What is a fecal diversion?
Fecal diversion refers to the surgical creation of an ileostomy or colostomy. An ileostomy is an opening between the surface of the skin and the small intestine; a colostomy is an opening between the surface of the skin and the colon. This opening is called a stoma.
Fecal diversion is used to treat:
- complex rectal or anal problems (especially infections)
- poor control of the bowels (incontinence).
The stoma can measure from 1 to 1-1/2 inches around (see figure below). Unlike your anus, the stoma has no sphincter muscle, so most people cannot control the exit of waste. You will probably need to wear a pouch (ostomy collecting device) at all times to collect the waste flow.
The two incisions required for fecal diversion. The larger dot is the incision site of the stoma in colostomy. In ileostomy, the incision and the stoma sites are reversed.
Stomas can be permanent or temporary. A temporary stoma may be made when a diseased section of bowel is removed, rejoined, and given time to heal. Once the reconnection site (anastomosis) has healed, the stoma can be removed. If the anus and rectum have been removed, the stoma must be permanent.
You are bound to go through many psychological and physical adjustments after surgery. It will take time to cope with all of these changes and, at times, you may feel overwhelmed. This handout has been prepared to answer some of the questions you may have about your surgery. It's likely you will have many more questions. Your enterostomal therapist (ET nurse), a nurse specially trained in stoma care, will explain the stoma to you and provide you with further resources. Do not hesitate to call your ET nurse after surgery for further support.
What happens during the surgery?
The term "laparoscopic" refers to a type of surgery called laparoscopy. Laparoscopy enables the surgeon to complete the procedure through very small "keyhole" incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through an incision near the belly button.
A laparoscopic fecal diversion requires only two incisions. The first incision is made at the intended site of the stoma. A second incision is made opposite this area and is used to place the laparoscope. In some cases, a third incision will be made so that more of the large intestine can be reached. Images taken by the laparoscope are projected onto video monitors placed near the operating table.
How is the stoma made?
There are two types of stomas: the end stoma and the loop stoma.
- End stoma An end stoma can be made in the ileum (end of the small intestine) in a procedure called end ileostomy, or in the colon (large intestine) in a procedure called end colostomy. First, a small disk of skin will be removed from the stoma site. Next, your surgeon will bring 1 to 2 inches of healthy bowel up through the abdominal wall to skin level. If you are having a colostomy, the end of the intestine will be stitched to your skin. If you are having an ileostomy, the small intestine will be stitched to your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed.
- Loop stoma A loop stoma can be made in the ileum (loop ileostomy) or colon (loop colostomy). A loop stoma is often made when the stoma will be temporary. However, not all loop stomas are temporary.
To make the loop stoma, a small loop of intestine will be brought up through the abdominal wall to skin level. A plastic rod will be passed underneath the loop to keep the new stoma in place. The loop will be cut half way through to make the site for the bowel opening. Each open end of the bowel created by this cut will appear as two openings in the stoma. If you are having a loop colostomy, the end of the intestine will be stitched to your skin. If you are having a loop ileostomy, the loop will be turned back on itself like a small cuff and then stitched just below your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed. The rod will be removed 3 to 7 days after surgery.
How long will I be in the hospital?
Hospital stays after fecal diversion average 2 to 3 days. You will be fitted with a pouch as soon as your surgery is complete. It will take a day or two for your digestive system to become active again. When it does start functioning, you will notice changes in the consistency of your stoma output.
While you are recovering, your ET nurse will change your pouch for you. You will learn a lot about changing the pouch by watching the ET nurse. You will also be given instructions and coached through the process so you are able to care for the stoma when you return home.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/15/2006...#4183