with added sugar;
from the twelfth to the twenty-first day, it is allowed to gradually introduce other foods into the diet, with the exception of raw fruits and vegetables;
Only after three months have passed since the operation can you start eating apple peels, corn, raw cabbage, legumes, fried and spicy foods.

Summing up

The operation to close a colostomy is one of the stages of reconstructive surgical intervention, in which the temporary artificially created anal opening located on the anterior part of the abdominal wall is eliminated. One of the main conditions for carrying out such an operation is the absence of obstructions in the intestine along its entire length to the anus. Also important is the recovery rehabilitation period after such an intervention, which is characterized by a strict daily routine and a strict dietary program for a long time.

What is a colostomy?
The term colostomy refers to a surgically created connection between the colon and the anterior abdominal wall to remove intestinal gases and stool. A colostomy is formed during surgical interventions for colon cancer, injuries, Crohn's disease, and ulcerative colitis.
The stoma can be placed permanently, in which case the patient will have it for the rest of his life, or temporarily, in order to further restore the integrity of the intestine.

When to close a colostomy?

Most often, surgery to close a colostomy is performed three to six months after the first surgery, but there are other options. Some surgeons prefer to perform reoperation within the first two months, arguing that this period is the least likely to cause complications. Studies have also been conducted that show that closing the stoma within the first two weeks is most effective. But this method is not suitable for all patients; it is used for isolated injuries of the rectum and in cases where the postoperative period passes without complications.

Technique of reconstructive surgery
The essence of reconstructive surgery is to restore intestinal continuity by connecting the remaining parts of the intestine. The technique for closing the stoma depends on the technique of the first surgical intervention and occurs through local access or full laparotomy. In any case, this decision should only be made by the attending physician. The operation can be one- or two-stage. If the operation is performed in two stages, then repeated surgery can be performed laparoscopically, which significantly reduces trauma and therefore reduces the risk of complications.
Additional complications may arise from adhesions, scars, or the small size of the remaining portion of the rectum.

Postoperative period
Undoubtedly, after the operation you will have to get used to a new way of life: diet and adherence to a diet are necessary. The intestines are not yet able to process all products and bowel movements occur irregularly, and there may be problems with stool. Therefore, it is worth following certain rules.
Food must be taken at a certain time, and breakfast should be hearty and dinner light.
Before breakfast, you should drink a glass of boiled, chilled water - this will enhance peristalsis and you will be able to control bowel movements.
Determine which foods cause increased peristalsis in you (most often these are foods high in plant fiber, sugary substances, fermented milk products), and which slow them down (rice, jelly, crackers, cottage cheese, coffee, strong cocoa tea).

And most importantly, if something bothers you, you should immediately contact your doctor.
Be healthy!

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

A colostomy is an artificially created fistula to communicate the colon with the external environment (colon - colon, stoma - opening).

It is applied to drain feces in cases where the natural passage of feces through the intestines to the anus is impossible for one reason or another.

Colon is the main part of the large intestine. Its main function is the formation of feces, their advancement and removal through the anus to the outside. The colon consists of the following sections:

Cecum.
Ascending colon.
Transverse colon.
Descending colon.
Sigmoid.

Digested food gruel (chyme) enters the large intestine from the small intestine. It's liquid. As it moves through the large intestine, water is absorbed and formed feces are formed at the exit. Therefore, the contents of the ascending colon are still liquid and slightly alkaline. The closer to the intestinal outlet, the denser the contents.

The sigmoid colon continues into the rectum. The sphincter apparatus of the rectum holds feces in the ampullary region. When it is sufficiently full, there is a urge to defecate, which occurs in a healthy person approximately once a day. This is how the natural process of removing feces occurs.

When is a colostomy indicated?

It is quite obvious that creating a fistula of the colon for the unnatural discharge of feces is a very extreme measure, and it is carried out for health reasons. The colostomy may be temporary or permanent (permanent stoma).

Recently, sphincter-preserving operations have been intensively developed and implemented. But despite this, about 25% of operations on the large intestine result in an ostomy.

