Types of Ostomies and Alternate 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 openings 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.

Colostomy

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.

Temporary Colostomy

Allows the lower portion of the colon to rest or heal. It may have one or two openings (if two, one will discharge only mucous).

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 and can be right or left sided.

Loop Colostomy

Usually created in the transverse colon. This is one stoma with two openings; one discharges stool, the second mucous.

Ileostomy

This is the surgical procedure during which the small intestine, usually at the end of the ileum, 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.

Ileoanal Anastomosis

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, and who have not previously lost their rectum or anus. It is also called J-pouch, pullthrough, endorectal pullthrough, pelvic pouch, or a combination of these terms.

Continent Ileostomy

This surgical variation of the ileostomy is also called a Kock pouch. A reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is constructed in the pouch which 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 pouch. A newer version of this procedure called the Barnett Continent Ileal Reservoir is practiced at a limited number of facilities.

Types of Appliances.

The term appliance refers to the combination of a flange (barrier or wafer) and pouch (or collection bag or reservoir). Often the entire appliance is called a pouch. The appliance attaches to the abdomen by the adhesive backed faceplate and is fitted over and around the stoma to collect the diverted output, either feces or urine. Other common terms for the barrier are wafer, faceplate, flange, disc, body holder, mounting ring or adhesive ring. The barrier is made from either soft molded rubber or plastic, which together with its karaya, pectin or other adhesive backing, is designed to protect the skin from the stoma output and to be as neutral to the skin as possible.

Colostomy and Ileostomy Pouches

Can be either open-ended, requiring a closing device usually called a clamp or tail clip; or closed and sealed at the bottom. Open-ended pouches are called drainable and are reused after they are emptied. Most commonly closed end pouches are used by colostomates who can irrigate (see below), or by patients who have regular elimination patterns. Closed end pouches are usually discarded after one use.

Two-Piece Systems

Consist of a separate flange and pouch. The pouch contains a closing ring which mechanically attaches to a mating piece on the flange. The most common closure is a pressure fit snap ring, very similar to that used in Tupperware TM.

One-Piece Systems

As the name implies, are those in which the wafer and pouch are assembled together in one piece and not separate.

Both two-piece and one-piece appliances can be either drainable or closed.

Some colostomates can "irrigate," using a procedure analogous to an enema. This is done to clean stool directly out of the colon through the stoma. This requires special irrigation appliances. These consist of an irrigation bag and a connecting tube (or catheter), a stoma cone and an irrigation sleeve. A special lubricant is sometimes used on the stoma in preparation for irrigation. Following irrigation, some colostomates can use a stoma cap, a one- or two-piece system which simply covers and protects the stoma. This procedure is usually done to avoid the need to wear an appliance.