The purpose of an ileostomy is to allow stool to bypass the colon
The purpose of an ileostomy is to allow stool to bypass the colon (large bowel or large intestine). An ileostomy may be temporary or permanent, depending on the medical reason for the surgery.
An ileostomy is often performed in the following conditions:
- Ulcerative colitis: It is ulcers and swelling in the large intestine and rectum/anus.
- Crohn’s disease: It is a severe inflammatory disease of the gastrointestinal (GI; digestive) tract.
- Diverticular disease: It develops when pouches form along the digestive tract, typically in the colon (large intestine).
- Fecal incontinence: It is the inability to control bowel movements, causing feces (stool) to leak unexpectedly from the rectum. It is also called bowel incontinence.
- Cancer: An ileostomy is performed in patients with cancer of the large intestine.
- Trauma: It is any type of abdominal injury that may affect a patient’s bowel movement, especially in their large intestine.
- Familial adenomatous polyposis: It is a rare inherited cancer predisposition syndrome characterized by hundreds to thousands of precancerous colorectal polyps (adenomatous polyps). If left untreated, patients with familial adenomatous polyposis inevitably develop cancer of the colon and/or rectum at a relatively young age.
- Radiation damage: It is damage to the digestive tract due to radiation exposure.
- Congenital abnormalities: These are any abnormalities of the GI since birth that may be causing stool incontinence or obstruction, especially in the large intestine.
Permanent ileostomies are typically performed for ulcerative colitis or familial adenomatous polyposis.
A temporary end ileostomy is typically created during emergency conditions such as a severe infection or bleeding.
What is an ileostomy?
An ileostomy is a surgically created opening into the small intestine through the abdomen. The colon’s (large intestine) main purpose is to absorb water and store stool; however, the body may continue to function even without a colon. After an ileostomy, the stool is no longer eliminated through the anus but through the ileostomy. An ileostomy does not have a sphincter muscle, so there would be no voluntary control over bowel movements. Instead, the patient may need to wear a disposable pouch to collect the stool.
Before an ileostomy is formed, the doctor may decide the location of the stoma (artificial opening). It is usually somewhere on the right-hand side of the abdomen.
Different types of an ileostomy include:
- Loop ileostomy: The loop of the small intestine is pulled out through an incision (cut) in the abdomen and stitched to the skin to form a stoma.
- End ileostomy: In this, the ileum (final section of the small intestine) is separated from the colon (large intestine) and is brought out through the abdomen to form a stoma.
- Ileal pouch–anal anastomosis: Sometimes, the doctor creates an ileo-anal pouch (an internal pouch that's connected to the anus). This means there's no stoma, and stools are passed out of the back passage in a similar way to normal.
End ileostomies and ileo-anal pouches are usually permanent. Loop ileostomies are usually intended to be temporary and can be reversed during an operation later.
- The surgeon may use an open technique or a laparoscopic technique to perform an ileostomy.
- The surgeon usually performs it under general anesthesia. They may monitor the patient vitals throughout the procedure.
- In the open technique, the surgeon makes a cut in the abdomen to reach the intestine.
- In the laparoscopic technique, the surgeon makes small cuts in the abdomen. They insert an endoscope and tools through the cuts to perform the surgery.
- The open technique is used more commonly than the laparoscopic technique for an ileostomy.
- Depending on the reason for performing an ileostomy, the surgeon may perform a bowel resection first to completely remove the diseased or damaged part of the intestine.
- In an end ileostomy, the surgeon brings one end of the colon or ileum to an opening on the surface of the abdomen. They stitch the edges of the cut part of the colon or ileum to the skin of the abdomen to make the stoma. They close the other cut end of the colon or ileum with stitches or staples.
- In a loop ileostomy, the surgeon stitches the cut edges of the colon or ileum to the skin on the abdomen to make a stoma with two openings.
- The surgeon may place a tube in the abdomen to drain fluids. This helps prevent infection and allows the area to heal properly.
- The surgeon places an ostomy appliance (a special pouch) around the stoma. This pouch collects stool that passes out of the body through the stoma.
- In a laparoscopic procedure, the procedure time may be less than 90 minutes, and in an open procedure, the time may be more than 120 minutes, depending upon the patient’s condition and cause of the procedure.