Ask Dr. Schiller: When Is Ileostomy Surgery Necessary?

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An ileostomy is often times a life-saving surgery for many, and can greatly improved the quality of life for patients who have chronic illnesses. Some of the most common questions patients and their families have pertain to when this type of surgery is necessary.

What is an ileostomy?

Ileostomies are surgical procedures used to provide an alternative way for waste to leave the body after removing the colon, rectum, and anus. In a traditional procedure, a surgeon creates an opening in the abdomen, then brings the end of the ileum – the terminal portion of the small intestine – through this opening, called a stoma. The final step is attaching this last part of the small bowel to the skin, according to MedlinePlus. An external pouch collects waste.

The traditional procedure usually includes placing the stoma on the lower right side of a patient’s abdomen. The United Ostomy Associations of America indicates that when an individual looks at a stoma, what is visible is the lining of the small bowel. It is pink and resembles the lining of the cheek.

Continent procedures involve using the bowel as a type of reservoir and give the patient control over elimination. Surgeons opt to use them when it is necessary to remove only the patient’s colon. indicates that the three types of ileostomies available include:

  • Conventional, also known as the Brooke procedure
  • J-pouch, or ileoanal reservoir, a continent procedure that hooks the intestine to the rectum
  • Barnett Continent Intestinal Reservoir, a modification of the earlier Koch pouch

Ileostomies can be temporary or permanent, depending on the reason for the procedure.

When the surgeon finds it necessary to remove or bypass the entire rectum, colon, and anus, the procedure is permanent. If the physician leaves at least some of the rectum intact but removes all or a portion of the colon, the procedure could be temporary.

The American Cancer Society indicates that surgeons perform ileostomies for many disorders. Doctors usually decide they are necessary once medications or other types of surgery have failed to cause sufficient improvement in the underlying condition. Sometimes trauma or a birth defect is a reason to perform the procedure.

The most common disorders that necessitate ileostomies include:

  • Ulcerative colitis
  • Crohn’s disease
  • Familial polyposis
  • Issues related to cancer

To enjoy the control associated with continent procedures, many patients opt for revision surgery of traditional ileostomies. However, when a patient with Crohn’s disease needs the entire colon removed, the only option is a traditional procedure, the Crohn’s & Colitis Foundation of America reports. This is because patients with this incurable disorder face a risk for complications like strictures, fistulas, and abscesses that prevent the reservoir created from functioning properly. Also, about 60% of patients who undergo any type of Crohn’s surgery may experience a recurrence within a decade.