Ostomy: Ileostomy & Colostomy

Introduction

An ostomy, whether an ileostomy or a colostomy, is a surgical procedure that creates an opening (stoma) in the abdomen to allow waste to leave the body. This is sometimes necessary due to conditions like Crohn’s disease, ulcerative colitis, or colorectal cancer. While an ostomy can significantly improve quality of life, it is often seen as a temporary measure. Reversal surgery restores the normal function of the bowel, allowing waste to pass through the rectum.

Understanding Ostomies

Ileostomy

An ileostomy involves bringing the end of the small intestine (the ileum) through the abdominal wall to create a stoma. It is typically performed when the colon (large intestine) needs to be bypassed or removed.

Colostomy

A colostomy, on the other hand, involves bringing part of the colon through the abdominal wall to create a stoma. This procedure is often performed when a part of the colon or rectum is removed or needs to heal.

Ostomy Reversal

Ostomy reversal, also known as stoma reversal, is a surgical procedure to reconnect the bowel and restore normal bowel function. Not all ostomies can be reversed, and the decision to proceed with a reversal depends on various factors, including the patient’s overall health and the reason for the original surgery.

Preparation for Reversal Surgery

Before undergoing ostomy reversal surgery, several steps are taken to ensure the patient’s readiness:

• Medical Evaluation: A thorough medical evaluation, including blood tests and imaging studies, is conducted to assess the patient’s health status.
• Bowel Preparation: The bowel is usually prepared before surgery through dietary restrictions and laxatives to ensure it is clean.
• Nutritional Support: Proper nutrition is crucial for healing, so patients may receive dietary guidance or supplements.

The Surgical Procedure

The reversal surgery generally follows these steps:

• Anesthesia: The patient is placed under general anesthesia to ensure they are unconscious and pain-free during the surgery.
• Incision: An incision is made around the stoma to access the bowel.
• Reconnection: The surgeon reconnects the ends of the bowel, restoring the continuity of the digestive tract.
• Closure: The stoma is closed, and the abdominal wall is sutured.

Recovery and Aftercare

Recovery from ostomy reversal surgery involves several stages:

• Hospital Stay: Patients typically stay in the hospital for several days to a week, during which they are monitored for complications.
• Pain Management: Pain relief measures, including medications, are administered to manage postoperative pain.
• Gradual Diet: Patients start with a liquid diet and gradually transition to solid foods as the bowel begins to function normally.
• Activity Restrictions: Physical activities are limited initially to allow for proper healing.

Side effects of ileostomy reversal

Common short-term side effects include:

• Some discomfort. Most people are sore after surgery, but most can manage with household pain relievers. Your abdomen might feel bloated or swollen at first, and you might feel tired.
• Paralytic ileus. It’s typical for your bowels to be temporarily paralyzed after abdominal surgery. Your healthcare team will expect this and treat you accordingly. It should resolve in a few days.
• Poop changes. Your bowels may take some time to regain their normal functioning. Some of the nerves and muscles involved will be out of practice, and swelling from surgery can also have an effect. Diarrhea is common, but constipation can also occur. You might also feel you have to go more frequently or urgently than before. This may last from a few days up to a few months.

Possible long-term side effects include:

• Hernias. Since repeat abdominal surgeries weaken your abdominal wall, it’s possible you could develop a hernia at the incision site. That’s when an organ or tissue pokes through the weak spot. Some hernias never need treatment, but some may eventually need surgical repair.
• Abdominal adhesions. Abdominal surgery can sometimes cause bands of scar tissue, called adhesions, to develop in your abdomen that make your tissues stick together. They don’t always cause trouble, but occasionally they might obstruct your bowels and need to be removed.
• Fecal incontinence. Some people may continue to have difficulties with bowel control after ostomy reversal if their anorectal muscles and nerves remain weak or uncoordinated. In this case, healthcare providers recommend physical therapy to help retrain the muscles.

Potential Complications

As with any surgery, ostomy reversal carries potential risks and complications, including:

• Infection: There is a risk of infection at the surgical site.
• Anastomotic Leak: The reconnection site may leak, leading to infection or other complications.
• Adhesions: Scar tissue may form, causing bowel obstruction.
• Bowel Dysfunction: Patients may experience changes in bowel habits, such as frequent bowel movements or diarrhea.

Long-term Outlook

The long-term outlook for patients who undergo ostomy reversal surgery is generally positive. Most patients regain normal bowel function and experience an improved quality of life. However, some may experience ongoing bowel issues that require management.

