COLOSTOMY AND REVERSAL

The surgeons at North Orlando Surgical Group have a combined total of 45 years of experience offering surgical services to the community. We pride ourselves on providing the least invasive, innovative surgical techniques in an environment focused on quality care and exemplary customer service. Our physicians have performed thousands of hernia repairs with a very low complication rate. We recognize that surgery is a frightening proposition and we pride ourselves in assuring confidence in our abilities while getting you through the process with caring and compassion.

There are different types of “ostomy’s”, one being an ileostomy which is an opening between the surface of the skin and the small intestine and one being a colostomy which is an opening between the surface of the skin and the colon. This opening is called a stoma. This laparoscopic procedure is used to treat:

• Complex rectal or anal problems (especially infections)
• Colon cancer
• Poor control of the bowels (incontinence)

The stoma can measure from 1 to 1 ½ inches around. Unlike your anus, the stoma has no sphincter muscle (the muscles that control bowel movements), so most people cannot control the exit of waste. You will need to wear a pouch (ostomy collecting device) at all times to collect waste flow.

Stomas can be permanent or temporary. A temporary stoma may be made when a diseased section of bowel is removed, rejoined and needs time to heal. Once the reconnection site has healed, the stoma can be removed. If the anus and rectum have been removed, the stoma must be permanent.

The term “laparoscopic” refers to a type of surgery called laparoscopy. Laparoscopy allows the surgeon to perform the procedure through very small, “keyhole” incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through an incision near the bellybutton. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.

A laparoscopic fecal diversion requires only a few incisions. The first incision will be made at the intended site of the stoma. A second incision will be made opposite this area and will be used to place the laparoscope. In some cases, additional incisions will be made so that more of the large intestine can be reached.

There are two main types of stomas, an end stoma and a loop stoma:
• The end stoma can be made in the ileum (end of the small intestine, called “end ileostomy”) or colon (end colostomy). First a small part of skin will be removed from the stoma site. Then your surgeon will bring 1-2 inches of healthy bowel up through the abdominal wall to skin level. If you are having a colostomy, the end of the intestine will be stitched to your skin. If you’re having an ileostomy, the small intestine will be stitched to your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed.
• The loop stoma can be made in the ileum (loop ileostomy) or colon (loop colostomy). A loop stoma is often made when the stoma will be temporary. To make the loop stoma, a small loop of intestine will be brought up through the abdominal wall to skin level. A plastic rod will be passed underneath the loop to keep the new stoma in place. The loop will be cut half way through to make the site for the bowel opening. Each open end of the bowel created by this cut will appear as two openings in the stoma. If you are having a loop colostomy, the end of the intestine will be stitched to your skin. If you are having a loop ileostomy, the loop will be turned back on itself like a small cuff and then stitched just below your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed. The rod will be removed several days after surgery.

Hospital stays after fecal diversion average two to three days. You will be fitted with a pouch as soon as your surgery is complete. It will take a day or two for your digestive system to become active again. When it does start functioning, you will notice changes in the consistency of your stoma output.

If your colostomy is intended to be temporary, further surgery will be needed to reverse it at a later date.

The reversal operation will only be carried out when you’re in good health and fully recovered from the effects of the colostomy formation operation. This will usually be at least 12 weeks or more after the initial surgery.

However, the reversal may need to be delayed for longer if you require further treatment such as chemotherapy, or haven’t recovered from the original operation when the colostomy was formed. There’s no time limit for having the stoma reversed and some people may live with their colostomy for several years before it’s reversed.

Reversing a loop colostomy is a relatively straightforward process. An incision is made around the stoma to allow the surgeon to gain access to the inside of your abdomen. The upper section of your colon is reattached to the remaining section of your colon.

It’s also possible to reverse an end colostomy. However, the surgeon needs to make a larger incision to locate and reattach the two sections of the colon. Therefore, it takes longer to recover from this type of surgery and there’s a greater risk of complications.

Most people are well enough to leave hospital 3-10 days after colostomy reversal surgery, depending on which colostomy procedure you had reversed.

It’s likely to take some time before you resume normal bowel function and routine. Some people experience constipation or diarrhea, although this normally resolves with time.

As your digestive system is often sensitive after a colostomy reversal, you may be recommended to avoid eating late at night. Avoiding large meals and eating little and often instead may also help. Certain foods are also more likely to irritate the gut, and it may be helpful to limit or avoid:

• citrus fruits – such as grapefruits and oranges
• spicy food – such as curries
• large fatty meals
• vegetables that increase flatulence – such as cabbage and onions
• large amounts of alcohol or fizzy drinks

The reversal operation is usually a smaller procedure than the initial colostomy procedure. However, it still takes several weeks to recover and return to normal activities.

While having an ostomy can be upsetting, sometimes it is the best course of treatment, either in the short or long term. We here at North Orlando Surgical Group understand that our patients not only need our surgical skills, but our compassion as well. Call our office today to schedule an appointment.