The Surgical Creation Of An Opening Is Called

The surgical creation of an opening in the body, often to establish a new route for bodily fluids or access an internal organ, is known as a stoma. This procedure, while sometimes perceived as daunting, is a life-saving intervention for individuals facing various medical conditions. Understanding the nuances of stomas, including their creation, types, care, and potential complications, is crucial for both patients and healthcare professionals.

Understanding Stomas: A Comprehensive Guide

A stoma, derived from the Greek word for "mouth" or "opening," is a surgically created opening that connects an internal organ to the surface of the body. This opening allows for the passage of waste, such as urine or stool, or can provide access for feeding or medication administration. The creation of a stoma, often referred to as ostomy surgery, is a significant medical procedure that requires careful planning, execution, and ongoing management.

Why are Stomas Created? Common Indications

Stomas are created for a variety of medical reasons, generally when the normal passage of bodily fluids or waste is obstructed, damaged, or diseased. Some common indications for stoma creation include:

• Bowel Cancer: When a tumor blocks the colon or rectum, a colostomy or ileostomy may be necessary to divert stool.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can severely damage the intestines, requiring a stoma for healing or long-term management.
• Diverticulitis: Severe or recurrent diverticulitis can lead to complications like perforations or abscesses, necessitating a temporary or permanent stoma.
• Bowel Obstruction: Blockages in the intestines, caused by adhesions, hernias, or other factors, can require a stoma to relieve pressure and allow healing.
• Trauma: Injuries to the abdomen can damage the intestines, requiring a stoma as part of the reconstructive process.
• Bladder Cancer: In cases of bladder cancer requiring bladder removal (cystectomy), a urostomy is created to divert urine.
• Spinal Cord Injuries: Neurological conditions affecting bowel or bladder control may necessitate a stoma to manage waste elimination.
• Congenital Anomalies: Birth defects affecting the intestines or urinary tract may require a stoma for proper function.

Types of Stomas: A Detailed Overview

Stomas are classified based on the organ involved and the purpose of the diversion. The primary types of stomas include:

1. Colostomy

A colostomy involves bringing a portion of the colon to the abdominal surface, creating an opening for stool to pass through. The location of the colostomy on the abdomen depends on which part of the colon is used.

• Ascending Colostomy: Located on the right side of the abdomen, this type of colostomy diverts stool from the ascending colon. Stool output is typically liquid to semi-liquid and contains digestive enzymes.
• Transverse Colostomy: Created in the middle of the abdomen, using the transverse colon. This colostomy can be a loop colostomy (where a loop of bowel is brought to the surface) or a divided colostomy (where the bowel is completely separated). Stool output is usually pasty to semi-formed.
• Descending Colostomy: Located on the left side of the abdomen, this type of colostomy diverts stool from the descending colon. Stool output is typically more formed.
• Sigmoid Colostomy: The most common type of colostomy, located in the lower left abdomen, using the sigmoid colon. Stool output is usually formed and predictable.

2. Ileostomy

An ileostomy involves bringing the ileum (the last part of the small intestine) to the abdominal surface. This type of stoma diverts stool before it reaches the colon.

• Standard Ileostomy: The ileum is brought through the abdominal wall, and the end is everted to create a spout. Stool output is liquid to pasty and contains digestive enzymes.
• Continent Ileostomy (Kock Pouch): An internal pouch is created from the ileum, and a nipple valve is constructed to prevent leakage. The pouch is emptied several times a day using a catheter. This type of ileostomy eliminates the need for an external bag.
• Ileoanal Pouch (J-Pouch): This procedure involves removing the colon and rectum and creating a pouch from the ileum, which is then connected to the anus. This allows for near-normal bowel function, although bowel movements may be more frequent. Note: This is not technically a stoma, but often considered in the context of stoma alternatives.

3. Urostomy

A urostomy involves diverting urine away from the bladder. This is typically done after the bladder has been removed or bypassed due to cancer, injury, or other conditions.

• Ileal Conduit: A segment of the ileum is removed and used as a conduit to connect the ureters (tubes carrying urine from the kidneys) to the abdominal surface. Urine flows continuously into an external collection bag.
• Continent Urinary Diversion (Indiana Pouch): An internal pouch is created from a section of the colon, and the ureters are connected to the pouch. A stoma is created on the abdomen, and the pouch is emptied several times a day using a catheter.
• Ureterostomy: The ureters are directly brought to the abdominal surface, creating small stomas on one or both sides of the abdomen. This procedure is less common due to potential complications.

4. Other Types of Stomas

While colostomies, ileostomies, and urostomies are the most common types of stomas, other types exist for specific medical situations:

• Gastrostomy: A feeding tube is inserted directly into the stomach through the abdominal wall, providing a route for nutrition.
• Jejunostomy: A feeding tube is inserted into the jejunum (part of the small intestine) through the abdominal wall, also providing a route for nutrition.
• Tracheostomy: An opening is created in the trachea (windpipe) to provide an airway. This is typically done when a person is unable to breathe on their own.

The Surgical Process: Creating a Stoma

The creation of a stoma is a surgical procedure performed under general anesthesia. The specific techniques used depend on the type of stoma being created and the patient's individual anatomy and medical condition.

