The formation of a stoma will likely form only part of an operation. It is advisable that a specialist stoma nurse discuss with the patient pre-operatively (when possible) the implications involved and also to aid in the siting. The important points when informing a patient of a potential stoma
The important points when informing a patient of a potential stoma are:
- Permanent or temporary: If it is anticipated to be temporary it is important to stress that it may be permanent depending on intra- and postoperative events.
- Site: An ileostomoy is commonly sited in the right iliac fossa.
- Single- versus double-barrelled.
- Possibility of a mucous fistula.
End: Formed following the complete removal of the colon including the rectum. A mucous fistula may be fashioned in addition, termed a double-barrelled stoma.
Loop: Formed in order to defunction either a distal obstructing colonic lesion or in order to protect a distal anastomosis.
End: Formed in order to defunction a distal segment of bowel. Commonly performed following an anterior resection, APER, or as part of a Hartmann’s operation. May be indicated in a distal colonic fistula. A mucous fistula may be fashioned in addition to this procedure.
Loop: Formed in order to defunction either a distal obstruction colonic lesion, a distal anastomosis or complex pelvic disease.
Reversal of Ileostomy or Colostomy
Is performed in order to restore the integrity of the intestinal tract. If performed open, involves either a circumferential incision around the stoma or possibly through the previous laparotomy incision. Reversal of loop ileostomies or colostomies can generally be performed through the circumferential incision around the stoma whereas reversal of end-ileostomies or colostomies usually involves opening the old scar in order to safely access the bowel. The anastomosis is performed and the wound is closed.
The formation of a stoma and indeed the reversal may also be performed either open or laparoscopically.