Recovery after stoma closure. Restoring colonic continuity in patients with colostomy. Contraindications and possible complications when closing a colostomy

Are you here: Questions and answers

Many patients look forward to operations to close a colostomy, because then a person has the opportunity to live a normal life again and relieve his needs with the help of an anus located not on the stomach, but in the right place. But from the closure of the colostomy to the normalization of stool elimination processes, a long rehabilitation period will have to go through, and the functionality of the large intestine will be established.

What to expect from such an operation and when the recovery period will end can be found in the article below.

How does surgery to close a colostomy work?

A colostomy is an artificially created opening in the large intestine that allows stool to pass out. It is applied in various cases: for problems with the lower intestines, for malignant neoplasms and other factors. Colostomy can be either temporary or permanent.

The operation to close a temporary colostomy is called reconstructive surgery and is the elimination of a previously created stoma.

The operation is performed by a qualified and experienced surgeon and takes place within one hundred to one hundred and twenty minutes. In some cases, the operation lasted up to three hours. Sometimes the elimination of a colostomy occurs in two stages, the interval between which is several days. This operation is performed under general anesthesia, and if the patient’s heart is not able to cope with general anesthesia, then the colostomy is not closed until his heart can cope with such a load.

This method of surgical intervention consists of several stages.

If a double-barreled stoma was applied, then an incision is made between the holes; with a previously applied single-barrel colostomy, the length of the incision directly depends on the longitudinal incision of the colon.

After the incision, the section of the intestine where the ostomy was performed is removed.

With a single-barrel colostomy, the two ends of the intestine are connected, and with a double-barrel colostomy, the holes are simply sutured. When closing an end stoma, it is most often accompanied by the removal of that section of the intestine that was cut longitudinally. It turns out that the intestines will no longer function as before. The most striking consequence of this is rapid bowel movement, which lasts from fifteen minutes to two hours from the moment of eating. Therefore, to increase the digestibility of foods, you need to eat several times more, but for these purposes, the method of fractional meals is most often used. That is, they eat often, but in small portions. Thus, the operation to close a double-barreled stoma is easier for both the patient and the surgeon who performs it than the closure of an end stoma with a single opening.

Then the muscle tissue is sewn together, and then the upper sutures are applied using self-absorbing threads. Lastly, the intestines are checked for leaks. Such an operation may also contain additional stages when, for example, a rectal lobe transplant is required.

Contraindications and possible complications when closing a colostomy

It is possible to restore intestinal function to the previous level only in forty percent of all cases. After such an operation, some complications are possible, which affect both the area where the colostomy was previously placed and the functioning of the intestine, which has not functioned for a long period of time. The most severe complications arise after the elimination of a terminal single-barreled colostomy, since such a stoma is considered permanent and is placed for the rest of life.

When closing any type of colostomy, the following complications arise:

prolapse of the rectum from the anus;
intestinal perforation or rupture in the area of the operation;
intestinal obstruction in the operated area associated with the accumulation of large amounts of feces;
infectious-inflammatory or purulent processes in the place where the colostomy was previously located.

Colostomy has a certain number of contraindications:

atrophy or damage to the sphincter muscles;
removal of more than thirty percent of the intestine when applying a stoma, in addition to removal from the rectum;
long course of chemotherapy for cancer;
atrophy or more than fifty percent damage to the villous epithelium, since this may result in fecal stagnation, which often leads to sepsis.

Recovery in the postoperative period

The rehabilitation period after surgery to close a colostomy is usually several months. And all possible complications often arise when at this moment the patient does not follow all the doctor’s recommendations, or are not followed in full.

When the recovery and rehabilitation period ends is decided only by the attending physician based on diagnostic studies of the intestines.

The most important thing in the postoperative period is to follow a diet and maintain a healthy lifestyle with a strict daily routine.

The diet program during the recovery period looks something like this:

3-5 days after surgery only drips with the necessary medications;
from the fifth to the twelfth day you can only eat liquid porridge with added sugar;
from the twelfth to the twenty-first day, it is allowed to gradually introduce other foods into the diet, with the exception of raw fruits and vegetables;
Only after three months have passed since the operation can you start eating apple peels, corn, raw cabbage, legumes, fried and spicy foods.

Summing up

The operation to close a colostomy is one of the stages of reconstructive surgical intervention, in which the temporary artificially created anal opening located on the anterior part of the abdominal wall is eliminated. One of the main conditions for carrying out such an operation is the absence of obstructions in the intestine along its entire length to the anus. Also important is the recovery rehabilitation period after such an intervention, which is characterized by a strict daily routine and a strict dietary program for a long time.

In each case, some time must pass between the operation and the removal of the stoma, perhaps ten weeks. During this time, the general condition of the patient improves, the colostomy site is strengthened, local immunity to the infected intestinal contents is developed, any wound infection goes away, and wounds from technical procedures performed on the distal colon heal.

This period may be shortened dramatically if the colostomy was done to decompress or drain the injured normal colon. Sometimes the colostomy partially or completely closes on its own after the obstruction is cleared, allowing fecal flow to return to its normal path through the anastomosis site. After the Mikulicz procedure, the surgeon must ensure that the bony outgrowth has been removed before attempting to close the colostomy. Stoma removal should be delayed until the swelling and hardening of the bowel around the colostomy opening have subsided and the bowel has returned to its normal appearance. Patency of the bowel anastomosis distal to the colostomy should be confirmed by barium studies.

Preparing for stoma removal

A few days before surgery, the patient is prescribed a waste-free diet and oral antibiotics, and the intestines are emptied as completely as possible. During the day before surgery, multiple lavages are done in both directions through the colostomy opening to empty the colon.

Spinal or general anesthesia can be used. Local anesthesia is contraindicated if there is an infection near the wound.

