Stoma Creation and Reversal Surgery: An Overview

What Is a Stoma?

A stoma is an opening created in the abdomen. It is connected to the digestive or urinary system, allowing waste to exit the body. They are used when part of the bowels or bladder needs healing or removal. Stomas can be lifesaving for individuals with certain medical conditions such as cancers, types of inflammatory bowel disease (IBD), etc.

Stroma may look like a small, pinkish, reddish, moist, circular piece of flesh attached to the body. To create a stoma, the surgeon will pull a part of the small or large intestine onto the skin’s surface and sew it onto an opening in the abdomen. It may lie fairly flat on the body or protrude out. A pouch will be attached to the top of the stroma to collect the waste products.

What Are the Different Types of Stoma?

There are various types of stomas, depending on their purpose and the location of the body where they are created.

The most common types of stomas include:

• Colostomy - This stoma surgery is performed in the colon, located on the left side of the abdomen. This type of surgery is used to divert feces from the colon.

• Ileostomy - This stoma surgery is performed in the ileum, located on the right side of the abdomen. This type of surgery is used to divert feces when the entire colon and rectum need to be bypassed.

• Urostomy - This stoma is created to divert urine outside the body. It can be located on the lower abdomen and is generally necessary when the bladder is damaged or removed.

What Is Stroma Creation Surgery?

Stoma creation surgery is also called ostomy surgery. It is a surgical procedure in which an opening is made in the body to divert the flow of waste products such as urine or feces when the natural route is not functional anymore. This opening goes from an area inside the body to the outside, usually through the abdominal muscles and skin. This surgery may be necessary for various medical conditions, and it significantly impacts the individual's quality of life.

What Are the Indications for Stoma Creation Surgery?

There are various reasons for undergoing stoma creation surgery.

Some medical conditions that require stoma creation include:

• Colorectal Cancer - This is the most common reason for stoma creation. In cases of large tumors, or if the rectum needs to be removed, a stoma-creation surgery is done to allow waste to exit the body through an opening in the abdomen.

• Inflammatory Bowel Disease (IBD) - Crohn's disease and ulcerative colitis can cause damage to the colon and rectum. In such cases, stoma creation may be needed to divert waste from the affected areas and allow healing.

• Diverticulitis - It refers to the inflammation and infection of pouches in the colon. Diverticulitis can lead to the need for a stoma if severe complications arise.

• Trauma - Injuries to the abdominal area, such as from a gunshot wound or car accident, may require the creation of a stoma to manage the damage.

• Birth Defects - Some individuals are born with conditions that may require creating a stoma, such as imperforate anus, where the rectum does not connect to the anus.

How Is Stroma Creation Surgery Performed?

Stoma creation surgery is a highly specialized procedure performed by a colorectal or general surgeon. This surgery for creating a stoma involves the following steps:

• The patient is put under general anesthesia to make the surgery comfortable and pain-free.

• An incision on the abdomen is made where the stroma needs to be created.

• The segment of the intestine or urinary system is isolated by the surgeon, which will form the stoma. The healthy end of the segment is brought to the surface of the abdomen, and the stoma is created.

• Depending on the type of stoma, a bag or pouch is attached around the stoma to collect waste products such as urine or feces. The pouch is designed to be discreet, secure, and easy to manage.

• The incision around the stoma is closed well, ensuring it is well-sealed to prevent infection and leakage.

What is Stoma Reversal Surgery?

Stoma reversal surgery is also called ostomy closure surgery. It is a surgical procedure in which a previously created stoma is surgically closed, and the natural route for eliminating waste is restored. This procedure is usually done at least three months after the initial colostomy surgery, or it may be delayed further depending on the patient’s health and disease condition.

What Are the Indications for Stoma Reversal Surgery?

Stoma reversal surgery is generally performed when the medical condition that necessitated the stoma creation has improved, and the patient's overall health is stable.

The following are the reasons for stoma reversal surgery:

• Successful Treatment - When the initial medical condition, such as colorectal cancer or inflammatory bowel disease, has been successfully treated and no longer requires diversion, stroma removal surgery is indicated.

• Healing - A stoma reversal surgery is performed if the injured or diseased part of the digestive or urinary system has healed sufficiently.

• Patient's Choice - Some individuals may choose stoma reversal due to their desire to return to a natural digestive or urinary system function.

How Is Stoma Reversal Surgery Performed?

The stoma reversal procedure is planned when the patient's overall health is stable. The procedure aims to reconnect the healthy segments of the digestive or urinary system.

The following are the steps involved in the stoma reversal surgery:

• Before scheduling the surgery, the patient undergoes a thorough evaluation to check if the patient is medically stable and the underlying condition has improved.

• General anesthesia is provided to the patient to ensure comfort during the surgery.

• The surgeon makes an incision around the stoma and carefully closes the opening. Then, the healthy portions of the intestine or urinary system are reconnected to restore the natural route for waste elimination.

• The incisions are closed, and the site is carefully sutured to promote proper healing.

Recovery from stoma reversal surgery is critical, as the patients need to adapt to the restored natural route for eliminating waste products from the body.

Post-operative care generally includes:

• Monitoring - Constant monitoring is required immediately after surgery to ensure that the reconnection is functioning correctly without any complications.

• Diet and Nutrition - Solid foods are often recommended gradually, and a dietitian should create a suitable meal plan.

• Stoma Care - Proper stoma care and hygiene are important during this time. Some patients may experience temporary incontinence or diarrhea after the surgery as their body adjusts to the reconnection.

• Follow-up - Patients will have regular follow-up appointments with their healthcare professionals to assess their progress and address concerns.

Conclusion

Stoma creation and reversal surgeries are life-changing procedures that can impact an individual's life. Stoma creation surgery is a critical surgery performed to improve patients' health and quality of life. Emotional support, education, and proper post-operative care are essential for stoma-creation and reversal patients.