From the Guidelines
Colostomy and end surgery should be performed with careful consideration of the patient's overall health, goals, and functional status, with a focus on improving morbidity, mortality, and quality of life. This surgical procedure creates an opening (stoma) in the abdominal wall to allow stool to exit the body when normal bowel function is compromised. End colostomy surgery involves dividing the colon and bringing one end through the abdominal wall to form a stoma, while the other end may be removed or closed and left inside the body. According to a recent study 1, enteral ostomies, including colostomies, are common in the management of patients with gastrointestinal conditions, and adequate stomal care improves clinical outcomes and reduces hospitalizations.
Key Considerations
- The procedure is typically performed for conditions like colorectal cancer, inflammatory bowel disease, diverticulitis, or trauma.
- Post-surgery, patients need to wear a colostomy bag to collect waste, and recovery takes about 6-8 weeks.
- Pain management is crucial and may include medications like acetaminophen or NSAIDs for mild pain, and stronger medications like oxycodone for severe pain.
- Stoma care is essential and includes changing the colostomy bag every 3-7 days, keeping the skin around the stoma clean and dry, and watching for complications like skin irritation, bleeding, or changes in stoma appearance.
Management and Follow-up
Regular follow-up appointments with healthcare providers are necessary to monitor healing and address any complications. As noted in a study on the optimal management of malignant alimentary tract obstruction 2, for patients with malignant colonic obstruction who are not candidates for resection, either SEMS placement or a diverting colostomy are reasonable choices depending on the patient’s goals and functional status. Therefore, a comprehensive approach to colostomy and end surgery, including careful patient selection, meticulous surgical technique, and thorough post-operative care, is essential to optimize outcomes and improve quality of life.
From the Research
Colostomy and End Surgery
- Colostomy is an operation frequently performed in pediatric surgery, and its closure can be performed with minimal morbidity if a meticulous technique is observed 3.
- The role of colostomy in the treatment of abdominal trauma has changed over the past several decades, and it is now used for two purposes: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream 4.
- Reoperative stomal surgery includes the correction of complications and closure of a colostomy, and death after closure of colostomy is infrequent, but anastomotic complications occur after all types of closure 5.
- Ostomy-related complications, such as peristomal skin complications, retraction, stomal necrosis, stomal stenosis, prolapse, bleeding, dehydration from high ostomy output, and parastomal hernia, are common and are associated with significant morbidity as well as cost 6.
- A colostomy for large bowel obstruction at the end of life can provide palliative benefits, but patients may have high healthcare utilization at the end of life, with a significant proportion dying within 60 days of surgery 7.
Types of Colostomy Complications
- Intestinal obstruction and incisional hernias are potential complications of colostomy closure 3.
- Anastomotic complications, such as leak and sepsis, can occur after colostomy closure 5.
- Peristomal skin complications, retraction, stomal necrosis, stomal stenosis, prolapse, bleeding, dehydration from high ostomy output, and parastomal hernia are common complications of stoma formation 6.