What is an Ostomy?
This section covers terminology in the area of: types of ostomies and continent procedures. The reader should be sure to “know your ostomy.” This is critical information to provide any caregiver.
Types of Ostomies and Continent Procedures
The terms ostomy and stoma are general descriptive terms that are often used interchangeably though they have different meanings. An ostomy refers to the surgically created opening in the body for the discharge of body wastes. A stoma is the actual end of the ureter or small or large bowel that can be seen protruding through the abdominal wall. The most common specific types of ostomies are described below.
The surgically created opening of the colon (large intestine) which results in a stoma. A colostomy is created when a portion of the colon or the rectum is removed and the remaining colon is brought to the abdominal wall. It may further be defined by the portion of the colon involved and/or its permanence.
Allows the lower portion of the colon to rest or heal. It may have one or two openings (if two, one will discharge only mucus).
Permanent Colostomy Usually involves the loss of part of the colon, most commonly the rectum. The end of the remaining portion of the colon is brought out to the abdominal wall to form the stoma.
Sigmoid or Descending Colostomy The most common type of ostomy surgery, in which the end of the descending or sigmoid colon is brought to the surface of the abdomen. It is usually located on the lower left side of the abdomen.
Transverse Colostomy The surgical opening created in the transverse colon resulting in one or two openings. It is located in the upper abdomen, middle or right side.
Loop Colostomy Usually created in the transverse colon. This is one stoma with two openings; one discharges stool, the second mucus.
Ascending Colostomy A relatively rare opening in the ascending portion of the colon. It is located on the right side of the abdomen.
A surgically created opening in the small intestine, usually at the end of the ileum. The intestine is brought through the abdominal wall to form a stoma. Ileostomies may be temporary or permanent, and may involve removal of all or part of the entire colon.
(J-Pouch) This is now the most common alternative to the conventional ileostomy. Technically, it is not an ostomy since there is no stoma. In this procedure, the colon and most of the rectum are surgically removed and an internal pouch is formed out of the terminal portion of the ileum. An opening at the bottom of this pouch is attached to the anus such that the existing anal sphincter muscles can be used for continence. This procedure should only be performed on patients with ulcerative colitis or familial polyposis who have not previously lost their anal sphincters. In addition to the “J” pouch, there are “S” and “W” pouch geometric variants. It is also called ileoanal anastomosis, pull-thru, endorectal pullthrough, and pelvic pouch and, perhaps the most impressive name, ileal pouch anal anastomosis (IPAA).
(Kock Pouch) In this surgical variation of the ileostomy, a reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted into the pouch several times a day to drain feces from the reservoir. This procedure has generally been replaced in popularity by the ileoanal reservoir (above). A modified version of this procedure called the Barnett Continent Intestinal Reservoir (BCIR) is performed at a limited number of facilities.
This is a general term for a surgical procedure that diverts urine away from a diseased or defective bladder. The ileal or cecal conduit procedures are the most common urostomies. Either a section at the end of the small bowel (ileum) or at the beginning of the large intestine (cecum) is surgically removed and relocated as a passageway (conduit) for urine to pass from the kidneys to the outside of the body through a stoma. It may include removal of the diseased bladder.
There are two main continent procedure alternatives to the ileal or cecal conduit (others exist). In both the Indiana and Kock pouch versions, a reservoir or pouch is created inside the abdomen using a portion of either the small or large bowel. A valve is constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube is inserted several times daily to drain urine from the reservoir.
Indiana Pouch The ileocecal valve that is normally between the large and small intestines is relocated and used to provide continence for the pouch that is made from the large bowel. With a Kock pouch version, which is similar to that used as an ileostomy alternative, the pouch and a special “nipple” valve are both made from the small bowel. In both procedures, the valve is located at the pouch outlet to hold the urine until the catheter is inserted.
Orthotopic Neobladder A replacement bladder, made from a section of intestine, that substitutes for the bladder in its normal position and is connected to the urethra to allow voiding through the normal channel. Like the ileoanal reservoir, this is technically not an ostomy because there is no stoma. Candidates for neobladder surgery are individuals who need to have the bladder removed but do not need to have the urinary sphincter muscle removed.