Stomal Matters: Classification, Purpose, Surgery, Maintenance, and Additional Insights
Ostomy surgery is a life-saving procedure that creates an external opening (stoma) from either the colon or the small intestine (ileum) to help manage various health conditions. This article provides an overview of the common reasons for ostomy surgery, the types of stomas, and the process involved.
Common conditions requiring ostomy surgery include colorectal cancers, severe diverticulitis with complications, inflammatory bowel diseases like Crohn's disease and ulcerative colitis, traumatic injuries to the abdomen or pelvis, and certain congenital defects such as Hirschsprung's disease or imperforate anus.
The types of stomas created by different ostomy surgeries vary based on the underlying condition and surgical goals. For instance, a colostomy involves bringing the end (or sometimes a loop) of the colon through the abdominal wall to form a stoma, which can be temporary or permanent. An ileostomy, on the other hand, brings out the end of the small intestine (ileum) to create a stoma, also with the option of being temporary or permanent.
Regarding stoma configurations, end stomas are created when the distal bowel is removed or cannot be preserved, with the bowel end brought out as a stoma and the other end closed off inside. Loop stomas involve bringing a loop of intestine out and opening it to divert stool temporarily.
Specific surgeries leading to stomas include Abdominoperineal resection (APR), which removes the anus and rectum for low rectal cancers, resulting in a permanent end colostomy, and Hartmann’s procedure, which often creates an end colostomy with the rectal stump closed internally.
After an ostomy operation, a person receives instructions on how to care for their stoma, including how to clean and empty the collection bag or pouch and how often to change it. The method depends on the type of stoma—for example, an ileostomy connects to the small intestine, causing digestive contents to bypass the colon and collect in a bag or pouch outside the body.
Surgeons may perform open surgery or laparoscopic stoma surgery, and a stoma is an opening created by a surgeon on a person's abdomen that allows bodily wastes to exit the body. Stoma bags are devices that fit over the stoma's opening in a person's abdomen and are usually made of hypoallergenic, waterproof material.
Whether a stoma is permanent or temporary depends on the reason a person needs ostomy surgery. A person can care for their stoma at home, either on their own or with the help of a caregiver. It's essential to be aware that, like any surgery, stomas can have complications, such as ostomy prolapse, ostomy stenosis, parastomal hernia, skin rashes, ostomy retraction, stoma obstructions, ostomy ischemia or necrosis, dehydration, electrolyte imbalance, hemorrhage, hematoma, and fistula.
In summary, ostomies provide a vital solution for managing various health conditions by creating external openings (stomas) from either the colon or ileum, depending on the disease and surgery type. These can be temporary or permanent with different configurations (end or loop) tailored to patient needs.
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