Surgical Creation Of An Artificial Opening To The Body Surface

Surgical Creation of an Artificial Opening to the Body Surface: A Comprehensive Overview

Surgical creation of an artificial opening to the body surface, more formally known as stoma creation or stoma formation, is a complex surgical procedure with significant implications for patient care. This article delves into the various types of stomas, their indications, surgical techniques, postoperative care, and potential complications. Understanding this procedure is crucial for healthcare professionals and patients alike.

Types of Stomas

Several types of stomas exist, each serving a specific purpose and location on the body:

1. Colostomy:

A colostomy involves creating an opening in the large intestine (colon) and bringing it to the surface of the abdomen. This is often a temporary measure following bowel surgery, allowing the bowel to heal, or it can be permanent, depending on the underlying condition.

• Location: The location of the colostomy (e.g., ascending, transverse, descending, sigmoid) affects stool consistency. Ascending colostomies produce liquid stool, while sigmoid colostomies produce more formed stool.
• Indications: These can include bowel obstruction, inflammatory bowel disease (Crohn's disease or ulcerative colitis), diverticulitis, colon cancer, trauma, and congenital anomalies.
• Surgical Technique: The surgeon selects a suitable site on the abdomen, carefully creating an opening in the abdominal wall and then suturing the colon to the skin. A stoma appliance is then applied to collect the stool.

2. Ileostomy:

An ileostomy creates an opening in the ileum (the terminal part of the small intestine) and brings it to the abdominal surface. Stool from an ileostomy is typically liquid and requires a specialized appliance for collection.

• Location: Usually situated in the right lower quadrant of the abdomen.
• Indications: Ulcerative colitis (particularly when affecting the entire colon), Crohn's disease involving the colon, familial adenomatous polyposis (FAP), and bowel cancer requiring removal of the colon and rectum. It can also be temporary following bowel resection.
• Surgical Technique: Similar to colostomy, the ileum is brought through the abdominal wall and attached to the skin. The surgical technique must carefully manage the delicate nature of the ileum.

3. Jejunostomy:

A jejunostomy is an opening created in the jejunum (a section of the small intestine) and brought to the abdominal wall. It's less common than colostomies and ileostomies.

• Location: Typically situated in the upper abdomen.
• Indications: Used primarily for feeding purposes, bypassing the stomach and upper small intestine. It can be a short-term or long-term solution, depending on the clinical situation.
• Surgical Technique: The jejunum is surgically brought to the abdominal surface, and a feeding tube is inserted through the stoma. Surgical technique ensures minimal trauma to the jejunum's delicate structure.

4. Urostomy:

A urostomy involves creating an opening to divert urine from the urinary tract to the abdominal surface. The most common type is an ileal conduit, which uses a section of the ileum to create a conduit for urine.

• Location: Usually located in the lower abdomen.
• Indications: Bladder cancer, severe bladder dysfunction, birth defects of the urinary tract, trauma, and radiation damage.
• Surgical Technique: A section of the ileum is isolated, and the ureters (tubes carrying urine from the kidneys) are attached to it. This newly created conduit is then brought to the abdominal wall, creating the urostomy.

Surgical Techniques and Considerations

The specific surgical technique employed will vary depending on the type of stoma being created and the patient's individual circumstances. However, common elements include:

• Preoperative Assessment: This involves a thorough medical history, physical examination, blood tests, imaging studies (such as CT scans or MRIs), and often a consultation with a stoma therapist.
• Anesthesia: General anesthesia is usually required.
• Incision: A surgical incision is made to expose the appropriate part of the bowel or urinary tract.
• Stoma Creation: The bowel or urinary tract is brought through the abdominal wall, creating the stoma. The stoma is carefully sutured to the skin to ensure a secure attachment and prevent leakage.
• Closure of the Abdominal Wall: The abdominal wall is carefully closed in layers, often using absorbable sutures.
• Postoperative Care: The patient will require close monitoring for several days after surgery. Pain management, wound care, and assessment of stoma function are critical.

Postoperative Care and Management of Stomas

Postoperative care is crucial for successful stoma management. Key aspects include:

• Pain Management: Pain medication is often necessary to control postoperative pain.
• Stoma Assessment: Regular assessment of the stoma's appearance, size, and output is essential.
• Stoma Appliance Application: The patient will be taught how to apply and change the stoma appliance correctly. This involves cleaning the stoma area, measuring the stoma, cutting the appliance opening to the correct size, and applying the appliance securely.
• Dietary Advice: Dietary adjustments may be needed depending on the type of stoma. For example, individuals with ileostomies may need to avoid certain foods that can cause gas or diarrhea.
• Bowel or Bladder Training: Training programs may be helpful, especially for managing bowel habits.
• Psychological Support: Creating a stoma can be emotionally challenging. Psychological support and counseling can be beneficial.
• Long-Term Follow-up: Regular follow-up appointments with the surgical team and stoma nurse specialist are essential to monitor the stoma and address any problems.

Complications Associated with Stoma Creation

While generally safe, stoma creation carries potential complications, including:

• Bleeding: Bleeding can occur during or after surgery.
• Infection: Infection at the stoma site is a possible complication.
• Hernia: A hernia may develop around the stoma.
• Stenosis: Narrowing of the stoma can occur, hindering the passage of stool or urine.
• Necrosis: Death of the stoma tissue can occur if the blood supply is compromised.
• Prolapse: The stoma may protrude excessively from the abdominal wall.
• Retraction: The stoma may recede into the abdominal wall.
• Parastomal Hernia: A hernia that forms around the stoma.

Living with a Stoma: Adapting to Life After Surgery

Adjusting to life with a stoma takes time and patience. Support from healthcare professionals, family, and friends is crucial. Patients will learn how to manage their stoma, including applying appliances, dealing with potential complications, and adjusting their diet and lifestyle. Support groups and stoma therapy services provide invaluable assistance in adapting to the changes in daily life that a stoma brings. With proper care and support, individuals can lead fulfilling and active lives.

Conclusion: A Multifaceted Procedure with Significant Impact

The surgical creation of an artificial opening to the body surface is a significant surgical procedure with wide-ranging implications for patient care. This article has provided a detailed overview of the various types of stomas, their indications, surgical techniques, postoperative management, and potential complications. While challenging, with appropriate medical care and support, individuals can adapt to living with a stoma and maintain a good quality of life. Understanding this procedure is essential for healthcare professionals and patients to manage the short-term and long-term challenges associated with stoma creation. Furthermore, ongoing research and improvements in surgical techniques and stoma care products continue to improve patient outcomes and quality of life for those living with stomas. The multidisciplinary approach to care, involving surgeons, nurses, stoma therapists, and dieticians, is vital for comprehensive patient support and optimal results.