Method of stoma removal surgery

The patient is placed in a comfortable position lying on his back. In addition to the usual skin preparation, the skin around the artificial anus is carefully shaved, and a sterile gauze pad is inserted into the colostomy opening.

Progress of the operation

Holding a piece of gauze in the intestinal lumen, an oval incision is made through the skin and subcutaneous tissue around the colostomy. The surgeon inserts his or her index finger into the stoma as a guide to prevent cutting through the bowel wall or peritoneal opening while the skin and subcutaneous tissue are separated using blunt and sharp techniques. In cases where the stoma has already been in effect for some time, before proceeding with closure, the ring of scar tissue at the junction of the mucous membrane and the skin should be excised. Continuing to hold the index finger in the lumen of the intestine, the surgeon makes an incision with scissors around the edge of the mucous fold. This incision is made through the seromuscular layer down into the submucosa, taking care to create separate layers for closure. By pulling the edge of the mucous membrane with tweezers, it is closed in the transverse direction to the longitudinal axis of the intestine. Use a continuous Connell-type suture made of thin catgut or interrupted sutures made of thin 0000 silk on a French needle. After closing the mucous membrane, the previously created serous-muscular layer, freed from fat, is brought together with interrupted Halstead sutures made of thin silk. After the stoma is removed, the wound is washed several times, and clean towels are placed around the wound. All instruments and materials are removed, gloves are changed, and the wound is closed only with clean instruments. The closed part of the intestine is held on one side, while separating the adjacent fascia with curved scissors. The separation of the fascia from the intestine is facilitated by exposure of the silk sutures previously placed to secure the intestine during the colostomy. With this method of closure, the peritoneal cavity is not opened. The surgeon checks the patency of the intestine with his thumb and forefinger. If a small hole was accidentally made in the peritoneum, it is carefully closed with interrupted sutures made of thin silk. The wound is washed repeatedly with warm saline solution. The suture line is pressed with forceps while the edges of the overlying fascia are approximated with interrupted 00 silk sutures. A rubber drain can be removed at the lower corner of the wound. The subcutaneous tissue and skin are closed in layers as usual. Some people choose not to have the skin covered because of the possibility of infection.

Postoperative care after stoma removal

Parenteral fluids and antibiotics are given for several days. Clear liquids are given for several days, then a slag-free diet. You can return to your normal diet after your bowels begin to function. If a lump forms, applying hot compresses to the wound may help. Sometimes a leak occurs at the site of closure, but no immediate measures should be taken to close the fistula because closure often occurs spontaneously. The patient is allowed to get out of bed early.

The main treatment method for rectal cancer is surgery. In the fight against tumors, modern oncology combines several treatment methods. Sometimes, to control the disease, chemoradiotherapy may be prescribed before surgery. However, surgery to remove a malignant tumor is the most effective, albeit radical, method of treating this disease. Many patients are interested in the question of survival rate after surgery. How long do they live after rectal cancer surgery, and what should the recovery period be like to completely defeat the disease?

Before answering these questions, you need to know exactly what surgical methods are used in the treatment of rectal cancer, their features, as well as the rules of rehabilitation.

Currently, doctors for rectal cancer prescribe 2 types of surgical treatment methods, which are divided into palliative and radical. The first are aimed at improving the well-being and quality of life of patients. Radical surgery to remove rectal cancer eliminates developing tumors and metastases. If we take into account the surgical technique of carrying out such an operation, then this method is quite complex in medicine.

The diseased organ is located in the very depths of the small pelvis and is attached to the sacrum. Near the rectum there are large blood vessels that supply blood to the ureters and legs. Nerves located near the rectum control the activity of the urinary and reproductive systems. To date, several methods of radical surgery have been developed:

Anterior resection.

This surgical intervention is prescribed when the tumor is localized in the upper rectum. The surgeon makes an incision in the lower abdomen and removes the junction of the sigmoid colon and rectum. As is known, during the operation the tumor and adjacent healthy tissue areas are also eliminated.

Low resection.

The operation is performed if there is a tumor in the middle and lower intestines. This method is called total mesorectumectomy and is considered in medicine the standard method for removing tumors in these parts of the rectum. During this surgical intervention, the doctor performs almost complete removal of the rectum.

Abdominoperineal extirpation.

The operation begins with two incisions - in the abdomen and perineum. The method is aimed at removing the rectum, parts of the anal canal and surrounding tissues.

Local resection allows you to remove small tumors in the first stage of rectal cancer. To perform this, an endoscope is used - a medical instrument with a small camera. Such endoscopic microsurgery makes it possible to successfully combat tumors in the primary stages of the disease. In cases where the tumor is located near the anus, the endoscope may not be used by the surgeon. Surgeons remove the malignant tumor from the patient directly using surgical instruments that are inserted through the anus.

In modern medicine there are also new methods of surgical treatment of rectal cancer. They allow you to preserve the sphincter of the organ, so radical measures are rarely used in surgery. One such method is transanal excision.

The method is used to eliminate small tumors that are localized in the lower rectum. To perform the operation, special equipment and medical instruments are used. They allow you to eliminate small areas of the rectum and preserve surrounding tissue. This operation is performed without removing the lymph nodes.

A malignant tumor of the rectum can also be removed using open laparoscopy. With the laparoscopic method, the surgeon makes several small incisions in the abdominal cavity. A laparoscope with a camera, which is equipped with illumination, is inserted into the organ through one incision. Surgical instruments are inserted through the remaining incisions to remove the tumor. Laparoscopy differs from abdominal surgery in its rapid recovery period and surgical technique.

Immediately after surgery, many patients have a special stoma created to remove bowel movements. It is an artificial opening in the abdomen, to which a vessel is attached to collect feces. A stoma is made from an open section of the intestine. The hole can be temporary or left permanently. A temporary stoma is created by surgeons to help the rectum heal after rectal surgery. This kind of hole, created temporarily, is closed by surgeons after a few months. A permanent opening is only required if the tumor is located near the anus, that is, low enough in the rectum.