In what cases might this situation arise:

Inoperable tumor. If it is impossible to perform radical surgery (for example, the tumor has grown into neighboring organs or the patient is very weakened, with distant metastases), colostomy is performed as a palliative operation.
After radical removal of anorectal cancer. If the tumor is located in the ampullary and middle sections, the rectum is extirpated along with its sphincter, and natural bowel movement becomes impossible.
Anorectal fecal incontinence.
Congenital anomalies of the intestinal outlet.
Failure of a previously performed anastomosis.
Intestinal obstruction. In this case, a colostomy is applied at the end of the first stage of the operation after removing the obstacle. After some time it is removed.
Intestinal injury.
Enterovaginal or enterovesical fistulas during their treatment.
Severe ulcerative colitis or diverticulitis with bleeding and intestinal perforation.
Perineal wounds.
Post-radiation proctosigmoiditis.

Types of colostomy

As already mentioned, a stoma can be

Temporal.
Constant.

By localization And:

Ascending stoma (ascendostomy).
Transverse stoma (transverse stoma).
Descending stoma (descendostomy).
Sigmostoma.

By shape

Double-barreled (loop) – mostly temporary.
Single-barrel (or end) - often permanent.

Preparing for surgery

Colostomy is almost always the final part of another operation (elimination of intestinal obstruction, amputation and extirpation of the rectum). Therefore, preparation for surgery is standard for all intestinal operations. In case of planned intervention this is:

Colonoscopy.
Irrigoscopy.
Blood and urine tests.
Biochemical blood parameters.
Coagulogram.
Electrocardiogram.
Fluorography.
Markers of infectious diseases.
Examination by a therapist.
Colon cleansing using cleansing enemas or osmotic intestinal lavage.

In cases of serious condition of the patient (anemia, exhaustion), preoperative preparation is carried out whenever possible - transfusion of blood, plasma, protein hydrolysates, replenishment of fluid and electrolyte losses.

Quite often, a colostomy is the outcome of emergency operations for developed intestinal obstruction. In these cases, preparation is minimal and the obstruction must be cleared as soon as possible. If the patient’s condition is very severe, surgeons at the first stage minimize intervention: they impose a colostomy above the obstruction site, and the main intervention aimed at eliminating the cause of obstruction is postponed until the patient’s condition has stabilized.

Formation of a temporary colostomy

Usually, as a temporary measure, a double-barreled colostomy is formed (two ends of the intestine are brought to the abdominal wall - afferent and efferent).

temporary double-barreled colostomy

It is most convenient to form a colostomy from the transverse or sigmoid colon, which have a long mesentery; they are quite easy to remove into the wound.

The colostomy incision is made separately from the main laparotomy incision.

The skin and subcutaneous layer is excised using a circular incision. The aponeurosis is dissected crosswise. The muscles are separated. The parietal peritoneum is incised, its edges are sutured to the aponeurosis. This creates a tunnel for the removal of the intestine.

A hole is made in the mesentery of the mobilized intestine, and a rubber tube is inserted into it. By pulling the ends of the tube, the surgeon removes a loop of intestine into the wound.

A plastic or glass rod is inserted in place of the tube. The ends of the stick are placed on the edges of the wound, the loop of intestine seems to hang on it. The intestinal loop is sutured to the parietal peritoneum.

After 2-3 days, when the parietal and visceral peritoneum have fused, an incision is made into the withdrawn loop (pierced, then incised with an electric knife). The length of the incision is usually 5 cm. The posterior uncut wall of the intestine forms the so-called “spur” - a septum separating the proximal and distal knee of the stoma.

With a properly formed double-barreled colostomy, all fecal matter is removed through the adductor end to the outside. Mucus may be released through the distal (outflow) end of the intestine, and medications can be administered through it.

Closing a temporary colostomy

The closure of a temporary colostomy is carried out in a time frame individual for each patient. This could be several weeks or several months. It depends on the diagnosis, prognosis, and the condition of the patient himself.

Closing a colostomy is a separate operation. It can be done in several ways:

The loop of intestine is sharply separated from the skin and other layers of the abdominal wall. The edges of the bowel defect are refreshed and the defect is sutured. A loop of intestine is immersed into the abdominal cavity. The peritoneum and abdominal wall are sutured in layers.
The ostomized portion of the intestine is separated from the skin. Intestinal clamps are applied to both ends of the loop. A section of intestine with an exposed loop is resected and an end-to-end or end-to-side anastomosis is performed.

