A diverting loop ileostomy is a surgical procedure that reroutes the small intestine to an opening on the abdomen, called a stoma. This is achieved by bringing a loop of the final section of the small intestine, the ileum, to the surface of the skin. The term “diverting” refers to its function: to temporarily redirect the flow of stool away from a downstream section of the bowel. The procedure is designed to be temporary, providing a controlled period for healing.
Purpose of the Procedure
The primary reason for creating a diverting loop ileostomy is to protect a new surgical connection, known as an anastomosis, lower down in the large intestine or rectum. Following surgeries for conditions like colorectal cancer or inflammatory bowel disease (IBD), surgeons often join two ends of the bowel. By diverting the flow of stool, the ileostomy prevents fecal matter from irritating the delicate new connection, reducing the risk of complications such as infection or leakage.
This protective measure is a common strategy in the management of colorectal cancer, ulcerative colitis, Crohn’s disease, and complicated cases of diverticulitis. The ileostomy gives the surgical site an undisturbed environment to heal, which is a factor in successful recovery. The duration can vary, often lasting for at least six weeks but sometimes longer if additional treatments like chemotherapy are required.
Before the reversal can be planned, surgeons confirm the integrity of the healed anastomosis. This is typically done through imaging studies, such as a contrast enema, or an endoscopic evaluation like a flexible sigmoidoscopy. These tests ensure that the connection is secure and free of leaks before normal bowel function is restored.
The Surgical Creation
The creation of a diverting loop ileostomy involves a surgeon making a small incision in the abdominal wall, typically on the right side. Through this opening, a loop of the ileum is gently pulled to the surface. The surgeon then makes an incision in this exposed loop of bowel and stitches the edges to the skin, forming the stoma. This procedure can be performed using either minimally invasive laparoscopic techniques or through a traditional open incision.
A distinctive feature of a loop ileostomy is that it has two openings that sit side-by-side within the stoma. One opening, the proximal limb, is the functional part that expels stool. The other opening, the distal limb, is connected to the resting part of the bowel and will only pass a small amount of mucus.
The stoma itself will appear moist and red, similar to the inside of a cheek, and does not have any nerve endings, so it is not painful to touch. Its location is carefully selected before surgery to ensure it is situated on a flat surface away from skin folds, the navel, or bones. This placement makes it easier to attach and manage the pouching system.
Managing a Loop Ileostomy
Living with a loop ileostomy requires adjusting to new daily routines, primarily centered on managing the stoma’s output and the pouching system. The output from an ileostomy is liquid or paste-like and continuous because the stoma is created from the small intestine, before the colon can absorb water. The high volume of fluid output increases the risk of dehydration and electrolyte imbalances.
To manage this, individuals must be diligent about their fluid intake, often consuming more water and beverages containing electrolytes. Dietary adjustments are also necessary. It is recommended to avoid high-fiber foods, especially in the initial weeks after surgery, as they can cause blockages. Foods like nuts, seeds, and raw vegetables may need to be introduced cautiously, and chewing food thoroughly is an important practice to aid digestion.
The pouching system, or ostomy bag, is a medical device that adheres to the skin around the stoma to collect the output. These systems consist of a skin barrier, which protects the skin, and a collection pouch. Proper skin care around the stoma is needed to prevent irritation and skin breakdown from the enzymatic digestive fluids in the stool. The skin must be kept clean and dry, and the pouching system should be fitted correctly to prevent leakage.
Regularly emptying the pouch is a part of the daily routine, typically when it is about one-third to one-half full. The entire pouching system is usually changed every few days, depending on the type of system and individual needs.
The Reversal Process
The reversal surgery, often called a “takedown,” is generally less complex than the initial operation to create the stoma. The procedure involves the surgeon making an incision around the stoma to free the loop of ileum from the abdominal wall. The two ends of the bowel that formed the loop are then reconnected, either with sutures or surgical staples, to restore the continuous path of the digestive tract.
The reconnected intestine is placed back inside the abdominal cavity, and the incision on the abdomen where the stoma was located is closed. The hospital stay for a reversal surgery is often shorter than for the creation surgery, typically averaging between three to five days. The timing of the reversal depends on the healing of the downstream anastomosis and the patient’s overall health, but it is often performed several weeks to months after the initial surgery.
Following the reversal, it takes time for the bowel to adapt to functioning along its original path again. The rectum, which has been inactive, needs to readjust to storing stool. It is common for individuals to experience frequent and urgent bowel movements in the weeks following the surgery. Bowel function will gradually become more regulated, but the time it takes to establish a new normal pattern varies from person to person.