What happens before a colostomy?
A colostomy is a major surgery, and it involves some preparation.
Before the surgery: You’ll have what’s called a pre-operation assessment meeting with your surgeon. They’ll make sure you fully understand the procedure, the risks involved and the lifestyle changes you’ll have to make afterward before you sign your consent forms. You may also discuss your pain management options at this time. A nurse will take a blood sample to check that you are well enough for surgery. They may also have an EKG test to check that your heart is in good health.
On the day of the surgery: You’ll need to avoid eating or drinking for six hours before surgery. Sometimes, you may be given an enema or bowel prep (like before a colonoscopy) to take at home. When you arrive at the hospital, you’ll change into a hospital gown. You’ll then be taken to a pre-op room to wait for your operation. Once you are in the operating room, you'll receive your anesthesia for surgery.
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What happens during the colostomy procedure?
Colostomies may be performed through either laparoscopic surgery or open surgery:
Laparoscopic surgery
Laparoscopic surgery is a newer, less invasive method than traditional open surgery. It’s done using a tiny lighted camera called a laparoscope. Your surgeon makes a small incision in your abdomen and inserts the laparoscope, which shows your abdominal organs on a screen. Your surgeon can then complete the surgery using one or more smaller incisions to access your organs. Because the incisions are smaller, laparoscopic surgery is associated with fewer complications, less pain and a faster recovery time. But not every surgery can be successfully carried out this way. Sometimes, a complicated case may require a planned laparoscopic surgery to convert to open surgery.
Open surgery
In an open surgery, the surgeon uses one long incision to open up your abdominal cavity. This the traditional way to access your abdominal organs, and it allows for better access, which is sometimes required. But it is considered a major surgery and carries a longer recovery time. Whether you have an open or a laparoscopic colostomy may depend on the condition you are treating and what else the surgeon needs to accomplish during the surgery besides the colostomy. In most cases, you’ll know in advance which type you’ll have and be able to plan accordingly.
There are two general types of colostomy operations performed:
Loop colostomy
A loop colostomy is often the method of choice when a colostomy is meant to be temporary because it's easier to reverse. In this procedure, your surgeon identifies the section of your bowel that needs to be turned into the colostomy and pulls that section as a loop through an incision in your abdomen. The surgeon then snips the loop and places the two open ends side by side in your abdominal opening, creating two ends of the stoma. One is where your poop will come out through the remaining active part of your bowel. The other is connected to the remaining inactive part of your bowel, leading to your anus. This opening allows mucus to be discharged.
End colostomy
An end colostomy is often done when the colostomy is expected to be permanent. In this procedure, after your bowel is cut, the end of your remaining active bowel is stitched to the opening in your abdominal wall, and the end of the remaining inactive bowel is sealed. You’ll have one stoma for poop to come out, and if you still have your anus intact, you'll discharge mucus through your anus instead of a stoma.
What happens after the procedure?
Your colon has four different sections where it may have been cut, depending on where the problem was. Colostomies in each section will have slightly different outcomes.
Ascending colostomy
The ascending colon is the first section of colon that your small intestine feeds into. It’s called “ascending” because it travels up the right side of your abdomen. If you have an ascending colostomy, only a small segment of your colon will be left active. This means that the remaining colon will not have much chance to do what the colon does with food waste. Food waste that passes from the small intestine into the ascending colon is still very liquid and not fully digested. In the ascending colon, there are a lot of digestive enzymes in the mix to help break the waste down further. This is the liquid waste that will pass through your stoma after an ascending colostomy. You’ll have to take special care to prevent leakage and protect your skin from the abrasive enzymes in the poop.
Transverse colostomy
The transverse colon is the second segment of the colon, which travels horizontally across your abdomen from the right side to the left side. This is also roughly the middle of your bowel. Transverse colostomies are often done to give the lower half of your bowel a rest, and sometimes to bypass it permanently. If you have a transverse colostomy, your poop will be a little more solid and have fewer digestive enzymes in it, but it still won’t be like the stool you’re used to. Because this is the high point of the colon, your colostomy may also be placed relatively high on the abdomen, which can make it more challenging to conceal.
Descending and sigmoid colostomies
The descending and sigmoid colon are the lower segments of the colon. The descending segment travels down the left side of your abdomen, and the short sigmoid “tail” end curves a little to the right and down. If you have a colostomy in either of these sections, you’ll have most of your colon left active. This means the poop that comes out of your stoma will be more familiar. It will have had time to solidify and the digestive enzymes will have been absorbed, so it won’t be irritating to the skin. You might even have a natural reflex to poop at a regular time of day and be able to plan around your bowel movements.