In cases where cancer affects organs located near the rectum, extensive operations are performed to remove the tumor - pelvic exenteration, which includes the mandatory removal of the bladder and even the genitals.

Sometimes a cancerous tumor can create an obstruction in the intestines, blocking the organ and causing vomiting and pain. In such a situation, stenting or surgery is used. With stenting, a colonoscope is inserted into the blocked area to hold the colon open. With the surgical method, the blocked area is removed by the surgeon, after which a temporary stoma is created.

Preparing for surgery to remove colorectal cancer

Surgery for rectal cancer requires mandatory preparation. The day before surgery, the intestines are completely cleansed of feces. These actions are necessary to ensure that the bacterial contents of the intestine do not enter the peritoneum during surgery and cause suppuration in the postoperative period. In severe cases, when an infection enters the abdominal cavity, a dangerous complication such as peritonitis can develop.

In preparation for radical surgery, your doctor may prescribe certain medications that help cleanse the intestines. You cannot refuse to accept these funds. It is important to strictly follow all medical recommendations before surgery - take the right amount of fluid, not eat food, etc.

Recovery after surgery

Rehabilitation in hospital

Surgery to remove cancer requires compliance with all medical recommendations during the recovery period. Surgery to remove rectal cancer improves the quality of life of sick people and increases the survival rate of the disease. Today, surgeons are focused on carrying out organ-preserving methods and strive to minimize various functional disorders of the body after surgery. Interintestinal anastomosis allows maintaining the continuity of the intestine and sphincter. In this case, the stoma is not exposed to the intestinal wall.

Recovery of the body begins in intensive care. Under the supervision of staff, the patient recovers from anesthesia. Medical control will help stop possible complications and prevent bleeding. On the second day after the operation, the doctor allows you to sit down. Under no circumstances should you refuse and continue to lie down.

After surgery, abdominal pain and discomfort are relieved by taking analgesics. All ailments must be reported to medical personnel. Taking medications will help alleviate the condition. The doctor may prescribe spinal or epidural anesthesia using injections. Painkillers can also be administered into the body through IVs. A special drainage can be placed in the area of the surgical wound, which is designed to drain excess fluid. A few days later he cleans up.

You can eat and drink on your own two to three days after surgery. Food must consist only of semi-liquid porridges and pureed soups. Food should not contain fat.

On the fifth day, the doctor allows movement. To heal the intestines, you need to wear a special bandage. Such a device is necessary to reduce the load on the abdominal muscles. The bandage also allows for uniform pressure in the abdominal cavity and promotes effective healing of postoperative sutures.

If there is an artificial opening (stoma), it will be swollen in the first days. However, after a few weeks the stoma decreases in size and shrinks. Typically, postoperative hospital stay does not take more than seven days. If the surgeon places clips or sutures on the surgical wound, they are removed after ten days.

Rehabilitation at home: important points

Surgery to remove colorectal cancer is a major surgical procedure. After discharge from the clinic, it is very important to focus your attention on avoiding stress on the digestive tract. You must adhere to a special diet. High-fiber foods, fresh vegetables and fruits, and large pieces of food are excluded from the daily diet. Under no circumstances should you eat various smoked and fried foods. The menu should consist of cereals, pureed soups and boiled vegetable dishes.

Many patients report significant changes in bowel function after rectal surgery. It will take a particularly long time for complete recovery to occur when performing a total mesorectumectomy. With such a complex operation, the intestines are restored only after several months. After surgery, diarrhea, an increased number of bowel movements, fecal incontinence, and bloating are possible. The functioning of the organ can also be affected by radiation therapy given before surgery.

Over time, disturbances in intestinal function disappear. Regular eating in small, frequent portions will help restore the functioning of the organ. It is also important to drink plenty of fluids daily. For quick healing, you need to eat protein foods - meat, fish, eggs. The overall diet should be well balanced.

If diarrhea occurs, you should eat foods low in fiber. Over time, the diet is completely restored, and foods that previously could have caused serious problems in the functioning of the organ are gradually introduced into the menu. If you maintain your previous diet, you should seek help from a nutritionist.

During the recovery period, it is important to carry out the necessary exercises that are aimed at strengthening the muscles of the rectum and sphincter. Performing special gymnastics will prevent the occurrence of stool incontinence and help improve sexual life and normal functioning of the organ.

Reviews about the operation and recovery after it

Review #1

I had a tumor in the lower part of my rectum. A serious and radical operation was prescribed. A colostomy was made into the abdominal wall. Recovery after surgery took a lot of effort, money and time.

Today, three years have passed since the operation. I constantly take all the necessary tests and undergo regular examinations. So far no complications have been identified. Therefore, I am grateful to the doctors for the positive result.

Kirill, 49 years old - Kazan

Review #2

They also made a hole after removing a rectal tumor. The doctor explained to me that without a colostomy, intestinal function is restored in only a few cases. Afterwards, an operation was performed to close the stoma. I haven’t remembered the operation for five years now. Together with the surgeons, I managed to defeat the disease! But I still follow the diet and try to undergo treatment in sanatoriums once a year.

Anatoly, 52 years old - St. Petersburg

Review #3

My mother had a tumor removed from her rectum at age 65. She did not receive any radiation before the operation. The stoma in the abdomen was also not removed, and intestinal functions improved quite quickly.

Our family firmly believed in the success of the operation. Today two months have passed since the operation. Mom feels great, walks with a walking stick, eats low-fat boiled dishes and fresh vegetables.

Irina, 33 years old - Novosibirsk

A colostomy is an artificially created fistula to communicate the colon with the external environment (colon - colon, stoma - opening).

It is applied to drain feces in cases where the natural passage of feces through the intestines to the anus is impossible for one reason or another.

