A loop ileostomy is a surgical procedure where a loop of the small intestine, the ileum, is brought through the abdomen to create a temporary opening called a stoma. This stoma allows waste to exit the body, diverting it from a lower section of the bowel that needs time to rest and heal. The stoma itself does not have nerve endings and is not painful to the touch.
Medical Reasons for a Loop Ileostomy
A temporary loop ileostomy is frequently employed to protect a newly created surgical connection in the bowel. Following surgery for colorectal cancer, it diverts stool from the new connection, or anastomosis, reducing the risk of complications like a leak. This gives the surgical site an undisturbed environment to heal properly.
This procedure is also a common approach for managing severe cases of inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis. In these conditions, inflammation can make the bowel fragile, and surgery may be required. A loop ileostomy provides a temporary break for the inflamed bowel, allowing it to heal or preparing it for subsequent surgeries.
Complicated diverticulitis, where small pouches in the colon become inflamed or infected, may also necessitate a loop ileostomy. If an abscess forms or the bowel perforates, creating a temporary ileostomy diverts the fecal stream. This allows the infection and inflammation to resolve before the bowel is reconnected.
The Surgical Procedure
A loop ileostomy can be performed using one of two techniques: laparoscopic or open surgery. In a laparoscopic, or “keyhole,” procedure, a surgeon makes several small incisions in the abdomen to insert a camera and specialized instruments. Open surgery involves a single, larger incision to access the abdominal cavity, and the choice between these methods depends on the patient’s medical situation and surgical history.
During the procedure, the surgeon identifies a suitable section of the ileum and brings a loop of it through an opening in the abdominal wall, on the right side. This loop is then opened, and the edges are sutured to the skin to create the stoma. This results in a stoma with two distinct openings that are joined together.
One opening, the proximal end, is connected to the active part of the small intestine and is where stool will exit. The other opening, the distal end, leads to the inactive portion of the bowel. This distal opening may occasionally discharge small amounts of mucus, which is a normal function of the resting bowel lining. A supporting device, like a stoma rod, may be temporarily placed under the loop to keep it from retracting during the initial healing phase.
Daily Life and Management
Living with a loop ileostomy requires adjusting to a routine centered around managing the stoma. This involves using a pouching system with a skin barrier that adheres to the abdomen and a collection bag. These systems are secure and odor-proof, allowing individuals to go about daily activities with confidence. The pouch is emptied several times a day, and the entire system is changed every few days.
Proper skin care around the stoma is important to prevent irritation and infection. The skin in this area, known as the peristomal skin, must be kept clean and dry. It is important to use products designed for stoma care and ensure the skin barrier fits snugly to prevent output from contacting the skin. Any redness or itching should be addressed promptly with a stoma care nurse.
Dietary adjustments are necessary after an ileostomy. Because the colon, which absorbs water, is bypassed, the output is liquid or paste-like. To avoid dehydration, individuals must increase their fluid intake and may be advised to use oral rehydration solutions. Monitoring urine color is a simple indicator of hydration status, as pale yellow urine signals adequate hydration. Maintaining electrolyte balance with foods rich in sodium and potassium is also important. Certain high-fiber foods may cause blockages and should be introduced cautiously while chewing all food thoroughly.
The Reversal Process
A loop ileostomy is a temporary measure, and once the downstream bowel has fully healed, a reversal surgery can be performed. This procedure, often called a takedown, is less complex than the initial operation. The timing for reversal occurs several weeks to months after the first surgery, allowing time for recovery and for other treatments like chemotherapy to be completed. Before scheduling the reversal, surgeons may perform tests, such as a flexible sigmoidoscopy or a contrast enema, to confirm the healed status of the bowel.
The reversal surgery is performed under general anesthesia. The surgeon makes an incision around the stoma to detach it from the abdominal wall. The two ends of the previously divided ileum are then reconnected using either sutures or surgical staples to restore the continuity of the bowel. The intestine is then placed back inside the abdominal cavity, and the incision is closed.
Recovery from a reversal procedure is quicker than from the initial stoma surgery. Hospital stays average between 3 to 5 days. Bowel function gradually returns, and patients may initially experience frequent bowel movements and urgency as the rectum readjusts to holding stool. Over time, bowel control improves, and function becomes more predictable. Patients are encouraged to engage in gentle physical activity to promote recovery.