Permanent colostomy

The most common reason for a permanent colostomy is cancer of the lower and middle ampullary rectum. With such a localization of the tumor, it is almost impossible to perform surgery while preserving the anal sphincter. In this case, treatment according to oncological criteria is considered radical: the tumor itself and regional lymph nodes are removed as widely as possible. If there are no distant metastases, the patient is considered cured, but...he will have to live without a rectum.

Therefore, the quality of the patient’s life directly depends on the quality of the formed colostomy.

The location of the colostomy is planned in advance before the operation. This is usually the middle of the segment connecting the navel and the left iliac crest. The skin in this area should be smooth, without scars or deformations, as they can interfere with the tight fit of the colostomy bags. The mark is made in a lying position, then adjusted in a standing position (patients with a pronounced subcutaneous fat layer may have skin folds).

A permanent stoma is usually single-barrel, that is, only one end of the intestine (proximal) is brought to the abdominal wall to drain feces.

At the final stage of the operation (,), an incision is made in the skin, subcutaneous tissue and rectus abdominis muscle at the marking site. The parietal peritoneum is dissected, along the edges of the wound it is sutured to the aponeurosis and muscles.

A loop of intestine is brought out into the wound and intersected. The abductor end is sutured tightly and plunged into the abdominal cavity. The proximal end is brought out into the wound.

It is possible to form two types of colostomies:

Flat - the intestine is sutured to the aponeurosis and parietal peritoneum, almost does not protrude above the surface of the skin.
Protruding - the edges of the intestine are brought out into the wound by 2-3 cm, pulled together in the form of a “rose” and sutured to the peritoneum, aponeurosis and skin.

It is important that the incision of the skin and aponeurosis is not too small, the intestine should be brought out without tension or twisting, and the end of the intestine brought out must have a good blood supply. If all these conditions are met, the risk of complications and dysfunction of the colostomy in the future is minimized.

After surgery, how to live with a colostomy

After the stoma is placed, it takes some time for the intestine to heal. Therefore, the patient receives only parenteral nutrition for several days. You are allowed to drink liquid every other day.

On the 3rd day after surgery, you are allowed to take liquid and semi-liquid foods.

After the colostomy operation, the patient remains in the hospital for 10 to 14 days. During this time, he will be taught how to care for his colostomy and use colostomy bags.

The psychological preparation of the patient before surgery is very important. The news that he will have to live with an unnatural anus is taken very hard. Due to insufficient information and insufficient psychological support, some patients refuse such an operation, dooming themselves to death.

You can live with a colostomy for a long time. Modern colostomy bags and stoma care products allow you to lead a normal, full life.

Possible complications after ostomy

Intestinal necrosis. It develops when its blood supply is disrupted, if the intestine is poorly mobilized during surgery and the mesentery is too stretched, a blood vessel is stitched, or it is pinched in an insufficiently wide incision of the aponeurosis. With necrosis, the intestine turns blue, then turns black. Necrosis is eliminated by repeated surgery.
Paracolostomy abscesses. Occurs when an infection occurs. The skin around the stoma becomes red and swollen, pain intensifies, and body temperature rises.
Retraction (retraction) of the stoma. It can also occur if the surgical technique is violated (too much tension). Requires surgical reconstruction.
Evagination (prolapse) of the intestine.
Colostomy stricture. It can develop gradually as a result of scarring of the tissues surrounding the stoma. Narrowing of the outlet may be complicated by intestinal obstruction.
Irritation, wetting of the skin around the stoma, addition of a fungal infection.

Ostomy care

It will take some time to adapt to a stoma (from several months to a year).

The intestinal wall exposed to the skin will be swollen for some time after the operation. It will gradually decrease in size (stabilize in a few weeks). The mucous membrane of the excreted intestine is red.

Touching the stoma during care does not cause pain or discomfort, since the mucous membrane has almost no sensitive innervation.

The first time after surgery, feces will be released continuously. Gradually, you can achieve their release several times a day.

