Post-Operative Instructions After End Ileostomy
After end ileostomy surgery, patients should follow a multifaceted approach to recovery that includes early mobilization, careful monitoring of fluid balance, progressive diet advancement, stoma care education, and vigilance for potential complications. 1
Immediate Post-Operative Care
- Remove urinary catheter as early as possible to encourage mobility and reduce risk of catheter-associated urinary tract infections, unless ongoing strict fluid management is required 1
- Avoid routine use of nasogastric tubes; use only therapeutically for patients with ileus or gross intestinal edema 1
- Implement a multifaceted approach to minimize postoperative ileus, including optimized fluid management, opioid-sparing analgesia, early mobilization, and early food intake 1
- Monitor for signs of surgical site infection, anastomotic leakage, or sepsis 1
Nutrition and Hydration Management
- Initiate early oral nutrition within 24 hours after surgery when possible, starting with small portions 1
- If early oral nutrition is not possible, consider early tube feeding (within 24 hours) for patients whose oral intake will be inadequate for more than 7 days 1
- For patients with contraindications to enteral feeding (intestinal obstruction, ileus, sepsis), implement early parenteral nutrition until gastrointestinal function recovers 1
- Monitor for high ostomy output which can lead to dehydration and electrolyte imbalances 2
- Regularly assess serum electrolytes, particularly sodium, potassium, and magnesium due to significant losses through the ileostomy 2
- Consider loperamide to reduce the volume of discharge from the ileostomy 3
Stoma Care and Education
- Begin stoma care education as soon as the patient is able to participate 4
- Teach proper appliance application and removal techniques to prevent leakage and skin complications 2, 4
- Regularly assess stoma size and function, as significant changes will occur during the first 8 weeks 2
- Monitor for common stoma complications including retraction, prolapse, stenosis, and parastomal hernia 5
- Provide education about peristomal skin care to prevent irritation and breakdown 2, 4
Mobilization
- Encourage early mobilization to reduce risk of thromboembolism, pulmonary complications, and to promote return of bowel function 1
- Begin with sitting at bedside and progress to walking as tolerated 1
- Avoid prolonged bed rest which increases risk of pulmonary complications, thromboembolism, insulin resistance, and decreases muscle strength 1
Medication Management
- Implement opioid-sparing analgesia to reduce risk of postoperative ileus 1
- Consider laxatives such as bisacodyl and magnesium oxide to help prevent postoperative ileus 1
- Evaluate need for medication adjustments due to altered absorption with an ileostomy 6
- Continue thromboprophylaxis with low molecular weight heparin and compression stockings 1
Discharge Planning and Follow-up
- Provide clear instructions on monitoring hydration status, including signs of dehydration 2, 6
- Educate about dietary modifications to maintain electrolyte balance and prevent food blockages 6
- Instruct on when to seek medical attention (high output, signs of dehydration, stoma complications) 2, 4
- Schedule follow-up appointments to monitor recovery and stoma function 4
- Provide information about community support services and ostomy support groups 4
Risk Factors for Complications
- Monitor patients with anemia and high BMI more closely as these factors are associated with higher risk of reoperation after ileostomy surgery 7
- Be vigilant for signs of small bowel obstruction, anastomotic leakage, and wound infection which are common complications requiring reoperation 8, 7
- Address nutritional deficiencies to reduce risk of complications and improve healing 2, 6