What is a Stoma?
A stoma is an artificial opening of the intestine on the body surface( skin ). An end or a loop of the intestine is surgically created on the skin and serves as a means of allowing the stool to be passed from the intestine onto the skin. A bag is placed on the skin overlying the stoma, into which the contents flow. Stomas are surgically created, as a part of the operation to remove or palliate a cancer in the intestine/colon.
- Colostomy: when a piece of colon is brought to the skin
- Ileostomy: when a piece of the ileum ( small intestine ) is brought on the skin
Where the stoma is located on the abdominal wall, depends on what part of the intestine is brought
out as a stoma
WHEN IS A STOMA REQUIRED TO BE DONE AS PART OF THE OPERATION?
A stoma is done under the following circumstances
1. Permanent end Colostomy:
This is a permanent stoma done, when cancer affects the lower rectum and the rectum and stool passage needs to be completely and permanently removed to cure the cancer. The surgical procedure is called Abdominal Perineal Resection: APR
2. Temporary Colostomy or Ileostomy:
Right transverse colostomy or ileostomy either of the above may be done alongside a rectal cancer operation. After operation for rectal cancer, the continuity of the intestine is restored by joining the left colon to the lower part of the rectum. This is a delicate join and hence to facilitate healing of this bowel anastomosis, a temporary stoma is created either from the colon ( colostomy ) or the small bowel ( ileostomy ). The stool passage is thereby temporarily diverted, while the joint heals. The stoma can then be closed ( reversed ) through a small operation as early as 3 weeks onwards after the index ( first ) operation.
3. Diverting Colostomy – to relieve immediate tumour obstruction presenting as an emergency.
This is done when the cancer ( tumour ) is obstructing and causing intestinal obstruction. This is done to remove the obstruction and allow passage of stool so that the gastrointestinal function and eating/digestion can be restored. the patient can then be treated for his cancer as required.
FEW FACTS ABOUT A STOMA
- Where the stoma is located on the body depends on what part of the intestine is brought out on the skin – if its the right colon or ileum ( small intestine )the stoma is located on the right side of the abdomen. the left colon and descending colon is brought on the left side of the abdomen – either upper or lower aspect.
- The stoma generally appears pink and light red – it’s warm and moist and secretes mucus.
- The stoma shrinks to its final size about 6-8 weeks following the surgery to make the stoma.
- Some stomas are flat and flush with the skin, while some are more protruding.
- The stomas don’t have a continent mechanism – hence there is no control of stool passing through into the bag.
- After surgery, some people still may feel urges and even have some discharge from the anus.
Stoma Bag and Appliance
There are a vast choice of bags and appliances available for care of a stoma. The bag is applied on the skin. The bag has to changed on a regular basis.
Dr Soumil Vyas- is a trained gastrointestinal and liver/ gall, bladder and pancreas surgeon, with a speciality in Surgical Oncology.
He specializes in the surgical management of the cancers of the gastrointestinal tract – stomach, colon, intestine along with the liver, gall bladder and the pancreas.