Name of the Procedure:

Colostomy or Skin Level Cecostomy; with Multiple Biopsies (e.g., for Congenital Megacolon) (Separate Procedure)

Summary

A colostomy or skin-level cecostomy with multiple biopsies is a surgical procedure that creates an opening (stoma) from the colon or cecum to the skin surface. This is done to allow waste to exit the body bypassing a diseased or non-functional part of the colon. Biopsies are performed to take tissue samples from the colon to diagnose conditions such as congenital megacolon.

Purpose

The primary purpose of this procedure is to manage severe conditions that affect bowel function, such as congenital megacolon (Hirschsprung's disease). The goal is to relieve obstruction, redirect the flow of waste, and diagnose underlying issues through biopsies.

Indications

• Diagnosed or suspected congenital megacolon (Hirschsprung's disease)
• Severe bowel obstruction
• Chronic constipation not responding to conservative treatments
• Need for diagnostic tissue samples from the colon

Preparation

• Fasting for several hours prior to surgery
• Preoperative bowel cleansing regimen
• Discontinuing certain medications as advised by the surgeon
• Pre-surgical diagnostic tests, such as blood tests, imaging, or colonoscopy

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A small incision is made in the abdominal wall.
3. Stoma Creation: The colon (for colostomy) or cecum (for cecostomy) is brought to the surface and an opening (stoma) is created.
4. Biopsies: Multiple tissue samples are taken from the colon to diagnose conditions like congenital megacolon.
5. Securing the Stoma: The stoma is secured to the skin and an ostomy bag is attached to collect waste.
6. Closure: The incision site is closed with sutures or staples.

Duration

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

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• General surgeon or colorectal surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the incision or stoma site
• Bleeding
• Injury to surrounding organs
• Stoma retraction or prolapse
• Obstruction of the stoma
• Adverse reactions to anesthesia

Benefits

• Relief of bowel obstruction
• Improved bowel function
• Diagnostic clarity from biopsies
• Reduced symptoms related to congenital megacolon

Recovery

• Post-procedure hospital stay for monitoring (typically a few days)
• Pain management with medications
• Stoma care education by a specialized nurse
• Gradual return to normal activities over several weeks
• Follow-up appointments with the surgeon for wound and stoma assessment

Alternatives

• Conservative management with medications and dietary changes
• Less invasive diagnostic tests, such as imaging or non-surgical biopsies
• Other forms of bowel surgery, depending on the underlying condition

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-surgery, there may be discomfort or pain at the incision site, which will be managed with pain medication. Adjusting to life with a stoma might be challenging initially, but specialized nursing care and support can aid in the transition. Daily activities can typically be resumed gradually.