Ask Dr. Schiller: What Ileostomy Alternatives Are Available To Patients? - OstomyConnection

Ask Dr. Schiller: What Ileostomy Alternatives Are Available To Patients?

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Ileostomy surgery can both save and change patients’ lives. Over the last two decades, doctors have developed a number of different procedures to accomplish the work of an ileostomy. Understanding the ileostomy alternatives currently available can help reduce the stress associated with major surgery.

Patients who require removal of their colon (large intestine) via a colectomy and those whose rectums must also be removed in a proctocolectomy need a way for waste to exit the body. The procedure known as a traditional or Brooke ileostomy came about in the 1950's, according to BCIRhistory.com.

Many patients today still undergo this type of surgery, whether it be temporary or permanent. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the main reasons it might be necessary include:

  • Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease
  • Cancer in the large intestine or rectum
  • Bowel obstructions that completely block the large intestine
  • Familial adenomatous polyposis
  • Bowel injuries such as punctures
  • Diverticulitis

Surgeons perform an ileostomy by creating an opening in the abdomen called a stoma, then direct the end of the small intestine through it. Waste exits the body and collects into an ostomy appliance system applied to the stomach which is emptied periodically.

What surgical options do you have?

Surgeons recommend an ileostomy, or an alternative procedure based on whether the patient requires removal of both the colon and the rectum and whether the surgery is intended to be temporary or permanent.

NIDDK indicates the following current options:

The Brooke ileostomy still requires patients to wear an external appliance attached to them and to empty it at random intervals. Many individuals who had this type surgery for years are now opting for revision surgery for convenience. Today, surgeons most often recommend this procedure for individuals with rectal cancer or Crohn’s disease. For a Crohn’s patient who requires removal of the colon, this is the only surgical option as reported by the Crohn’s & Colitis Foundation of America. This may be due to the high risk these individuals face as far as developing strictures, abscesses, and fistulas and to the tendency of the disorder to flare periodically.

Internal pouch surgery is also called the J-pouch procedure which does not require creating a stoma. The surgeon creates an internal reservoir in which waste collects. The procedure connects the end of the small bowel to the anus. Doctors most often recommend this surgery for patients with ulcerative colitis or familial adenomatous polyposis.

Continent ileostomies include an internal pouch with a valve, enabling patients to drain them each day using a catheter through the stoma. The Kock pouch was one version used extensively. The most recent improvement, known as the Barnett Continent Intestinal Reservoir, features an improved design created to give patients more control and convenience, according to BCIRhistory.com.