Megan Freedman

What is a colostomy?

A colostomy is a surgery in which the colon (large intestine) is re-routed and attached to an opening in the abdomen and skin 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 allow a diseased or injured colon to rest. A temporary colostomy is reversed when the colon has healed enough to function normally. 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 serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion before having a colostomy. 

Types of colostomy

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The most common types of colostomy surgeries are:

  • Descending colostomy places the stoma in the lower-left abdomen.

  • Sigmoid colostomy places the stoma in the lower-left abdomen, a little lower than where it is for a descending colostomy.

  • Transverse colostomy places the stoma in the upper-middle or upper-right abdomen.

Other surgical procedures that may be performed

Your doctor may perform other procedures to treat certain conditions. These 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? 

Your doctor may recommend a colostomy when the colon is diseased or injured and cannot eliminate stool normally through the rectum. 

Your surgeon may only consider a colostomy for you if other treatment options that involve less risk and fewer complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a colostomy.

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

Who performs a colostomy?

General surgeons and colon and rectal surgeons perform colostomies. General surgeons specialize in the surgical treatment of a variety of diseases, disorders, and conditions including diseases of the colon. Colon and rectal surgeons are general surgeons with advanced training in the treatment of colon and rectal problems. 

How is a colostomy performed?

Your colonoscopy will be performed in a hospital. Your surgeon will make either a large incision (open surgery) or several smaller incisions (minimally invasive surgery) in your abdomen. Your surgeon then cuts out the diseased or damaged colon and pulls the new end out through one of the incisions. 

The colon opening is stitched to the outside of the abdomen on the skin. This new opening from your colon is a called 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 involves 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 abdomen to a video screen. Your surgeon watches the screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded 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 surgeon to see and access the surgical area directly.  Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. 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.

Surgeons sometimes combine a minimally invasive technique with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you need an open surgery to safely and most effectively complete your surgery.