Colon is the main part of the large intestine. Its main function is the formation of feces, their advancement and removal through the anus to the outside. The colon consists of the following sections:

Cecum. Ascending colon. Transverse colon. Descending colon. Sigmoid.

Digested food gruel (chyme) enters the large intestine from the small intestine. It's liquid. As it moves through the large intestine, water is absorbed and formed feces are formed at the exit. Therefore, the contents of the ascending colon are still liquid and have a slightly alkaline reaction. The closer to the intestinal outlet, the denser the contents.

The sigmoid colon continues into the rectum. The sphincter apparatus of the rectum holds feces in the ampullary region. When it is sufficiently full, there is a urge to defecate, which occurs in a healthy person approximately once a day. This is how the natural process of removing feces occurs.

When is a colostomy indicated?

It is quite obvious that creating a fistula of the colon for the unnatural discharge of feces is a very extreme measure, and it is carried out for health reasons. The colostomy may be temporary or permanent (permanent stoma).

Recently, sphincter-preserving operations have been intensively developed and implemented. But despite this, about 25% of operations on the large intestine result in an ostomy.

In what cases might this situation arise:

Inoperable tumor. If it is impossible to perform radical surgery (for example, the tumor has grown into neighboring organs or the patient is very weakened, with distant metastases), colostomy is performed as a palliative operation. After radical removal of anorectal cancer. If the tumor is located in the ampullary and middle sections, the rectum is extirpated along with its sphincter, and natural bowel movement becomes impossible. Anorectal fecal incontinence. Congenital anomalies of the intestinal outlet. Failure of a previously performed anastomosis. Intestinal obstruction. In this case, a colostomy is applied at the end of the first stage of the operation after removing the obstacle. After some time it is removed. Intestinal injury. Enterovaginal or enterovesical fistulas during their treatment. Severe ulcerative colitis or diverticulitis with bleeding and intestinal perforation. Perineal wounds. Post-radiation proctosigmoiditis.

Types of colostomy

As already mentioned, a stoma can be

Temporal. Constant.

By localization:

Ascending stoma (ascendostomy). Transverse stoma (transverse stoma). Descending stoma (descendostomy). Sigmostoma.

Double-barreled (loop) - mostly temporary. Single-barrel (or end) - often permanent.

Preparing for surgery

Colostomy is almost always the final part of another operation (elimination of intestinal obstruction, colon resection, hemicolectomy, amputation and extirpation of the rectum). Therefore, preparation for surgery is standard for all intestinal operations. In case of planned intervention this is:

Colonoscopy. Irrigoscopy. Blood and urine tests. Biochemical blood parameters. Coagulogram. Electrocardiogram. Fluorography. Markers of infectious diseases. Examination by a therapist. Colon cleansing using cleansing enemas or osmotic intestinal lavage.

In cases of serious condition of the patient (anemia, exhaustion), preoperative preparation is carried out whenever possible - transfusion of blood, plasma, protein hydrolysates, replenishment of fluid and electrolyte losses.

Quite often, a colostomy is the outcome of emergency operations for developed intestinal obstruction. In these cases, preparation is minimal and the obstruction must be cleared as soon as possible. If the patient’s condition is very severe, surgeons at the first stage minimize intervention: they impose a colostomy above the obstruction site, and the main intervention aimed at eliminating the cause of obstruction is postponed until the patient’s condition has stabilized.

Formation of a temporary colostomy

Usually, as a temporary measure, a double-barreled colostomy is formed (two ends of the intestine are brought to the abdominal wall - afferent and efferent).

temporary double-barreled colostomy

It is most convenient to form a colostomy from the transverse or sigmoid colon, which have a long mesentery; they are quite easy to remove into the wound.

The colostomy incision is made separately from the main laparotomy incision.

The skin and subcutaneous layer is excised using a circular incision. The aponeurosis is dissected crosswise. The muscles are separated. The parietal peritoneum is incised, its edges are sutured to the aponeurosis. This creates a tunnel for the removal of the intestine.

A hole is made in the mesentery of the mobilized intestine, and a rubber tube is inserted into it. By pulling the ends of the tube, the surgeon removes a loop of intestine into the wound.

A plastic or glass rod is inserted in place of the tube. The ends of the stick are placed on the edges of the wound, the loop of intestine seems to hang on it. The intestinal loop is sutured to the parietal peritoneum.

After 2-3 days, when the parietal and visceral peritoneum have fused, an incision is made into the withdrawn loop (pierced, then incised with an electric knife). The length of the incision is usually 5 cm. The posterior uncut wall of the intestine forms the so-called “spur” - a septum separating the proximal and distal knee of the stoma.

With a properly formed double-barreled colostomy, all fecal matter is removed through the adductor end to the outside. Mucus may be released through the distal (outflow) end of the intestine, and medications can be administered through it.

Closing a temporary colostomy

The closure of a temporary colostomy is carried out in a time frame individual for each patient. This could be several weeks or several months. It depends on the diagnosis, prognosis, and the condition of the patient himself.

Closing a colostomy is a separate operation. It can be done in several ways:

The loop of intestine is sharply separated from the skin and other layers of the abdominal wall. The edges of the bowel defect are refreshed and the defect is sutured. A loop of intestine is immersed into the abdominal cavity. The peritoneum and abdominal wall are sutured in layers. The ostomized portion of the intestine is separated from the skin. Intestinal clamps are applied to both ends of the loop. A section of intestine with an exposed loop is resected and an end-to-end or end-to-side anastomosis is performed.

Permanent colostomy

The most common reason for a permanent colostomy is cancer of the lower and middle ampullary rectum. With such a localization of the tumor, it is almost impossible to perform surgery while preserving the anal sphincter. In this case, treatment according to oncological criteria is considered radical: the tumor itself and regional lymph nodes are removed as widely as possible. If there are no distant metastases, the patient is considered cured, but...he will have to live without a rectum.

