Anatomy of Ostomy Surgery

Anatomy of a Stoma

The body needs to eliminate waste. It’s a process most people take for granted: we eat, the intestines extract nutrients and water from the food, and the leftover material is removed, usually into a toilet. But this seemingly simple process is essential for health and life. If the system stops working—for instance, if part of the intestine becomes inflamed or blocked—the body needs another way to remove its waste. Modern medicine’s answer to this problem is the stoma, a surgically-created opening in the abdomen for the body’s discharge of waste.

The definition of an Ostomy is the surgical procedure used to create the stoma. A surgeon makes a cut into the patient’s abdomen, removes the diseased or injured area of intestine, and draws the free end of the intestine out through the abdominal opening, where it can heal to the skin. This creates a new opening from the intestines, called a stoma. The stoma refers specifically to the protruding area of bowel. The stoma opens directly into the intestines, so the inner, mucus-covered lining of the intestine is visible.
 
The large intestine is an organ about five to six feet long. It is located in the abdomen, where it loops from the lower right abdomen, up over the small intestines, and down to the lower left abdomen. There it connects to the rectum, which releases waste from the body through the anus. The large intestine’s primary functions are to extract water from, move, and store the body’s waste material after the small intestine extracts nutrients.

Types of Ostomy Surgery

There are several different kinds of Ostomy surgery, named for the organ or area being operated on.
 
• Colostomy: surgery where part of the colon is brought through the abdomen to create a stoma. Ascending, transverse, and descending colostomies refer to the area of the colon brought to the surface of the abdomen.

• Ileostomy: surgery where the lowest part of the small intestine, the ileum, is brought through the abdominal wall to create a stoma. An ileostomy completely bypasses the colon for stool elimination.

• Urostomy: surgery where a small section of small or large bowel is used as a connector between the urinary tract and the stoma. This allows urine to be eliminated from the body without being stored in the bladder.

• Permanent versus Temporary: Ostomy surgeries can be temporary (usually performed to allow regions of the bowel to heal) or permanent (usually performed with loss of the rectum.)

• J-Pouch: Also known as the ileoanal reservoir, this is a two-step procedure. A temporary ileostomy is followed by a second surgery where the end of the small bowel is used to create a reservoir—the “J-Pouch”—and then connected to the anus. This surgery permits control of waste elimination and prevents the need for a permanent ileostomy.

Ostomy Support

The United Ostomy Associations of America, Inc. (www.uoaa.org) and the United Ostomy Ass of Canada (http://www.ostomycanada.ca/)  provides information, support and advocacy for people who require Ostomy surgery. They also host discussion boards where ostomates can find others for advice, encouragement, and camaraderie. Visit their website for guidebooks and brochures covering colostomy, ileostomy, Urostomy, j-pouches, and more.