Gastroenterology
Closure of Loop ileostomy Treatment
Ileostomy
An ileostomy is the opening that the surgeon made in the patient’s abdomen when they had surgery to remove a part of their rectum or colon. The patient’s ileostomy was created from the part of their small intestine known as the ileum. This allows their poop to pass through and into a stoma bag. The ileostomy was made so that the anastomosis can be healed.
What is an Ileostomy?
An ileostomy is the opening that the surgeon made in the patient’s abdomen when they had surgery to remove a part of their rectum or colon. The patient’s ileostomy was created from the part of their small intestine known as the ileum. This allows their poop to pass through and into a stoma bag. The ileostomy was made so that the anastomosis can be healed.
What is the Closure of Loop Ileostomy?
A loop ileostomy is a not permanent stoma which was formed at the initial surgery from the small bowel. Formation of a stoma allows the bowel to rest by diverting the feces away from the bowel while the bowls heal from a surgical anastomosis. These stomas, which are being created for a minimum of six weeks but are usually present for over six months or so depending on the requirement for the postoperative chemotherapy. The length of time the patients have the stoma will depend on their general health and recovery from their initial surgery as well as the indication for the surgery and the formation of the stoma.
How long does the operation take?
The surgery usually takes 1 to 2 hours for its completion.
How long the patients will stay in the hospital?
The length of stay varies from patient to patient but on average, the stay is generally between 3 to 5 days. Generally, once the patient’s bowels have opened their discharge will be planned.
Need for surgery:
- Crohn's disease: Crohn's disease is a long term problem where the digestive system becomes inflamed. Crohn's disease can generally be controlled with the help of medication, but surgery for creating an ileostomy may be sometimes be suggested for temporarily diverting the digestive waste away from the inflamed section of the digestive system for giving it a chance to heal.
- Ulcerative colitis: Ulcerative colitis is also a long-term problem where the lining of the large bowel or large intestine or large bowel becomes inflamed. In most of the cases, symptoms can be controlled with the help of the medication. But surgery for removing the colon and forming an ileostomy or ileoanal pouch may be advised if the condition is particularly severe or the medication is not helping the patients.
- Bowel cancer: Bowel cancer is a type of cancer that develops inside the rectum or colon. Radiotherapy or chemotherapy, or a combination of both, may be required for shrinking cancer first before the affected area of the bowel is being removed. Depending on the position and size of the removed section of bowel, permanent ileostomy a temporary ileostomy, or an ileoanal pouch may be formed during the surgery. In some of the cases, a section of the patient’s colon may be required to be diverted out of the patient’s tummy abdomen. This is called a colostomy, rather than an ileostomy.
What does the operation involve?
Reversal (closure) of the patient’s stoma is not as complex as their past surgery for creating the stoma. The surgery is done under a general anesthetic and usually involves taking the two ends of the stoma and stapling or stitching them together. A small incision will be made by the surgeon around the stoma area in order to free up the bowel loops, which is used to make the stoma. The surgeon will then join the two ends of the bowel back together with the help of staples or stitches. At the end of the operation, the wound is stitched back together and the skin is closed.
What happens after the surgery has been performed?
After the surgery, the patients will be taken to the recovery area in the theatre where they will be monitored until their condition is stable. Then the patients will be ready to return to the ward. On the ward, the patients will be able to drink when they feel they are able to. For the first 24 hours after surgery, the surgeons will advise the patients to stick to the liquids. The patients should be able to start eating within one to two days depending on how they are feeling. The patients will also be encouraged to move around as quickly as possible after they have undergone the surgery. This will help to improve in the recovery and thus reducing the risk of certain complications.
Recovering from ileostomy reversal surgery
Most of the people are well enough to leave the hospital after five days of having ileostomy reversal surgery. While the patients recover, they may have diarrhea and be required to go to the toilet more often than normal. It can take a few weeks for these problems to go away. The patient’s bowel activity may never return to the way it was before the patient had the ileostomy surgery. The patients may also feel a sore anus after the closure surgery. This condition should improve with the time as the anus becomes used to having stools pass through it again the common barrier creams can help the patients. The reversal surgery is often a smaller process than the initial ileostomy process, but it still required several weeks for a full recovery. An ileostomy may be required if the colon gets damaged, inflamed or does not work properly.
What are the risks involved?
As with any other surgery, the surgery for reversing the patient’s stoma has a high degree of risk of complications.
The general complications include the following:
- Chest infection
- Infection in the urinary tract
- Blood clots to the leg or lungs
- Heart irregularities due to the anesthetic or surgery
- Bleeding from the operational area which may need a blood transfusion
- Injury to nearby nerves, organs, or tissues
- Wound infection.
Whereas, the specific complications include:
- Anastomotic Leak
- Bowel obstruction: Caused due to scar tissue after abdominal surgery has been performed
- Ileus: In this, the bowel stops working after being handled, but it is temporary.
- Development of hernias at the reversal area
- Risk of conversion to a laparotomy
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