Bowel Cancer Surgery, Colostomy And Ileostomy
The type of bowel cancer operation you receive will depend on, the location of the cancer in the bowel, the type and size of the cancer and whether the cancer has spread. Your doctor will talk to you about the best type of surgery for you.
Removing Early Stage Tumours
If the tumour is very small and in the early stage cancer of the large bowel or back passage, your surgeon may be able to remove the cancer from the bowel lining. This type of operation is called a local resection. As part of the procedure the surgeon will also remove a border of healthy tissue from around the cancer, is it to prevent the cancer coming back by trying to remove all the cancer cells and not leave any behind.
This removed tissue and send to a laboratory.
A Colostomy is a surgical procedure that brings one end of the large intestine out through an opening (stoma) made in the abdominal wall. Stools moving through the intestine drain through the stoma into a bag attached to the abdomen.
A colostomy may be used when there is a problem with the colon. The colostomy diverts digestive waste away from the affected area. A colostomy is also formed after a section of the colon has been removed and the bowel can no longer be joined back together.
How a colostomy is performed?
A colostomy can be performed in many different ways. The technique used is specific to your personal condition and conditions.
The two main surgical types:
- Open Surgery (Laparotomy) - Where the surgeon makes a long incision in the abdomen to access the colon.
- Laparoscopic (keyhole) Surgery- Where the surgeon makes several smaller incisions and uses a miniature video camera and special surgical instruments to access the colon.
The preferred option wherever possible is the keyhole surgery. The research shows that patients recover quicker and have a reduced risk of complications. Both of these surgeries are performed under general anaesthetic, meaning you are asleep during the surgery.
Types of Colostomy
The two main types of Colostomy that are performed by surgeons are:
- A Loop colostomy
- An End colostomy
To form a loop colostomy, a loop of the colon is pulled through an incision in your abdomen. This section of the colon is then opened and stitched to the skin to form the opening that is called the stoma.
The stoma has two openings: one being connected to the functioning part of your bowel, this is where the waste will leave the body, and the other is connected to the inactive part of the bowel.
The position of the stoma depends on which section of the colon is diverted; it is usually on the left-hand side of your abdomen, below your belt line. If the operation is not an emergency you will meet with a specialist stoma nurse beforehand to discuss positioning.
The stoma will appear large at first; this is just the effect of the surgery to cause it to swell. This normally goes down within eight weeks where the stoma will reach its final size.
To form an end colostomy it is relatively the same procedure as a loop colostomy. However, the main different is that the stoma will have one opening through which waste products pass. The other end of the colon, which goes down to your rectum is sealed and left inside your abdomen.
Recovery from a Colostomy
Following the procedure, you will need to stay in hospital for a few days while you recover. A clear colostomy bag will be placed over the opening (stoma) in your abdomen, so it will be easily monitored and drained. The first bag placed over the opening is often larger than normal colostomy bags and is usually replaced with a smaller bag before you go home.
You will also be visited by a stoma nurse who will teach you how to care for your stoma including how to empty and change the pouch. They will also show you how to keep your stoma and surrounding skin clean and free from irritation.
Ileostomies are performed for either temporary or permanent reasons. They are used to stop digestive waste passing through the full length of the small intestine or colon.
An ileostomy is a procedure on which the small intestine (small bowel) is diverted through an opening in the abdomen (tummy). This opening is called a stoma. A special bag is then placed over the stoma to collect the waste product that would usual pass through the colon (large intestine) and out of the body through the rectum and anus (back passage).
This procedure is relatively common in the UK with over 9,000 being performed in England each year.
When is an ileostomy needed?
Ileostomies become necessary in a number of situations, including:
- Following an operation on the small intestine or colon in order to allow the area to heal (for example if a section has been removed to treat bowel cancer)
- It can also be for those who suffer from Crohn’s disease or ulcerative colitis to prevent inflammation of the colon
- To allow for complex surgery to be performed on the anus or rectum
Similar to a colostomy before an ileostomy is performed you will see a specialised nurse to discuss exactly where you would like your stoma to be and discuss living with a stoma.
The two main types of ileostomy:
- Loop ileostomy- this is where a loop of the small intestine is pulled out through an incision in your abdomen, before being opened up and stitched to the skin to form a stoma
- End ileostomy- where the ileum is separated from the colon and is brought through the abdomen to form a stoma
An alternative to these treatments is sometimes possible this is when an internal pouch is created and connected to your anus. This procedure is known as an ileo-anal pouch. This means unlike an ileostomy, there is no stoma and stools are passed out of your back passage in a similar way to normal.
End ileostomies and ileo-anal pouches are normally permanent. Loop ileostomies are usually only intended as a temporary solution and are reserved during an operation at a later date.
Following the surgery
After the surgery it is possible you will need to stay in hospital for up to two weeks after an ileostomy operation. Within this time, your specialist stoma nurse will teach you how to look after your stoma.
The recovery for this procedure can be challenging. It is common for people to suffer from short term physical and psychological problems, these can range from skin irritation around the area of the stoma to feeling of anxiety and self-consciousness.
With the practice and support from a designated stoma nurse, many people do adjust after surgery.
Any surgical procedure carries a certain level of risk. Some of the problems people with an ileostomy experience include:
- An obstruction- this is where the output of digestive waste is blocked
- A Vitamin B12 deficiency can occur- this is where the part of the intensine that absorbs vitamin b12 is removed
- Issues can also arise with the stoma, such as a widening or narrowing making it difficult to attach the external bag
If you have further concerns or questions its best to speak to your consultant or surgeon.