• Pre-operative Preparation: Before surgery, patients undergo a thorough medical evaluation, including blood tests, imaging studies, and a consultation with a stoma nurse. The stoma nurse will help determine the optimal location for the stoma, considering factors like abdominal contours, skin folds, and the patient's lifestyle. Bowel preparation may be required to clear the intestines before surgery.
• Surgical Procedure: The surgeon makes an incision in the abdomen and identifies the segment of bowel or urinary tract to be used for the stoma. The chosen segment is then brought through the abdominal wall, and the end is everted and sutured to the skin, creating the stoma opening. The remaining bowel or urinary tract is reconnected, if possible, or closed off.
• Stoma Construction Techniques: Different techniques can be used to construct the stoma. A loop stoma involves bringing a loop of bowel to the surface and supporting it with a bridge or rod. An end stoma involves dividing the bowel and bringing the end to the surface. The choice of technique depends on the specific situation and the surgeon's preference.
• Post-operative Care: After surgery, patients are closely monitored for complications. Pain management is provided, and the stoma is regularly assessed for proper function and signs of infection. The stoma nurse provides education and support on stoma care, including how to empty and change the ostomy bag, how to clean the skin around the stoma, and how to prevent complications.

Living with a Stoma: Practical Considerations

Living with a stoma requires adjustments to daily life, but with proper education and support, individuals can maintain a good quality of life.

• Stoma Care: Proper stoma care is essential to prevent skin irritation, infection, and other complications. This includes regularly emptying and changing the ostomy bag, cleaning the skin around the stoma with mild soap and water, and inspecting the stoma for changes in size, color, or shape.
• Diet: Dietary modifications may be necessary depending on the type of stoma. For example, individuals with an ileostomy may need to drink more fluids to prevent dehydration, while those with a colostomy may need to avoid gas-producing foods. A registered dietitian can provide personalized dietary recommendations.
• Clothing: Most people with a stoma can wear their normal clothing. High-waisted pants or skirts may be more comfortable, and loose-fitting clothing can help conceal the ostomy bag.
• Activity: Physical activity is generally encouraged for individuals with a stoma. However, it is important to avoid heavy lifting or strenuous activities that could put strain on the stoma. A stoma nurse or physical therapist can provide guidance on safe exercise.
• Travel: Traveling with a stoma requires some planning. It is important to pack extra ostomy supplies, carry a medical identification card, and be aware of the availability of medical care at your destination.
• Emotional Support: Adjusting to life with a stoma can be emotionally challenging. Support groups and counseling can provide a valuable source of emotional support and practical advice.

Potential Complications: What to Watch For

While stoma surgery is generally safe, complications can occur. It is important to be aware of the potential complications and seek medical attention if they arise.

• Stoma Retraction: The stoma pulls back below the skin level, making it difficult to attach the ostomy bag.
• Stoma Prolapse: The stoma extends too far out from the abdominal wall.
• Stoma Stenosis: The stoma opening narrows, obstructing the flow of stool or urine.
• Parastomal Hernia: A bulge develops around the stoma, caused by the intestines pushing through the abdominal wall.
• Skin Irritation: The skin around the stoma becomes red, itchy, or sore.
• Infection: The stoma or surrounding skin becomes infected.
• Bleeding: The stoma bleeds excessively.
• Bowel Obstruction: A blockage develops in the intestines.
• Dehydration: Excessive fluid loss can lead to dehydration, especially with an ileostomy.

The Future of Stoma Care: Innovations and Advancements

The field of stoma care is constantly evolving, with ongoing research and development aimed at improving the quality of life for individuals living with a stoma. Some promising areas of innovation include:

• Improved Ostomy Bags: New materials and designs are being developed to make ostomy bags more comfortable, discreet, and odor-resistant.
• Smart Stoma Devices: These devices use sensors to monitor stoma output and provide alerts for potential problems.
• Minimally Invasive Surgical Techniques: Laparoscopic and robotic surgery can be used to create stomas with smaller incisions, reducing pain and recovery time.
• Regenerative Medicine: Research is underway to explore the possibility of regenerating damaged bowel or urinary tract tissue, potentially eliminating the need for a stoma.

Conclusion: Empowering Individuals Living with a Stoma

The surgical creation of an opening, or stoma, is a life-altering procedure that can significantly improve the quality of life for individuals facing a variety of medical conditions. Understanding the different types of stomas, the surgical process involved, and the practical considerations for living with a stoma is crucial for both patients and healthcare professionals. By providing comprehensive education, support, and access to advanced technologies, we can empower individuals to live full and active lives with a stoma. While the journey may present challenges, it is important to remember that a stoma is not an end, but a new beginning – a chance to reclaim health and well-being.

Frequently Asked Questions (FAQ) About Stomas

• Is stoma surgery painful? While there will be some discomfort after surgery, pain can be effectively managed with medication.
• Will I be able to eat normally with a stoma? In most cases, yes. Dietary modifications may be necessary initially, but most people can return to a normal diet.
• Can I swim with a stoma? Yes, you can swim with a stoma. Special ostomy bags and accessories are available for swimming.
• Will people be able to tell I have a stoma? With proper clothing and bag management, a stoma is usually not noticeable to others.
• How long will I have to live with a stoma? The duration depends on the underlying medical condition. Some stomas are temporary, while others are permanent.
• Can a stoma be reversed? In some cases, a stoma can be reversed, restoring normal bowel or urinary function. This depends on the underlying medical condition and the extent of the surgery.
• What is the role of a stoma nurse? A stoma nurse provides specialized care and education to individuals before and after stoma surgery. They offer guidance on stoma care, bag management, diet, and emotional support.
• Where can I find support for living with a stoma? Numerous organizations and support groups offer resources and support for individuals living with a stoma. Your stoma nurse or healthcare provider can provide you with information on local and online resources.
• How often should I change my ostomy bag? The frequency of bag changes depends on the type of bag, the type of stoma, and individual factors. Generally, bags should be changed every 1-3 days or when they are leaking or full.
• What should I do if my stoma is bleeding? Minor bleeding from the stoma is not uncommon, but excessive bleeding should be reported to your healthcare provider.