A colostomy is a surgical procedure that creates a new path for waste to exit the body, bypassing the usual route through the rectum and anus. This operation involves forming an opening, known as a stoma, on the surface of the abdomen. A segment of the large intestine, or colon, is brought through the abdominal wall and stitched to the skin to create this opening. The primary purpose of a colostomy is to divert stool into an external collection pouch, allowing a diseased or injured section of the bowel to heal or providing a permanent means of waste elimination when the lower colon or rectum is removed or non-functional.
Reasons for the Procedure and Pre-Surgical Preparation
A colostomy becomes necessary for severe medical conditions that impair the normal function of the large intestine. Indications include complications from advanced colorectal cancer, severe inflammatory bowel disease (like Crohn’s disease), or acute diverticulitis leading to perforation or abscess formation. The procedure may also be performed following significant abdominal trauma or to address congenital defects, such as an imperforate anus. In many cases, the colostomy is a life-saving measure, providing immediate relief from intestinal obstruction or allowing time for tissues to recover.
Before the surgery, the patient and colon must be prepared. This typically involves a bowel preparation protocol, using laxatives or enemas to thoroughly clean the colon of stool, which minimizes the risk of infection. A specialized healthcare professional, often an enterostomal therapist (ET nurse), determines the optimal stoma site on the abdomen.
This site marking, or “siting,” is important; the stoma must be placed on a flat surface away from bony prominences, scars, and skin creases to ensure a proper seal for the collection appliance. The patient is also required to fast before the procedure to ensure the stomach is empty prior to general anesthesia. The operation requires the patient to be completely unconscious and pain-free while working within the abdominal cavity.
Surgical Creation of the Stoma
The colostomy can be created using two main techniques: open surgery (laparotomy) or a minimally invasive laparoscopic procedure. Open surgery involves a single, long incision down the center of the abdomen to access the colon. The laparoscopic method, often called keyhole surgery, utilizes several small incisions for a camera and specialized instruments, which can result in shorter recovery time and less post-operative pain.
Regardless of the approach, the surgeon identifies the segment of the colon to be diverted. This section is separated from surrounding tissues and brought through the pre-marked opening in the abdominal wall. The edges of the colon are turned back, similar to a cuff, and sutured to the skin to create the stoma, a process called maturation. The stoma is typically moist and has a pink or reddish appearance, similar to the inside lining of the mouth, due to the intestine’s rich blood supply.
The way the stoma is formed determines its type; the most common is the end colostomy. This is created when the healthy end of the colon is brought out to the skin, while the remaining bowel leading to the rectum is either removed or sealed inside the abdomen. This type is frequently used when a permanent diversion is required, such as after the removal of the rectum for cancer.
A loop colostomy is another variation, where a loop of the colon is brought out through the stoma opening and partially opened. This results in one stoma with two distinct openings: the proximal opening (discharging stool) and the distal opening (draining mucus from the inactive lower bowel). A loop colostomy is often temporary, used to divert waste away from a surgical connection further down the colon to allow healing. A double-barrel colostomy is less common but involves completely dividing the colon and bringing both the proximal and distal ends out as two separate stomas on the abdomen.
Immediate Post-Operative Care
Following the surgical creation of the stoma, the patient is transferred to a recovery area for close monitoring as they awaken from anesthesia. The care team focuses on managing pain and observing the new stoma. The stoma will appear swollen and potentially bruised, which is a normal response to surgical manipulation, but its color must be monitored constantly to ensure it remains a healthy pink or red, indicating adequate blood flow.
The colostomy will not begin to function immediately, as the bowel often goes through a temporary period of inactivity called an ileus, lasting a few days. Stool output is expected to begin within two to four days after the operation, often liquid and watery at first. A transparent, drainable pouching system is placed over the stoma immediately after surgery to collect the initial output and allow the team to monitor the stoma’s viability.
The enterostomal therapist plays a fundamental role in patient education during the hospital stay. They teach the patient or caregivers how to empty the appliance, clean the skin around the stoma, and change the collection pouch. This practical education is reinforced to ensure the patient is comfortable and proficient with self-care before discharge.
Initial dietary modifications are implemented, starting with clear liquids and progressing gradually to a soft or low-fiber diet to ease the digestive system back into function. A typical hospital stay ranges from two to seven days, depending on the patient’s health and the surgery type. Readiness for discharge is confirmed when the patient has adequate pain control, the stoma is functioning, and the patient can confidently manage their new appliance system.