Ileostomy

Overview  

An ileostomy is a surgical intervention utilized when the large intestine is unable to effectively manage and transport waste material. This procedure involves creating a stoma, an opening in the abdominal wall, to redirect the digestive process. Certain medical conditions or treatments can disrupt the body’s ability to eliminate intestinal waste, prompting the need for an ileostomy. Depending on the circumstances, patients may undergo either a permanent or temporary ileostomy. Temporary ileostomies are intended to be reversed once the patient has fully recovered from the initial surgery.  

Types  

Ileostomies come in two types: permanent and temporary. 

• Permanent ileostomy: The standard ileostomy, also known as the Brooke ileostomy, involves bringing the ileum through the abdomen to create a stoma. Waste is collected in an external pouch since the flow can’t be controlled. 
• Temporary ileostomy: These are reversible procedures used after bowel surgery to allow healing. They can also be the initial step towards a permanent ileostomy like the J-pouch or K-pouch. 
• J-Pouch (ileoanal reservoir): Involves creating a temporary end stoma to divert waste to an external pouch. Then, a pouch is made from ileum loops to connect to the anus. Waste is stored there until it can be passed through the anus. 
• K-Pouch (continent ileostomy): Requires a stoma but no external pouch. Surgeons create an internal pouch and a valve from ileum loops to store waste. The pouch is drained by inserting a catheter through the stoma. 

These procedures offer options for managing digestive waste depending on the patient’s condition and needs.

Reasons for undergoing the procedure  

Permanent ileostomies may be required for conditions such as Crohn’s disease, colonic motility dysfunction, or instances involving blockage, damage, or rupture of the large intestines. Conversely, temporary ileostomies are commonly employed in surgeries related to colorectal cancer, diverticulitis, ulcerative colitis, Crohn’s disease, and familial adenomatous polyposis. The intention with temporary ileostomies is for them to be reversed once the patient has recovered from the initial surgical procedure. The decision between temporary and permanent ileostomies is made based on the individual’s specific medical needs and the nature of the underlying conditions.

Risk  

Medical procedures like ileostomies come with risk. Risks that may be discussed prior to the procedure include:  

• Pouchitis, an infection  
• Injury to adjacent organs  
• Blockage of the digestive tract due to scar tissue  
• Bleeding from the stoma or from within the small intestine  
• Not being able to process meal nutrients well enough.  

Before the procedure  

The healthcare provider will discuss the necessary preparations, such as fasting, that one should do before surgery. Ileostomies also require administration of general anesthesia before the procedure.   

During the procedure  

The initiation of any ileostomy can be accomplished through traditional surgical incision or laparoscopic surgery techniques. It usually involves creating a small incision on the right side of the abdomen to access the terminal portion of the small intestine, known as the ileum.  

Laparoscopic surgery generally offers advantages such as minimizing blood loss and postoperative pain. In the case of a standard ileostomy, laparoscope is utilized to establish a small opening, through which a loop of the ileum is drawn. The ileum is then inverted to reveal its inner surface, constituting the stoma.  

Laparoscope is a slender tube-like instrument equipped with a light and lens to facilitate the operation. The laparoscope may incorporate a tool for extracting tissue, which can be examined under a microscope for disease indicators.  

After the procedure  

Full recovery from an ileostomy typically takes around two months as the healing process advances. Hospitalization typically lasts about a week, allowing time for the small intestine to heal. For those with a temporary ileostomy, closure or reversal surgery is usually required. Reversal surgery may take place three to six months after the initial ileostomy.  

Undergoing an ileostomy is a major surgical undertaking, and it necessitates a period of recuperation. Once the ileostomy has healed, individuals should be able to resume their regular activities, including driving, working, exercising, playing sports, and engaging in sexual activities.  

Outcome  

Contact a healthcare provider if certain post-operative condition is experienced, such as continuous nausea and vomiting, and cramps, pain, or nausea if more than four to six hours after the stoma has expelled waste. Other symptoms or circumstances to look out for include:  

• Persistent bad odor for more than a week, potentially signifying infection  
• Any cut or injury to the stoma  
• Presence of ulcers deep sores, and severe skin irritation  
• More than two or three hours of cramping  

Undergoing an ileostomy, whether temporary or permanent, can significantly impact an individual’s life, and adjusting to the associated routines may pose challenges. It is advisable to avoid consuming hard-to-digest foods such as nuts, popcorn, seeds, or crunchy vegetables.  

To minimize potential discomfort or pain around the stoma caused by output from the device, several measures can be taken. These include cleaning the skin around the stoma with water and ensuring thorough drying before applying the skin barrier or pouch. Additionally, unless absolutely necessary, it is best to refrain from removing the pouching system more than once a day.  

Other measures include:  

• Check the fit of the skin barrier opening and pouch to prevent issues like swelling or leakage.  
• When removing the pouching system, it is advised to be gentle and avoid pulling the skin barrier away from the skin; instead, push the skin away from the barrier.  
• Establish a regular schedule for pouch changes helps avoid leaks and skin irritation.