A stoma is a surgically created opening on the abdomen that connects to either the digestive or urinary system. This opening allows bodily waste, such as feces or urine, to exit the body into an external collection pouch. Stoma creation becomes necessary when disease, injury, or medical conditions prevent the normal passage of waste. This procedure can be temporary, allowing an organ to heal, or permanent if the affected organ needs removal or cannot be reconnected.
Preparing for Stoma Creation
Preparation for stoma creation involves several steps to ensure the best outcome. A thorough medical assessment evaluates the patient’s overall health and determines the most suitable stoma type. This assessment includes reviewing medical history, physical examinations, and diagnostic tests. The healthcare team provides comprehensive counseling, explaining the procedure, potential changes to daily life, and how to manage the stoma post-surgery.
Stoma site marking, typically by a specialized stoma nurse, is a key preparatory step. This involves identifying an optimal location on the abdomen for the stoma, considering body contours, skin folds, and the patient’s clothing and lifestyle. Marking the site while the patient is in various positions, like sitting, standing, and lying down, helps ensure the stoma will be visible, accessible for care, and comfortable. This careful planning aims to minimize complications and enhance the patient’s ability to manage the stoma independently after the operation.
The Surgical Process
The surgical creation of a stoma involves forming an opening in the abdominal wall and bringing a segment of the intestine or urinary tract to the surface. The specific technique varies for colostomy, ileostomy, or urostomy, but underlying principles remain consistent. The surgeon makes an incision, which can be open or laparoscopic. Once inside the abdominal cavity, the targeted section of the bowel or urinary conduit is identified.
For an ileostomy or colostomy, a segment of the small intestine (ileum) or large intestine (colon) is isolated from the digestive tract. The surgeon then creates a small, circular opening, a “trephine,” through the abdominal wall at the pre-marked site. This opening is sized to allow the bowel segment to pass through without constriction. The isolated bowel segment is then brought to the skin surface.
To form the stoma, the end of the bowel is everted, or folded back on itself, similar to cuffing a sleeve. This eversion creates a spout-like projection that protrudes from the abdomen, protecting the underlying skin from digestive enzymes. The everted edge of the bowel is then sutured to the skin around the opening, a process known as maturation. This suturing secures the stoma in place and creates a seal that helps prevent leakage. In some cases, particularly with colostomies, the stoma may be created as an “end” stoma, where the single end of the bowel is brought out, or a “loop” stoma, where a loop of bowel is brought through the opening and partially opened.
For a urostomy, often called an ileal conduit, a small section of the small intestine is removed to act as a conduit for urine. The ureters, which carry urine from the kidneys, are then surgically attached to one end of this isolated intestinal segment. The other end of the intestinal segment is then brought through the abdominal wall and matured to the skin surface, similar to an ileostomy, creating a channel for urine to exit the body. The bladder is typically removed in urostomy procedures.
Initial Post-Operative Appearance and Healing
Immediately following surgery, a newly formed stoma appears moist and has a pinkish-red color, similar to the inside of the mouth. It typically protrudes slightly from the abdominal surface, though the exact size and protrusion can vary among individuals. The surrounding skin may show some redness and swelling, which is a normal part of the body’s initial response to surgery.
A stoma has no nerve endings, meaning it does not have sensation and is not painful to touch. Patients will not feel pain from the stoma itself, although they may experience discomfort from the surgical incision. In the first few days and weeks after the procedure, the stoma gradually decreases in size as initial swelling subsides. This reduction in size is a natural part of the healing process as the tissues settle. The stoma will continue to heal and mature over several weeks, becoming more established in its final appearance.