Loop Colostomy

Overview

A colostomy entails splitting the colon and rerouting the upper portion to a new artificial opening in the abdominal wall called a stoma. The loop colostomy is the most commonly performed type, usually as a temporary solution. The loop method is preferred for colostomies when a temporary intervention is required for bowel healing, as it facilitates easier reversal of the procedure. The duration of a loop colostomy varies, spanning from weeks to months or even years, contingent upon individual medical circumstances.

A temporary loop colostomy serves two primary purposes: diversion and decompression.

• Diversion involves redirecting feces away from a specific segment of the colon that requires rest and healing. This may be necessary when the colon is recuperating from injury, surgery, or infection. By creating a diverting loop colostomy, poop is directed away from the traumatized site, preventing contamination and providing relief to that part of the colon.
• Decompression is employed when there is an obstruction in the colon that needs removal and alleviation. A decompressing loop colostomy enables the passage of bowel movements through the stoma while the lower portion of the bowel is temporarily inactive. Surgery is typically required to eliminate the blockage, and subsequent healing is necessary for the affected part of the colon. Once the healing is complete, the bowel can be reconnected.

Different types of loop colostomies

Physicians commonly partition the colon into distinct sections based on directional patterns, despite there being no physical separations between them. In the context of colostomies, the particular section of the colon that is severed and rerouted holds significance for both the surgeon and the patient. This consideration affects stoma placement and stool consistency, determining whether it will be more liquid or solid. As a result, your healthcare provider may discuss your colostomy in relation to the specific colon section involved and the chosen method, such as the loop colostomy.

An ascending loop colostomy redirects the ascending colon, the initial part ascending along the right side of your abdomen. A transverse loop colostomy redirects the transverse colon, the portion traversing horizontally across your abdomen from the right to the left. A descending loop colostomy redirects the descending colon, which descends along the left side. Lastly, a sigmoid loop colostomy redirects the last segment of your colon, known as the “tail,” which curves downward and to the right of the descending colon.

Reasons for undergoing the procedure

Various conditions may necessitate a loop colostomy, including:

• Diverticulitis
• Ulcerative colitis
• Crohn’s disease
• Partial colectomy
• Large bowel obstruction
• Severe anorectal or perineal injury or infection

Risks

The procedure itself is typically straightforward, but it entails the common risks associated with any surgery, such as:

• Infection.
• Injury to nearby organs.
• Reactions to anesthesia.
• Breathing difficulties under anesthesia.

Complications related to your colostomy may arise post-procedure, including:

• Bowel obstructions: caused by scar tissue or paralytic ileus after surgery, hindering the passage of stool. This can generally be addressed with home constipation remedies.
• Skin irritation: resulting from contact with stool, particularly the acidic nature of liquid stool from the upper colon. This is the most prevalent stoma complication, often resolved by using a better-fitting bag.
• Parastomal hernia. This hernia occurs when bowel loops bulge through weakened abdominal muscles around the stoma. It manifests as a visible bulge next to the stoma, potentially growing over time and impeding the stoma’s output. Your colostomy nurse will discuss preventive measures to minimize the risk of developing a hernia post-surgery.
• Stoma retraction or prolapse. A retracted stoma retreats below the skin surface, while a prolapsed stoma protrudes excessively. Both situations can pose challenges in securely fitting the colostomy bag. If an appropriately fitting bag cannot be found, your surgeon may need to re-site or revise your stoma.

Before the procedure

Before the surgery, you will attend a pre-operation assessment with your surgeon. This meeting is crucial for ensuring that you fully comprehend the procedure, its associated risks, and the lifestyle adjustments required after surgery. You’ll provide consent by signing necessary forms. Basic diagnostic tests may be performed to evaluate your suitability for surgery, and it’s also an opportunity to discuss potential pain management strategies.

On the day of the surgery, you will receive instructions to abstain from eating or drinking anything for six hours prior to the procedure. You may also be advised to use an enema or undergo a bowel prep at home to empty your bowels. Upon arrival at the hospital, you will be escorted to a pre-op room where you’ll change into a hospital gown and wait for the surgery to begin. Once in the operating room, anesthesia will be administered.

During the procedure

Depending on your medical condition, the creation of your loop colostomy may be accomplished through either laparoscopic or open surgery. Laparoscopic surgery, a less-invasive approach, involves micro-incisions and utilizes a small illuminated camera known as a laparoscope. Open surgery, on the other hand, requires a single large incision (laparotomy) to access your abdominal organs. Whenever possible, laparoscopic surgery is preferred due to its milder impact on the patient, but emergencies or complex conditions may necessitate open surgery.

For both procedures, you will undergo general anesthesia to induce sleep. In laparoscopic surgery, a small incision is made to introduce carbon dioxide gas into your abdominal cavity, facilitating the separation of your abdominal wall from your organs for better visibility. A camera (laparoscope) is inserted to project your organs onto a screen, guiding the placement of additional micro-incisions. In open surgery, a single large incision exposes your abdomen.

The location for your stoma will have been previously marked on your body. The surgeon will make an incision for the stoma, determine the appropriate site for dividing the colon, and bring the bowel loop through the incision. They will partially sever the loop and position the two open ends side by side in the stoma. To secure them, the surgeon folds back the intestine’s sheath and stitches the folded edge to your skin. Occasionally, a temporary support rod is placed between the two ends, to be removed in a few days.

After the procedure

Following the procedure, you will be transferred to a post-operative room where you will remain until you regain consciousness from the anesthesia. Subsequently, you’ll spend the next few days recuperating in the hospital, with the duration of your stay contingent on factors such as your condition and whether you underwent laparoscopic or open surgery.

Throughout your recovery, you will:

• Gradually reintroduce normal eating. Initially, you may follow a clear liquid diet for the first day post-surgery, progressing to a full liquid or soft diet before returning to solid food.
• Receive comprehensive education on colostomy care. A Wound, Ostomy, Continence Nurse will provide guidance on managing a colostomy bag and caring for your stoma.
• Gradually taper off pain medications, with the possibility of receiving a short-term prescription for home use.
• Experience healing of your wounds, and your bowel movements will gradually normalize, with the first movement potentially occurring several days post-surgery.

Outcome

The timing for reversal surgery varies based on your overall health. Achieving full recovery from both the surgery and the underlying condition prompting the need for surgery is crucial. While some individuals may be ready for reversal surgery within weeks or months following their loop colostomy procedure, others may require several years. Your healthcare provider will closely monitor your condition through follow-up visits after the initial operation. The decision to schedule reversal surgery will be made collaboratively, when both you and your doctor agree that you are ready for it.

If you encounter any of the following, please reach out to your primary care provider or ostomy nurse:

• Continual constipation or diarrhea
• Persistent nausea or vomiting
• Presence of blood in stool
• Alteration in size or color of your stoma
• Unusual foul odors emanating from your stoma
• Stoma blockage