Colostomy

What is a colostomy?

A colostomy is a surgery in which the colon is re-routed to the abdominal wall and attached to the skin. It is called a stoma. The colon, or large intestine, forms and eliminates stool through the rectum. After a colostomy, stool drains into a colostomy bag attached around the stoma instead of through the rectum. You may need a colostomy if your colon is diseased or injured and cannot form and eliminate stool normally.

Many colostomies are temporary and are performed to rest and recuperate your diseased or injured colon. A temporary colostomy is reversed when the colon has healed enough to function normally again. Some colostomies are permanent. Your surgeon will decide which type of colostomy is best for you based on your condition.

A colostomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options and should consider getting a second opinion about your treatment options before having a colostomy.

Types of colostomy

The most common types of colostomy procedures include:

• Descending colostomy is a surgery that places the stoma in the lower-left abdomen.
• Sigmoid colostomy is a surgery that places the stoma in the lower-left abdomen, a little lower than where it is for a descending colostomy.
• Transverse colostomy is a surgery thatplaces the stoma in the upper-middle or upper-right abdomen.

Other surgical procedures that may be performed

In addition to a colostomy, your doctor may perform one or more additional surgeries to treat certain conditions. These can include:

• Bowel obstruction repair is the surgical removal of a blockage in the colon. A bowel obstruction is a blockage that prevents passage of intestinal contents.
• Colectomy (also called a bowel resection) is the removal of part or the entire colon.

Why is a colostomy performed?

A colostomy is a major surgical procedure that your doctor may recommend when your colon is diseased or injured and cannot eliminate stool normally through the rectum.

For some conditions, your surgeon may only consider a colostomy for you if other treatment options that involve less risk and fewer complications have been ineffective. Talk with your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a colostomy to treat:

• Abdominal abscess, a collection of pus created by a serious infection in the abdomen
• Bowel obstruction, a blockage of the colon
• Certain birth defects of the colon, such as Hirschsprung’s disease in which the intestine does not function normally
• Colon cancer. Cancer of the colon and/or rectum may require extensive colon resection and colostomy.
• Diverticulitis, which is inflammation of small pouches of the bowel
• Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis
• Injury to the bowel, rectum or area just in front of the anus

How is a colostomy performed?                  

A surgeon will lead a team and perform your colostomy in a hospital.

Your surgeon will make either a large incision or several smaller incisions in your abdomen. He or she then cuts out the diseased or damaged colon and pulls the new end out through one of the incisions. Your surgeon stitches the colon to the outside of the abdomen on your skin. This new opening from your colon is a stoma. Feces will now exit your body through the stoma instead of through your rectum.

The location of your stoma varies depending on what part of your colon is diseased or injured. Your surgeon may locate it on either side of your abdomen or in the upper center area.

Surgical approaches to a colostomy

Your surgeon will perform a colostomy using one of the following approaches:

• Minimally invasive surgery is a procedure performed by inserting special instruments and a laparoscope through a few small incisions in the abdomen. The laparoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon watches the screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery andless pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeonwill make small incisions instead of a larger one used in open surgery. He or she can then thread surgical tools around structures and organs instead of cutting through or displacing them as in open surgery.
• Open surgery is a procedure performed by making a large incision in the abdomen. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. This is because it causes more trauma to tissues and organs. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues and organs than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.