The lower the colostomy is located along the intestine, the more formed the stool will come out of it.

If the colostomy is located on the sigmoid colon, it is even possible for feces to accumulate and be passed once a day like random stools.

Video: colostomy care

Colostomy bags

To collect stool from a colostomy, there are colostomy bags - disposable or reusable containers with devices for attaching to the body.

The colostomy bag is a plastic bag with a base that is adhesive to the body.

They are:

When changing the colostomy bag, the skin around the ostomy opening is cleaned. After peeling off the adhesive base, the skin is washed with water and baby soap or a special cleansing lotion and dried with a napkin (not cotton wool).

You need to cut a hole in the adhesive plate 3-4 mm larger than the diameter of the stoma and remove the paper backing from the plate. The plate is glued onto dry skin, starting from the bottom edge. The stoma itself should be placed strictly in the center of the hole. A mirror is used for control. It is necessary to ensure that folds do not form on the skin.

The ostomy bag is attached to the plate ring. Ostomy patients change the bag 1 or 2 times a day.

Nutrition for patients with colostomy

There is no special diet for ostomy patients. Food should be varied and rich in vitamins.

Basic rules for such patients:

It is advisable to eat at strictly defined times 3 times a day.
The bulk of food should be consumed in the morning, followed by a less dense lunch and a lighter dinner.
Drink enough liquid (at least 2 liters).
Food must be chewed thoroughly.

After a few months of adaptation, the patient himself will learn to determine his diet and select those products that will not cause discomfort. At first, it is advisable to eat foods that do not contain toxins (boiled meat, fish, semolina and rice porridge, mashed potatoes, pasta).

People with ostomies, like everyone else, can experience constipation or diarrhea. Usually, sweet, salty, fiber-containing foods (vegetables, fruits), brown bread, fats, cold foods and drinks enhance peristalsis. Mucous soups, rice, white crackers, cottage cheese, pureed cereals, black tea reduce peristalsis and retain stool.

You should avoid foods that cause increased gas formation: legumes, vegetables and fruits with peels, cabbage, carbonated drinks, baked goods, whole milk. Some foods produce an unpleasant odor when digested, which is very important in case of possible involuntary release of gases from the stoma. These are eggs, onions, asparagus, radishes, peas, some types of cheese, beer.

New foods should be introduced into the diet gradually, monitoring the intestinal reaction to each product.

Short-term use without a doctor's prescription is possible:

Activated carbon (for bloating, to absorb odors) 2-3 tablets 4-6 times a day.
Digestive enzymes (pancreatin, festal) - for bloating, rumbling to improve digestion processes.

It is not recommended to use other drugs without consulting a doctor.

If irritation occurs around the stoma, the skin around it is treated with Lassara paste, zinc ointment or special ointments for caring for the skin around the stoma.

Products for ostomy patients

In addition to colostomy bags, the modern medical industry produces various products for colostomy care. They are designed to maximally improve the quality of life for such patients and provide them with a sense of absolute usefulness in society.

Pastes for making the connection of the colostomy bag with the skin tight (they fill the slightest irregularities).
Lubricants with odor neutralizer.
Wipes and lotions for cleansing the skin around the stoma.
Special healing creams and ointments used for skin irritations.
Anal tampons and plugs. They are used to close a stoma without a colostomy bag.
Irrigation systems.

The patient can do without a colostomy bag for some time (when taking a shower, going to the pool, during sex). Some patients who have learned to regulate their bowel movements can also go without a receiver most of the time.

There is also an irrigation method for cleaning the intestines - a cleansing enema is done through the stoma once a day or every other day. After this, the stoma can be closed with a tampon and dispensed with without a colostomy bag. At the same time, you can lead a fairly active lifestyle with virtually no restrictions.

Rehabilitation after colostomy

After 2-3 months, in the absence of complications, the operated patient can return to normal work activity, unless it involves heavy physical labor.

The main point in rehabilitation is the right psychological attitude and support from loved ones.

Patients with ostomies lead full lives, attend concerts, theaters, have sex, get married and have children.

In large cities there are societies for ostomy patients, where they provide all kinds of help and support to such people. The Internet provides great assistance in finding information; reviews from patients living with a colostomy are very important.