Therefore, the quality of the patient’s life directly depends on the quality of the formed colostomy.

The location of the colostomy is planned in advance before the operation. This is usually the middle of the segment connecting the navel and the left iliac crest. The skin in this area should be smooth, without scars or deformations, as they can interfere with the tight fit of the colostomy bags. The mark is made in a lying position, then adjusted in a standing position (patients with a pronounced subcutaneous fat layer may have skin folds).

A permanent stoma is usually single-barrel, that is, only one end of the intestine (proximal) is brought to the abdominal wall to drain feces.

At the final stage of the operation (rectal resection, Hartmann's operation), an incision is made in the skin, subcutaneous tissue and rectus abdominis muscle at the marking site. The parietal peritoneum is dissected, along the edges of the wound it is sutured to the aponeurosis and muscles.

A loop of intestine is brought out into the wound and intersected. The abductor end is sutured tightly and plunged into the abdominal cavity. The proximal end is brought out into the wound.

It is possible to form two types of colostomies:

Flat - the intestine is sutured to the aponeurosis and parietal peritoneum, almost does not protrude above the surface of the skin. Protruding - the edges of the intestine are brought out into the wound by 2-3 cm, pulled together in the form of a “rose” and sutured to the peritoneum, aponeurosis and skin.

It is important that the incision of the skin and aponeurosis is not too small, the intestine should be brought out without tension or twisting, and the end of the intestine brought out must have a good blood supply. If all these conditions are met, the risk of complications and dysfunction of the colostomy in the future is minimized.

After surgery, how to live with a colostomy

After the stoma is placed, it takes some time for the intestine to heal. Therefore, the patient receives only parenteral nutrition for several days. You are allowed to drink liquid every other day.

On the 3rd day after surgery, you are allowed to take liquid and semi-liquid foods.

After the colostomy operation, the patient remains in the hospital for 10 to 14 days. During this time, he will be taught how to care for his colostomy and use colostomy bags.

The psychological preparation of the patient before surgery is very important. The news that he will have to live with an unnatural anus is taken very hard. Due to insufficient information and insufficient psychological support, some patients refuse such an operation, dooming themselves to death.

You can live with a colostomy for a long time. Modern colostomy bags and stoma care products allow you to lead a normal, full life.

Possible complications after ostomy

Intestinal necrosis. It develops when its blood supply is disrupted, if the intestine is poorly mobilized during surgery and the mesentery is too stretched, a blood vessel is stitched, or it is pinched in an insufficiently wide incision of the aponeurosis. With necrosis, the intestine turns blue, then turns black. Necrosis is eliminated by repeated surgery. Paracolostomy abscesses. Occurs when an infection occurs. The skin around the stoma becomes red and swollen, pain intensifies, and body temperature rises. Retraction (retraction) of the stoma. It can also occur if the surgical technique is violated (too much tension). Requires surgical reconstruction. Evagination (prolapse) of the intestine. Colostomy stricture. It can develop gradually as a result of scarring of the tissues surrounding the stoma. Narrowing of the outlet may be complicated by intestinal obstruction. Irritation, weeping of the skin around the stoma, the addition of a fungal infection.

Ostomy care

It will take some time to adapt to a stoma (from several months to a year).

The intestinal wall exposed to the skin will be swollen for some time after the operation. It will gradually decrease in size (stabilize in a few weeks). The mucous membrane of the excreted intestine is red.

Touching the stoma during care does not cause pain or discomfort, since the mucous membrane has almost no sensitive innervation.

The first time after surgery, feces will be released continuously. Gradually, you can achieve their release several times a day.

The lower the colostomy is located along the intestine, the more formed the stool will come out of it.

If the colostomy is located on the sigmoid colon, it is even possible for feces to accumulate and be passed once a day like random stools.

Video: colostomy care

Colostomy bags

To collect stool from a colostomy, there are colostomy bags - disposable or reusable containers with devices for attaching to the body.

The colostomy bag is a plastic bag with a base that is adhesive to the body.

They are:

One-component colostomy bags. This is a disposable package that is directly adhered to the skin. When the bag is filled to the middle of its volume, it must be peeled off and replaced with a new one. Two-component colostomy bag. It is a base with an adhesive surface, which is attached to the skin around the stoma, and has a flange connection in the form of a ring. Hermetically sealed disposable or reusable ostomy bags are attached to the ring. Such colostomy bags are more convenient. The adhesive base can remain glued to the skin for several days, and the bags are replaced as they are filled.

When changing the colostomy bag, the skin around the ostomy opening is cleaned. After peeling off the adhesive base, the skin is washed with water and baby soap or a special cleansing lotion and dried with a napkin (not cotton wool).

You need to cut a hole in the adhesive plate 3-4 mm larger than the diameter of the stoma and remove the paper backing from the plate. The plate is glued onto dry skin, starting from the bottom edge. The stoma itself should be placed strictly in the center of the hole. A mirror is used for control. It is necessary to ensure that folds do not form on the skin.

The ostomy bag is attached to the plate ring. Ostomy patients change the bag 1 or 2 times a day.

Nutrition for patients with colostomy

There is no special diet for ostomy patients. Food should be varied and rich in vitamins.

Basic rules for such patients:

It is advisable to eat at strictly defined times 3 times a day. The bulk of food should be consumed in the morning, followed by a less dense lunch and a lighter dinner. Drink enough liquid (at least 2 liters). Food must be chewed thoroughly.

After a few months of adaptation, the patient himself will learn to determine his diet and select those products that will not cause discomfort. At first, it is advisable to eat foods that do not contain toxins (boiled meat, fish, semolina and rice porridge, mashed potatoes, pasta).

