Ileostomy is a stoma (opening of the surgeon) built with a small intestine or circle (ileum ) out of the skin, or a surgical procedure that creates this opening. Bowel waste comes out of ileostomy and is collected in an artificial external pouch system attached to the skin. Ileostomies are usually located above the crotch on the right side of the abdomen.
Video Ileostomy
Medical use
Ileostomies are needed when an injury or surgical response to the disease has made the colon unable to process intestinal waste safely, usually because the colon and rectum have been partially or completely removed.
Colon diseases that may require surgical removal include Crohn's disease, ulcerative colitis, familial adenomatous polyposis, and total Hirschsprung colic disease. An ileostomy may also be needed in the treatment of colorectal cancer or ovarian cancer. One example is the situation in which a cancerous tumor causes a blockage. In such cases, ileostomy may be temporary, since the general surgical procedure for colorectal cancer is to reconnect the remaining part of the colon or rectum after removal of the tumor provided the rectum remains intact to maintain internal/external sphincter function.
In a temporary or loop ileostomy loop, a surgical ileum loop carried through the skin creates a stoma, but maintains the lower part of the ileum for future reattachment in cases where the entire colon and rectum are not removed but it takes time to heal. Temporary ileostomies are also often made as the first stage in ileo-anal sleeve surgical construction, so the feces do not enter newly created bags until they are healed and have been tested for leakage - typically requiring a period of eight to ten weeks. When the healing is complete, temporary ileostomy is then "lowered" (or reversed) by intestinal loop surgery that creates a temporary stoma and closes the incision.
In end ileostomy , the tip of the ileum is opened to make the spout and the edges are sewn under the skin to bind the ileum in place. End end ileostomy may be temporary or permanent, but it is usually an option for permanent ileostomy. A final ileostomy can be constructed temporarily if most or most of the large intestine is removed and the current bowel state or overall health is not considered to be able to perform further surgery, such as anastomosis to rejoin the small and large intestine.
Maps Ileostomy
Live with ileostomy
People with ileostomy should use a pouch of ostomy to collect intestinal waste. People with ileostomy usually use an open end (referred to as a "can-goable" pouch) of one or two sections secured at the lower end with a leak-proof clip, or velcro binder. The alternative is a sealed bag that must be removed when full. Typically, the bag should be emptied several times a day. Pockets and flanges (both one and two bags a piece) are usually replaced every 2-5 days.
The ostomy pouch is located close to the body and is usually not visible under the regular clothes unless the wearer allows the bag to be too full. It is important to have a stoma that is measured regularly when it changes shape after the initial surgery. Stomal or colorectal nurses do this initially for patients and advise them on the exact size required to open the bag (sack).
Some people find they have to make adjustments to their diet after performing ileostomy. Hard or high fiber foods (eg potato skins, tomato peels, and raw vegetables) are difficult to digest in the small intestine and can cause blockage or discomfort as it passes through the stoma. Chewing food thoroughly can help minimize such problems. Some people also find that certain foods cause disturbing gas or diarrhea. Many foods can change the color of the intestinal output, causing an alarm; bit, for example, produces a red output that may look like blood. However, people who have ileostomy as a treatment for inflammatory bowel disease usually find that they can enjoy a more "normal" diet than before surgery. Proper diet advice is essential in combination with patient gastroenterologists and hospital-approved nutritionists. Additional food can be prescribed and fluid intake and output monitored to repair and control the output. If the output does contain blood at all times, ileostomate is advised to visit the emergency department.
Other complications may include kidney stones, gallstones, and post-surgical adhesions.
More options
In some patients with Crohn's disease, there is a choice of procedure called ileorectal anastomosis, which is performed if Crohn's disease affects the entire colon but leaves the rectum unscathed. In this procedure, the entire colon is removed surgically, but the rectum is left intact. The ileum is then stitched into the rectum to allow the stool through the rectum as it does when the patient has a large intestine. One disadvantage of this procedure is that bowel movements become more frequent and stool may appear greenish as they no longer have a large intestine to extract water. Although this procedure requires temporary ileostomy loops to allow anastomosis to heal, with certain lifestyle adjustments, those who have undergone this procedure for Crohn's disease may be able to resume normal bowel movements without any artificial equipment.
Since the late 1970s an increasingly popular alternative to ileostomy has been Barnett's intestinal reservoirs (or BCIR). The formation of this bag (made possible through a procedure pioneered first by Dr. Nils Kock in 1969), involves the creation of an internal reservoir formed using ileum and connecting it through the abdominal wall in a manner very similar to the standard. "Brooke" ileostomy. The BCIR procedure should not be equated with the J-pouch, which is also an ileal reservoir, but is directly connected to the anus - after removal of the colon and rectum - avoiding the need for further use of external equipment.
Barnett continent's intestinal tract
The Barnett continent intestinal reservoir (BCIR) is a type of free intestinal ostomy tool. BCIR is a modified Kock pocket procedure pioneered by William O. Barnett. This is a surgically made pouch, or a reservoir, inside the abdomen, made up of the last part of the small intestine (ileum), and used for the storage of intestinal waste. The bag is internal, so BCIR does not need to use ostomy tools or pockets.
How it works
The bag works by storing liquid waste, which is dried several times a day using a small silicone tube called a catheter. The catheter is inserted through an operationally operated opening in the abdomen into a bag called a stoma. Internal bag capacity increases steadily after surgery: from 50cc, when first constructed, to 600-1000cc (about one liter) for several months, when the bag is fully mature.
