Introducing
Your new presentation assistant.
Refine, enhance, and tailor your content, source relevant images, and edit visuals quicker than ever before.
Trending searches
Overview of surgical ostomy for fecal diversion
- emotional support
- patient education
- early planning for subsequent discharge
- ongoing rehabilitation(patient,family)
In a normal-sized patient, the preferred site for stoma location is through the rectus muscle, slightly inferior to the umbilicus at the apex of the naturally occurring tissue mound of the abdomen (sabiston text book).
-visualize the stoma and access it without difficulty (obese patients)
-at least 5 cm from:
folds, creases, previous incisions, belt line, umbilicus, and bony prominences
-emergent procedure- two-thirds the way along the line from the anterior superior iliac spine and the umbilicus.
OSTOMY REVERSAL
- temporary end-colostomy (Hartmann’s procedure), closure is delayed until complete resolution of the underlying condition, which can take three to six months or more.
- loop ileostomy is performed, it is usually closed between eight weeks and three months following the initial procedure
Preoperative Workup and Stoma Planning
- Evaluation of nutritional status
- Patient education and counseling
- Use of a preoperative mechanical bowel preparation (MBP) or oral antibiotics
- Site selection and marking
- Colonoscopy to exclude synchronous lesions
- Postoperative fluid and pain management
Ostomy
OSTOMY COMPLICATIONS
Risk factors
- Height of stoma <10 mm
- Comorbid medical illnesses(obesity, IBD, diabetes)
- Tobacco
- Obesity is an independent risk factor for stomal complications, including retraction, and parastomal hernia.
- Indicated when :
- Protection (LAR,high risk for anastomotic leak)
- Diversion (Fournier's gangrene)
Classified according:
- segment of the bowel used to create the stomy
(eg, sigmoid, colon, ileum).
- manner of surgical construction
(eg, loop, end, reservoir).
Timing of complications
Early
Late
End-ileostomy – 1.8 to 28.3%
End-colostomy – 4.0 to 48.1%
Loop ileostomy – 0 to 6.2 %
Loop colostomy – 0 to 30.8 %
- Parastomal hernia
- Stomal prolapse
- Stomal stenosis
loop transverse colostomy
descending colostomies
- Stomal necrosis
- Stomal bleeding
- Stomal retraction
Ileostomy
loop ileostomy
Continent ileostomy
End-ileostomy
Colostomy
Temporary VS. Permanent
Colostomy for decompression
- Sigmoid loop colostomy
- Transverse loop colostomy
- Cecostomy
Clinical settings that may warrant construction of a permanent colostomy include:
- Fecal incontinence related anal outlet dysfunction or perianal sepsis
- Abdominal perineal resection for rectal cancer
- Total abdominal proctocolectomy for severe Crohn colitis\ulcerative colitis
Colostomy for fecal diversion
double barrel stoma
loop colostomy
end-loop colostomy
Hartmann’s procedure
Overview of surgical ostomy for fecal diversion
Yonatan Reuven, Surgery B Soroka Medical Center