People with ostomies, like everyone else, can experience constipation or diarrhea. Usually, sweet, salty, fiber-containing foods (vegetables, fruits), brown bread, fats, cold foods and drinks enhance peristalsis. Mucous soups, rice, white crackers, cottage cheese, pureed cereals, black tea reduce peristalsis and retain stool.

You should avoid foods that cause increased gas formation: legumes, vegetables and fruits with peels, cabbage, carbonated drinks, baked goods, whole milk. Some foods produce an unpleasant odor when digested, which is very important in case of possible involuntary release of gases from the stoma. These are eggs, onions, asparagus, radishes, peas, some types of cheese, beer.

New foods should be introduced into the diet gradually, monitoring the intestinal reaction to each product.

Short-term use without a doctor's prescription is possible:

Activated carbon (for bloating, to absorb odors) 2-3 tablets 4-6 times a day. Digestive enzymes (pancreatin, festal) - for bloating, rumbling to improve digestion processes.

It is not recommended to use other drugs without consulting a doctor.

If irritation occurs around the stoma, the skin around it is treated with Lassara paste, zinc ointment or special ointments for caring for the skin around the stoma.

Products for ostomy patients

In addition to colostomy bags, the modern medical industry produces various products for colostomy care. They are designed to maximally improve the quality of life for such patients and provide them with a sense of absolute usefulness in society.

Pastes for making the connection of the colostomy bag with the skin tight (they fill the slightest irregularities). Lubricants with odor neutralizer. Wipes and lotions for cleansing the skin around the stoma. Special healing creams and ointments used for skin irritations. Anal tampons and plugs. They are used to close a stoma without a colostomy bag. Irrigation systems.

The patient can do without a colostomy bag for some time (when taking a shower, going to the pool, during sex). Some patients who have learned to regulate their bowel movements can also go without a receiver most of the time.

There is also an irrigation method for cleaning the intestines - a cleansing enema is done through the stoma once a day or every other day. After this, the stoma can be closed with a tampon and dispensed with without a colostomy bag. At the same time, you can lead a fairly active lifestyle with virtually no restrictions.

Rehabilitation after colostomy

After 2-3 months, in the absence of complications, the operated patient can return to normal work activity, unless it involves heavy physical labor.

The main point in rehabilitation is the right psychological attitude and support from loved ones.

Patients with ostomies lead full lives, attend concerts, theaters, have sex, get married and have children.

In large cities there are societies for ostomy patients, where they provide all kinds of help and support to such people. The Internet provides great assistance in finding information; reviews from patients living with a colostomy are very important.

Closing the colostomy usually performed 3-6 months after the first surgery, although the timing is controversial. While some authors have extrapolated from the literature from non-traumatic cases and advocate this long interval between colostomy and closure, others argue that a shorter interval of one to two months produces the lowest complication rates.

Next, one prospective uncontrollable and two prospective randomized studies have shown that closure during the same hospitalization, 7 to 14 days after the first operation, is safe and cost-effective. Although closure at the same length of hospital stay is not appropriate for all patients, appropriately selected subgroups of patients without other major injuries or significant postoperative complications may benefit from colostomy closure within a short period of time after colostomy placement.

Most are not even sutured rectal injuries heals well on average after 7-10 days, and therefore closure of the colostomy during the same hospitalization seems feasible and safe.

Colostomy closure technique

Type colostomy determines access through a local incision or full laparotomy. Loop and double-barrel colostomies can be easily reconstructed through an incision in the colostomy area, which allows the edges of the intestine to be cleared and sutured into one row. Hartmann's operations with a mucous fistula next to a colostomy also allow local access.

Although most of these patients The operation will be performed under general anesthesia; the use of local anesthesia has also been described. However, among the 14 patients (12 with loop colostomy and two with end colostomy and mucosal fistula), the rate of major postoperative complications was unusually high (43%, three anastomotic leaks, two wound infections, one intestinal obstruction). It is unclear whether local anesthesia, which creates suboptimal operating conditions, is one of the reasons for these complications.

After Hartmann's operations without a mucous fistula, a repeat midline laparotomy under general anesthesia is necessary. To minimize the surgical trauma of the second intervention, laparoscopically assisted operations, with and without the application of pneumoperitoneum, are successfully used. There are fewer advantages to closure after the Hartmann procedure, as loop colostomies can be closed through a local incision in a short time and with minimal trauma.

Outcomes of colostomy closure

Closing a colostomy involves significant risk. In an analysis of 40 trauma patients who had 28 loop and 12 end colostomies closed an average of eight months after injury, we found that the postoperative complication rate was 30%. Serious postoperative complications included a fecal fistula that was treated nonsurgically, a stricture at the anastomotic site that required reoperation, and two small bowel obstructions, one of which was resolved conservatively and the other requiring operative release of adhesions. Interestingly, closure of a colostomy after colonic injuries results in a greater number of complications than after rectal injuries.

Similar results have been reported in other research, which gave complication rates of 24%, 35%, 32% and 27%. Although most complications were relatively minor and included wound infections and easily treatable extra-abdominal infections, serious complications such as anastomotic leaks or intra-abdominal abscesses are not uncommon and even mortality rates of up to 2% have been reported. Premorbid factors, especially diabetes, heart disease and kidney disease, increase the risk of complications.

Young and somatically unburdened Patients should have a low risk, but it is impossible to completely eliminate the risk. Complications associated with closure of colostomies should be considered as an additional argument for performing a primary suture for colon injuries.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

A colostomy is an artificially created fistula to communicate the colon with the external environment (colon - colon, stoma - opening).

It is applied to drain feces in cases where the natural passage of feces through the intestines to the anus is impossible for one reason or another.

Cecum.
Ascending colon.
Transverse colon.
Descending colon.
Sigmoid.

When is a colostomy indicated?

Recently, sphincter-preserving operations have been intensively developed and implemented. But despite this, about 25% of operations on the large intestine result in an ostomy.

