Name of the Procedure:

Colostomy or Skin Level Cecostomy

Summary

A colostomy or skin level cecostomy is a surgical procedure where an opening (stoma) is created from the colon or cecum through the abdomen to allow waste to bypass part of the digestive system. This can be a temporary or permanent solution, helping individuals whose intestines can't function properly due to disease, injury, or other conditions.

Purpose

• Medical Condition/Problem: It addresses conditions like bowel obstruction, chronic constipation, colorectal cancer, Crohn's disease, diverticulitis, and traumatic injuries to the intestines.
• Goals/Expected Outcomes: The procedure aims to relieve symptoms, improve bowel function, prevent serious complications, and enhance the patient's quality of life by diverting waste through an alternate route.

Indications

• Severe bowel obstruction or paralysis
• Inflammatory bowel diseases (e.g., Crohn's or ulcerative colitis)
• Colorectal cancer
• Traumatic injury to the intestines
• Severe diverticulitis
• Chronic idiopathic constipation unresponsive to other treatments

Preparation

• Patients may be asked to fast for a certain period prior to the surgery.
• Bowel preparation (cleaning the intestines) might be required.
• Certain medications, especially blood thinners, might need to be adjusted.
• Pre-operative diagnostic tests like blood work, imaging scans, and colonoscopy might be necessary.

Procedure Description

1. Anesthesia Administration: General anesthesia is used to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made on the patient's abdomen.
3. Creating the Stoma: The colon or cecum is brought through the abdominal wall and an opening is created to divert waste.
4. Securing the Stoma: The intestine is secured in place with sutures.
5. Closure: The abdominal incision is closed, and the stoma is fitted with an ostomy bag to collect waste.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and underlying conditions.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Surgeons specialized in colorectal or general surgery
• Anesthesiologists
• Operating room nurses
• Surgical technicians

Risks and Complications

• Common Risks: Infection, bleeding, stoma blockage or narrowing, skin irritation around the stoma.
• Rare Risks: Hernia at the stoma site, necrosis of the stoma, prolapse of the stoma, complications related to anesthesia.
• Management: Post-operative care, antibiotics, stoma care education, and follow-up appointments to monitor for complications.

Benefits

• Relief from symptoms like pain, bloating, and constipation.
• Prevention of life-threatening complications like bowel perforation or severe infection.
• Improved quality of life and ability to function normally.

Recovery

• Hospital stay typically lasts a few days post-surgery.
• Instructions include stoma care, dietary adjustments, and recognition of signs of infection or complications.
• Recovery time varies but generally spans several weeks to a few months.
• Patients may need to avoid strenuous activities until fully healed.
• Follow-up appointments are essential to monitor recovery and stoma function.

Alternatives

• Non-surgical treatments such as medications, dietary changes, or bowel training.
• Less invasive procedures like endoscopic stenting for obstruction.
• Compared to alternatives, a colostomy or cecostomy may provide more permanent relief but involves surgical risks and lifestyle adjustments.

Patient Experience

• During the procedure: Patients will be under general anesthesia and won't feel anything.
• After the procedure: Patients may experience discomfort and swelling around the surgical site.
• Pain management will be provided through medications.
• Learning to care for a stoma might be challenging, but support from healthcare professionals and ostomy support groups can be beneficial.