Indications:
The procedure is done for the following reasons: inflammatory conditions, functional disorders, injury to the colon or cancers of the colon, rectum and small bowel.
Procedure:
The section/portion of bowel to be exteriorised depends on the location along the bowel which needs to be resected or treated. There are three types of stomas:
- Ileostomy – performed for conditions such as ulcerative colitis or after the removal of the colon. The transected end of the portion of the small bowel named the ileum is brought through the abdominal wall and a portion is turned inside out and stitched to the skin surface.
- Double-barrel – usually performed as a temporary measure, the bowel is divided and both ends are brought to the margins of the skin incision and sutured to the skin. (Loop colostomy/ileostomy)
- Colostomy – performed in order to render a segment of the bowel non-functional. Commonly performed following an anterior resection (resection of portion of large intestine), Abdomino-perineal resection, or as part of a Hartmann’s operation. A mucous fistula may be fashioned in addition to this procedure. This can be performed at several sections of the large intestine.
- Reversal of Ileostomy or Colostomy – performed in order to restore the continuity of the intestinal tract. If performed open, involves either a circular incision around the stoma or possibly through the previous laparotomy (midline) 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 bowel ends are reconnected which is called an anastomosis, and the wound is closed.
- Bleeding – intra-operatively and/or post operatively
- Leak of bowel content – due to damage or breakdown of tissue at the area where the bowel was severed
- Infection – can occur in the wound(s), lungs, drip site or at the location where the operation took place along the bowel
- Deep vein thrombosis – blood clots forming in the deep veins can occur with any surgery
- Damage to surrounding structures – nearby structures can be damaged inadvertently although all efforts are made to prevent such damage
- Reversal of Stoma: Bleeding, infection (intra-abdominal abscess, urinary and wound infection), unintentional perforation of bowel, leak at site where bowels are reconnected, an abnormal opening between the bowel and the skin, paralysis temporary or permanent of the intestines, a narrowing at the site where the bowels are reconnected, reoperation.
After your consultation:
- Obtain authorization from your medical aid and book your bed for your hospital admission.
- Carefully read through pre-operative information provided.
Day before surgery:
- Do not eat/drink after 22h00, the night before your surgery, unless otherwise specified by your surgeon or anaesthetist (you should be fasting for at least 6 hours before the procedure for solids but you are allowed to take clear liquids up to two hours before your procedure).
Day of surgery:
- Arrive for admission at indicated time on ‘Code & Consent’ sheet.
- Change into theatre attire, remove all valuable belongings.
Approximately 60-90 minutes
Duration of hospital stay:
- 2-6 days (dependent on pain management, general state of patient and first bowel movement)
Activities:
- Refrain from strenuous activities (incl. exercise) for at least 4 post-operatively
Back to work:
- Sick leave required post-operatively is approximately 10-14 days
Some pain and discomfort post operatively may be expected following any operation, but the following measures are used to lessen the pain experienced:
- Warming devises in theatre as well as warm intravenous fluids.
- Intra-operative pain medication through the drip.
- Post-operative medication through the drip, please inform the nurses if you are in pain so that medication will be administered to you.
- As close to one week after discharge as possible. Please contact the rooms to schedule an appointment.
More procedures performed by Dr Jeske
A SKIN INCISION IS MADE AND THE CONTENTS OF THE ABSCESS IS DRAINED.
THE FISTULA TRACT IS IDENTIFIED AND IS OPENED ALONG ITS LENGTH, AND THE EXPOSED INSIDE OF THE TRACT IS THEN CLEANED OUT.
AN OPERATION TO REMOVE AN APPENDIX THAT IS INFLAMED/SWOLLEN/HAS RUPTURED/HAS FORMED AN ABSCESS.
THE COMMON BILE DUCT (CBD – THE MAIN TUBE CARRYING BILE FROM THE LIVER TO THE INTESTINE) IS OPENED UP. ANY GALLSTONES WITHIN THE DUCT CAUSING A BLOCKAGE CAN BE REMOVED.
PTC is a procedure performed by a radiologist (specialist X-ray doctor) who takes X-ray pictures of the bile ducts which are tubes inside the liver.