In what cases might this situation arise:

Inoperable tumor. If it is impossible to perform radical surgery (for example, the tumor has grown into neighboring organs or the patient is very weakened, with distant metastases), colostomy is performed as a palliative operation.
After radical removal of anorectal cancer. If the tumor is located in the ampullary and middle sections, the rectum is extirpated along with its sphincter, and natural bowel movement becomes impossible.
Anorectal fecal incontinence.
Congenital anomalies of the intestinal outlet.
Failure of a previously performed anastomosis.
Intestinal obstruction. In this case, a colostomy is applied at the end of the first stage of the operation after removing the obstacle. After some time it is removed.
Intestinal injury.
Enterovaginal or enterovesical fistulas during their treatment.
Severe ulcerative colitis or diverticulitis with bleeding and intestinal perforation.
Perineal wounds.
Post-radiation proctosigmoiditis.

Types of colostomy

As already mentioned, a stoma can be

Temporal.
Constant.

By localization And:

Ascending stoma (ascendostomy).
Transverse stoma (transverse stoma).
Descending stoma (descendostomy).
Sigmostoma.

By shape

Double-barreled (loop) – mostly temporary.
Single-barrel (or end) - often permanent.

Preparing for surgery

Colostomy is almost always the final part of another operation (elimination of intestinal obstruction, amputation and extirpation of the rectum). Therefore, preparation for surgery is standard for all intestinal operations. In case of planned intervention this is:

Colonoscopy.
Irrigoscopy.
Blood and urine tests.
Biochemical blood parameters.
Coagulogram.
Electrocardiogram.
Fluorography.
Markers of infectious diseases.
Examination by a therapist.
Colon cleansing using cleansing enemas or osmotic intestinal lavage.

Formation of a temporary colostomy

Usually, as a temporary measure, a double-barreled colostomy is formed (two ends of the intestine are brought to the abdominal wall - afferent and efferent).

temporary double-barreled colostomy

It is most convenient to form a colostomy from the transverse or sigmoid colon, which have a long mesentery; they are quite easy to remove into the wound.

The colostomy incision is made separately from the main laparotomy incision.

A hole is made in the mesentery of the mobilized intestine, and a rubber tube is inserted into it. By pulling the ends of the tube, the surgeon removes a loop of intestine into the wound.

Closing a temporary colostomy

The closure of a temporary colostomy is carried out in a time frame individual for each patient. This could be several weeks or several months. It depends on the diagnosis, prognosis, and the condition of the patient himself.

Closing a colostomy is a separate operation. It can be done in several ways:

The loop of intestine is sharply separated from the skin and other layers of the abdominal wall. The edges of the bowel defect are refreshed and the defect is sutured. A loop of intestine is immersed into the abdominal cavity. The peritoneum and abdominal wall are sutured in layers.
The ostomized portion of the intestine is separated from the skin. Intestinal clamps are applied to both ends of the loop. A section of intestine with an exposed loop is resected and an end-to-end or end-to-side anastomosis is performed.

Permanent colostomy

Therefore, the quality of the patient’s life directly depends on the quality of the formed colostomy.

A permanent stoma is usually single-barrel, that is, only one end of the intestine (proximal) is brought to the abdominal wall to drain feces.

At the final stage of the operation (,), an incision is made in the skin, subcutaneous tissue and rectus abdominis muscle at the marking site. The parietal peritoneum is dissected, along the edges of the wound it is sutured to the aponeurosis and muscles.

A loop of intestine is brought out into the wound and intersected. The abductor end is sutured tightly and plunged into the abdominal cavity. The proximal end is brought out into the wound.

It is possible to form two types of colostomies:

Flat - the intestine is sutured to the aponeurosis and parietal peritoneum, almost does not protrude above the surface of the skin.
Protruding - the edges of the intestine are brought out into the wound by 2-3 cm, pulled together in the form of a “rose” and sutured to the peritoneum, aponeurosis and skin.

After surgery, how to live with a colostomy

After the stoma is placed, it takes some time for the intestine to heal. Therefore, the patient receives only parenteral nutrition for several days. You are allowed to drink liquid every other day.

On the 3rd day after surgery, you are allowed to take liquid and semi-liquid foods.

After the colostomy operation, the patient remains in the hospital for 10 to 14 days. During this time, he will be taught how to care for his colostomy and use colostomy bags.

You can live with a colostomy for a long time. Modern colostomy bags and stoma care products allow you to lead a normal, full life.

Possible complications after ostomy

Intestinal necrosis. It develops when its blood supply is disrupted, if the intestine is poorly mobilized during surgery and the mesentery is too stretched, a blood vessel is stitched, or it is pinched in an insufficiently wide incision of the aponeurosis. With necrosis, the intestine turns blue, then turns black. Necrosis is eliminated by repeated surgery.
Paracolostomy abscesses. Occurs when an infection occurs. The skin around the stoma becomes red and swollen, pain intensifies, and body temperature rises.
Retraction (retraction) of the stoma. It can also occur if the surgical technique is violated (too much tension). Requires surgical reconstruction.
Evagination (prolapse) of the intestine.
Colostomy stricture. It can develop gradually as a result of scarring of the tissues surrounding the stoma. Narrowing of the outlet may be complicated by intestinal obstruction.
Irritation, wetting of the skin around the stoma, addition of a fungal infection.

Ostomy care

It will take some time to adapt to a stoma (from several months to a year).

Touching the stoma during care does not cause pain or discomfort, since the mucous membrane has almost no sensitive innervation.

The first time after surgery, feces will be released continuously. Gradually, you can achieve their release several times a day.

The lower the colostomy is located along the intestine, the more formed the stool will come out of it.

If the colostomy is located on the sigmoid colon, it is even possible for feces to accumulate and be passed once a day like random stools.

Video: colostomy care

Colostomy bags

To collect stool from a colostomy, there are colostomy bags - disposable or reusable containers with devices for attaching to the body.