The opening where the catheter is inserted into the bag is called the stoma. These are small holes, holes in the abdomen. Most patients close the stoma site with a small pad or pad to absorb the accumulated mucus at the opening. This mucus formation is natural, and makes catheter insertion easier. BCIR does not require external tools and can be dried anytime convenient. Most people report drying bags 2-4 times a day, and most of them sleep through the night. This may vary depending on the type and amount of food eaten. The drying process of the bag is simple and quickly mastered. Stoma has no nerve endings, and inserting catheters is not painful. The process of inserting a catheter and draining the pouch is called intubation and takes only a few minutes.
Background and origin
Finnish surgeon Dr. Nils Kock developed the first intra-abdominal continental ileostomy in 1969. It was the first continental reservoir of the continent. In the early 1970s, several major medical centers in the United States performed Kock bag ileostomies in patients with ulcerative colitis and familial polyposis. One problem with this initial Kock bag is the valve slippage, which often results in difficulty of intubation and wetting pockets. As a result, many of these pockets have to be revised or removed to allow for a better quality of life.
The late Dr. William O. Barnett began modifying Kock's bag in 1979. He believed in the concept of continental reservoirs, but was disappointed by the relatively high valve failure rate. Barnett intends to solve the problem. The first change is in the construction of the nipple valve. He changes the direction of flow in this intestinal segment to keep the valve firmly in place. This greatly increases the success rate. In addition, he uses a plastic material called Marlex to form a collar around the valve. It's more stable and supported valve, reducing valve slippage. This technique works well, but after a few years, the gut reacts to Marlex by forming a
After a series of tests of more than 300 patients, Dr. Barnett moved to St. Petersburg, Florida where he joined the Palms of Pasadena Hospital staff, where he trained other surgeons to perform a continental bowel reservoir procedure. With the help of Dr. James Pollack, the first BCIR Program was founded. Both surgeons further improve the procedure to bring it to the present place. These modifications include a pocket reconfiguration to reduce the number of stitches from three to one (this allows the pouch to heal faster and reduce the likelihood of developing a fistula); and create a serosal patch above the seam line that prevents leakage. The end result of this development is a continental reservoir of the continent with minimal complications and satisfactory function.
Surgical candidates
Ulcerative colitis and familial adenomatous polyposis are the two major health conditions that lead to the removal of all the colon and rectum, leading to the need for ileostomy.
Candidates for BCIR include: persons who are dissatisfied with the results of alternative procedures (whether conventional brooke ileostomy or other procedures); patients with damaged or failed Kock bags or IPAA/J-pouch; and individuals with poor internal/external anal sphincter controls who choose not to have a J-Pouch (IPAA) or are not good candidates for IPAA.
However there are some contraindications to undergo BCIR surgery. BCIR is not for people who have or need colostomy, people with active Crohn's disease, mesenteric desmoids, obesity, old age, or bad motivation.
When Crohn's disease only affects the colon, it may, in certain cases, be appropriate to perform BCIR as an alternative to conventional ileostomy. If the small intestine is affected, however, it is not safe to have BCIR (because the internal pouch is made from the small intestine, which should be healthy).
A patient should have sufficient length of small intestine to consider as a potential candidate.
Success rate and case study
- ASCRS study, 1995
A 1995 study by the American Society of Colon and Rectal Surgeons included 510 patients receiving BCIR procedures between January 1988 and December 1991. All patients between 1-5 years after surgery with the diagnosis of ulcerative colitis or familial polyposis. The study was published in Colon and Rectum Disease in June 1995. The study found that:
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- About 92% of patients have functional BCIR bags at least one year after surgery;
- 87.2% of patients do not require minor or minor surgery to ensure the bag is functioning;
- 6.5% of patients require subsequent excision (removal) of the bag (with most of this occurring within the first year (63.6%);
- The re-operative rate for complications associated with the main pouch (other than bag removal) was 12.8% (including: slip valve (6.3%), fistula valve (4.5%), and pouch fistula (6 , 3%));
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- Of the 32 patients treated for valve slippage, 23 reached a fully functional bag. Fistula bags or valves affecting 52 patients, 39 eventually achieving a successful outcome. Leakage of pockets occurred in 11 patients, from the seventh has been functioning pockets.
- Unrelated complications with the bag itself are parallel to those that accompany other stomach operations; with the most frequent small bowel obstruction (which occurs in 50 patients, 20 of which require surgical intervention);
- "Some questions are given to patients whose response indicates a significant increase in general quality of life, state of mind, and overall health More than 87% of patients in this study feel their quality of life is better after BCIR.
The study concludes: "BCIR is a successful alternative for patients with conventional Brooke ileostomy or those not candidates for IPAA."
- ASCRS special studies, 1999
In 1999 the American Society of Colon and Rectal Surgeons published a unique study on 42 patients with failed IPAA/J-pockets that were converted to Barnett modification of the Kock (BCIR) bag. The authors note that their study was significant in a large number of patients, about 6 times more than was previously studied by the authors. The study was published in Colon and Rectum Disease in April 1999. The study found:
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- that forty (95.2%) patients from the IPAA population failed to report fully functioning pockets;
- that two pouches had been cut, one after the development of a vesical vestal fistula, the other after the appearance of Crohn's disease, which had not been diagnosed at the time of the original colectomy;
- that "Forty (100%) of patients with IPAA failure who keep their pockets rate their lives after continental ileostomy is better or much better than before."
The study concludes: "The continental ileostomy offers an alternative with high patient satisfaction rates, for patients facing the disappearance of IPAA."
See also
- Colostomy
- Jejunostomi
- List of operations by type
Note
References
External links
- Ileostomy-surgery website
- American Society of Colon & amp; Rectal Surgeons ; ASCRS site
- The American Association of Ostomy of America ; Ostomy Association website (visited: May 23, 2018)
Source of the article : Wikipedia
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