Living with a stoma

• Care for your stoma: It is important to keep your stoma clean. The waste collected in your bag can irritate your skin, so gently clean the area with soap and water daily. Also, watch out for any redness, burning, or itching, and report those symptoms to your doctor.
• Stay hydrated: Your colon reabsorbs water and minerals back into your body. This means that after a colostomy, it can be harder to stay hydrated. Make an effort to drink more fluids than before your surgery.
• Monitor your diet: Your doctor will likely recommend a low fiber diet for the first several weeks after surgery. As you recover, you can gradually reintroduce foods into your diet.
• Adjust medications: You might need to take different forms or different dosages of medications. Many medications are designed to process the entire way through your digestive system. They may not be as effective if you have a stoma. Tell all your doctors about your ileostomy or colostomy so they can make adjustments to your medications if necessary.
• Stay active: Once you’ve recovered from surgery, you can get back to your usual activities. However, for some activities, such as sports, it might be a good idea to wear a stomach guard or other protective gear.

Nursing Care for Patients Undergoing Ileostomy and Colostomy (Ostomy) Reversal

Ostomy reversal surgery, whether it be ileostomy or colostomy, is a significant procedure aimed at restoring normal bowel function. This document provides a detailed overview of the nursing care required for patients undergoing ostomy reversal, focusing on preoperative preparation, postoperative care, and long-term management.

Preoperative Preparation

Patient Education

Prior to surgery, it is crucial to educate patients about the procedure, potential risks, and expected outcomes. Nurses should provide clear instructions on preoperative preparations, such as fasting requirements and bowel preparation.

Physical Preparation

Patients may need to undergo various tests, including blood work, imaging studies, and an evaluation of their overall health. Ensuring that patients are medically optimized reduces the risk of complications.

Emotional Support

Patients may experience anxiety about the upcoming surgery. Nurses should offer emotional support and encourage patients to express their concerns. Providing information about support groups or counseling services can also be beneficial.

Postoperative Care

Monitoring and Assessment

Continuous monitoring of vital signs, pain levels, and surgical site is essential. Nurses should look for signs of infection, anastomotic leak, or bowel obstruction. Early detection of complications can significantly improve outcomes.

Pain Management

Effective pain management is crucial for patient comfort and recovery. Nurses should administer prescribed pain medications and assess their effectiveness. Non-pharmacological methods, such as relaxation techniques, can also be utilized.

Wound Care

Proper care of the surgical site is critical to prevent infection. Nurses should follow sterile techniques when changing dressings and teach patients how to care for their wounds at home.

Bowel Function

Monitoring bowel function is essential. Nurses should observe for changes in bowel habits and report any signs of bowel dysfunction, such as frequent bowel movements or diarrhea. Providing dietary advice and medications, if necessary, can help manage these issues.

Hydration and Nutrition

Ensuring adequate hydration and nutrition is vital for healing. Nurses should encourage patients to drink plenty of fluids and follow a balanced diet. In some cases, dietary modifications may be needed to accommodate changes in bowel function.

Long-term Management

Follow-up Care

Regular follow-up appointments with the healthcare team are necessary to monitor the patient’s progress and address any ongoing issues. Nurses should coordinate care and ensure patients adhere to their follow-up schedule.

Education and Support

Providing ongoing education about lifestyle modifications, dietary changes, and signs of complications is essential. Nurses should empower patients to take an active role in their recovery and long-term health. Support groups and counseling services can offer additional assistance.

Quality of Life

The goal of ostomy reversal surgery is to improve the patient’s quality of life. Nurses play a crucial role in helping patients achieve this by providing comprehensive care, addressing concerns, and promoting a positive outlook on their recovery.

REFERENCES

1. Bladder & Bowel Community. Stoma Reversal. https://www.bladderandbowel.org/bowel/stoma/stoma-reversal/).
2. Steinhagen E, Colwell J, Cannon LM. Intestinal stomas—postoperative stoma care and peristomal skin complications. Clin Colon Rectal Surg. 2017;30:184-192. doi:10.1055/s-0037-1598159
3. Lopez NE, Zaghyian K, Fleshner P. Is there a role for ileal pouch anal anastomosis in Crohn’s disease? Clin Colon Rectal Surg. 2019;32:280-290. doi:10.1055/s-0039-1683917
4. National Health Service U.K.) Reversal of Stoma. Ileostomy or Colostomy. https://www.nbt.nhs.uk/sites/default/files/attachments/Reversal%20of%20Stoma_NBT002926.pdf.
5. Sherman KL, Wexner SD. Considerations in Stoma Reversal (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498167/). Clin Colon Rectal Surg. 2017 Jul;30(3):172-177.
6. Burke J, Toomey D, Reilly F, Cahill R. Single access laparoscopic total colectomy for severe refractory ulcerative colitis. World J Gastroenterol. 2020;26:6015-6026. doi:10.3748/wjg.v26.i39.6015
7. United Ostomy Associations of America. Facts About Ostomy Reversals (https://www.ostomy.org/facts-ostomy-reversals/). Published 2/13/2018.

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