The colostomy bag is a plastic bag with a base that is adhesive to the body.

They are:

The ostomy bag is attached to the plate ring. Ostomy patients change the bag 1 or 2 times a day.

Nutrition for patients with colostomy

There is no special diet for ostomy patients. Food should be varied and rich in vitamins.

Basic rules for such patients:

It is advisable to eat at strictly defined times 3 times a day.
The bulk of food should be consumed in the morning, followed by a less dense lunch and a lighter dinner.
Drink enough liquid (at least 2 liters).
Food must be chewed thoroughly.

New foods should be introduced into the diet gradually, monitoring the intestinal reaction to each product.

Short-term use without a doctor's prescription is possible:

Activated carbon (for bloating, to absorb odors) 2-3 tablets 4-6 times a day.
Digestive enzymes (pancreatin, festal) - for bloating, rumbling to improve digestion processes.

It is not recommended to use other drugs without consulting a doctor.

If irritation occurs around the stoma, the skin around it is treated with Lassara paste, zinc ointment or special ointments for caring for the skin around the stoma.

Products for ostomy patients

Pastes for making the connection of the colostomy bag with the skin tight (they fill the slightest irregularities).
Lubricants with odor neutralizer.
Wipes and lotions for cleansing the skin around the stoma.
Special healing creams and ointments used for skin irritations.
Anal tampons and plugs. They are used to close a stoma without a colostomy bag.
Irrigation systems.

Rehabilitation after colostomy

After 2-3 months, in the absence of complications, the operated patient can return to normal work activity, unless it involves heavy physical labor.

The main point in rehabilitation is the right psychological attitude and support from loved ones.

Patients with ostomies lead full lives, attend concerts, theaters, have sex, get married and have children.

Any patient perceives the closure of a colostomy with joy, because he has a chance, although not immediately, to send his needs through the anus, located at the end of the rectum, and not on the stomach, and to do this at his own request. However, to achieve the long-awaited normalization of stool, you need to go a long way to restore the functioning of the large intestine. How is the operation to close a colostomy performed and when will the period of life associated with many inconveniences, called life after a colostomy, end?

Unlike an ileostomy, a colostomy is an opening for removing feces from the large intestine.

A colostomy has some advantages over an ileostomy:

Although uncontrollable, the urge to defecate is an opportunity to mentally prepare in a few minutes.
The feces are practically formed - the skin around the stoma is subject to less irritation.
The course of the operation to apply a colostomy, just like the course of the operation to close it, consists of fewer stages.
The diet is not so strict.
The recovery period takes 2-3 times less time than if a stoma for the small intestine is closed.

The course of the operation to close a colostomy consists of the following stages:

With a double-barreled stoma, an incision is made between two holes, and with a single-barrel stoma, the length of the incision depends on the length of the longitudinal incision of the colon, which was made before the colostomy.
The section of intestine where the ostomy was performed is removed.
With double-barrel, the holes are sutured, and with single-barrel, the functioning ends of the intestine are connected. As a rule, the closure of an end stoma (single-barrel type) is carried out with the removal of a section of the intestine that was cut longitudinally, plus 10-15% beyond this length, and this is already a resection of the intestine, that is, the intestine will not function as before the ostomy. The consequences are expressed in rapid bowel movements from 15 minutes to 2 hours after eating. Accordingly, in order to increase the absorption of nutrients, you need to either eat several times more, or switch to high-calorie and frequent meals 5 times a day or more. Therefore, the procedure for closing a double-barreled stoma is easier for the surgeon and the patient than the operation for closing a single-hole stoma.
The muscle tissue is carefully sewn together and the top suture is applied. Sutures are applied with self-absorbing threads such as catgut.
The degree of tightness of the intestinal section is checked.

The operation may include additional steps, such as transplanting a section of the rectum or another section of the large intestine if a suitable donor is available.

The operation to remove a colostomy lasts on average 100-120 minutes, and in some cases up to 3 hours. Despite the fact that reconstructive surgery is entrusted only to professionals, due to the physiological characteristics of the body of some patients, for example, heart problems, colostomy and stoma elimination, it can be carried out in 2 stages with a break of several days. If the patient cannot withstand the effects of general anesthesia, the colostomy is not closed until the heart can cope with the required load.

It is possible to completely restore the former functionality of the intestines in 40% of cases. Often, after closing a colostomy, complications may arise both in the area of the stoma where the surgical actions were performed, and in the functioning of the intestine after a long period. The main complications arise when removing a single-barrel (end colostomy, since this type is not temporary.)

When removing both single-barrel and double-barrel stoma, the following complications may occur:

Perforation or rupture of the intestine in the stoma area.
Rectal prolapse.
Suppuration or inflammation in the area of the former stoma.
The occurrence of obstruction in the ostomy area due to the accumulation of feces in the area of the sutures.

You cannot do a colostomy:

if the sphincter muscles have atrophied or been damaged;
after a long course of chemotherapy;
if the villous epithelium is atrophied or damaged by more than 50%, fecal stagnation with subsequent sepsis is possible;
if during the stoma more than 30% of the intestinal tract was removed, except for the output from the rectum.

Recovery

As a rule, the complications described above arise when restorative procedures are not properly performed in the postoperative period, which can last from several weeks to several months.

The end date of the postoperative rehabilitation complex can only be announced by the attending physician after diagnosing the intestinal condition.

Postoperative rehabilitation includes an appropriate diet and a strict daily routine.

The diet looks like this:

the first 3-5 days after surgery - droppers with the necessary substances;
5-12 days – liquid porridge with sugar;
12-21 days – foods, except raw vegetables and fruits, are gradually introduced into the diet;
raw cabbage, apple peels, fried and spicy foods, as well as legumes and corn should not be consumed for 90 days or longer after surgery.

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