What is an Ostomy?
A ostomy is a surgical procedure that creates an opening in the abdominal wall through which a portion of the colon (large intestine) or ileum (small bowel) is brought to the surface of the skin. This opening allows stool to bypass a diseased or damaged part of the colon and be eliminated from the body into a disposable pouch (ostomy bag) worn over the stoma. An ostomy made using colon is a colostomy. An ostomy created using ileum is an ileostomy.
Why Would I Need an Ostomy?
Colostomies and Ileostomies are typically created to treat conditions that affect the lower part of the colon or rectum such as:
- Colorectal Cancer
- Inflammatory Bowel Disease
- Ulcerative colitis
- Crohn's disease
- Diverticulitis
- Traumatic injury to the colon
- Fecal Incontinence
- Decubitus wound healing
Are Ostomies Permanent?
Ostomies can be either temporary or permanent, depending on the underlying medical condition and the individual's health needs.
Temporary ostomies are often created to divert stool and allow a downstream portion of the bowel to heal. Once the healing process is complete, the ostomy can often be closed allowing reestablishment of intestinal continuity and restoring bowel movements via the rectum.
Permanent ostomies are created when the bowel needs to be permanently diverted. In these situations, the ostomy serves as a permanent way for waste to exit the body when the natural route is no longer functional or safe.
The decision to make an ostomy temporary or permanent depends on various factors, including the individual's overall health, the nature of the underlying condition, and the recommendations of healthcare providers.
What is Colostomy or Ileostomy Closure?
Colostomy closure, also known as colostomy reversal or colostomy takedown, is a surgical procedure to reconnect the colon (large intestine) after a colostomy has been created. Colostomy closure involves surgically reconnecting the remaining portions of the colon after the colostomy has served its purpose. During the procedure, the surgeon reattaches the ends of the colon and closes the opening in the abdominal wall where the stoma was located. This allows waste to once again pass through the colon and exit the body through the rectum in the normal manner.
When Can We Proceed with Colostomy or Ileostomy Closure?
The timing for ostomy closure depends on several factors including the reason for the colostomy, the individual's overall health, and the condition of the colon. Considerations regarding timing of closure include:
- Resolution of the underlying condition: Ostomy closure is typically performed after the underlying condition that necessitated the ileostomy or colostomy has been treated or resolved. For example, if the colostomy was created due to a bowel obstruction or injury, the obstruction needs to be cleared, or the injury needs to heal before reversal can be considered.
- Healing of the colon: The colon needs time to heal after the initial surgery that created the colostomy. This healing period can vary depending on the extent of the surgery and the individual's overall health. Surgeons typically prefer to wait several months to a year after the colostomy before considering closure to ensure that the colon has adequately healed.
- Assessment of bowel function: Before performing colostomy closure, healthcare providers will assess the function of the remaining colon and rectum to ensure that they are capable of resuming normal bowel function. This may involve tests such as colonoscopy or imaging studies to evaluate the health and function of the colon.
- Individual health status: The individual's overall health and fitness for surgery are important considerations. Conditions such as heart disease, diabetes, tobacco use, or obesity may increase the risks associated with surgery – it's important to optimize these factors before proceeding with colostomy closure.
Ultimately, the timing of ileostomy or colostomy closure is determined on a case-by-case basis considering each individual patient's unique situation and medical needs. Your colorectal surgeon has unique subspecialty training and experience to help navigate this important decision.