From the Guidelines
The steps of an ileostomy involve creating an opening in the abdominal wall to allow waste to exit the body from the small intestine, with the procedure typically beginning with general anesthesia administration and appropriate patient positioning 1. The procedure involves making an abdominal incision, either through a midline laparotomy or using laparoscopic techniques with multiple smaller incisions.
- After accessing the abdominal cavity, the surgeon identifies the portion of ileum to be diverted, typically the terminal ileum.
- This segment is divided, with the proximal end brought through a separate incision in the abdominal wall, usually in the right lower quadrant.
- The surgeon creates this stoma opening by making a circular incision through the skin and fascia, then bringing the ileum through this opening.
- The intestine is then everted and sutured to the skin, creating a protruding stoma that's pink to red in color. The distal end of the ileum may be closed and left inside (end ileostomy) or both ends may be brought to the surface (loop ileostomy) 1. The key to a successful ileostomy is proper preoperative planning, meticulous surgical technique, and thorough post-operative care, including patient education on stoma care and management of potential complications such as dehydration and skin excoriation 1. Some important considerations in the management of ileostomies include:
- Emptying the stoma appliance 3 to 4 times daily
- Changing the wafer every 4 days on average
- Managing potential complications such as early high ostomy output and ostomy leakage 1
- Providing patient education on stoma care and management of potential complications 1.
From the Research
Steps of Ileostomy
The steps involved in creating an ileostomy are crucial for a successful outcome. According to 2, attentive preoperative planning, including site marking and consideration of alternatives, is essential. The process involves:
- Selecting the appropriate intestinal segment
- Identifying the correct stoma site
- Creating a functional stoma, even in challenging situations
Importance of Preoperative Planning
Preoperative stoma site marking plays a significant role in reducing stoma-related complications, as noted in 3. This simple practice can improve the patient's quality of life and decrease complications.
Postoperative Care
After the creation of an ileostomy, good stoma care is essential to prevent complications, as discussed in 4 and 5. This includes managing peristomal skin conditions and preventing dehydration, which is a common complication.
Management of Ileostomy Diarrhea
Ileostomy diarrhea is a common issue, and its management is critical, as explained in 6. The process involves:
- Identifying the underlying cause of diarrhea
- Implementing directed therapies
- Ensuring prompt attention to rehydration and electrolyte depletion
Key Considerations
Creating a high-quality stoma is vital to decrease complications and improve the patient's quality of life, as emphasized in 2 and 5. A well-constructed ostomy can provide patients with a good, durable quality of life, despite being associated with morbidity.