Colostomy - Defunctioning Loop in India :
Minimally Invasive Surgery
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What is it?
The bowel is a tube of intestine which runs from the stomach to the back passage. It is much longer than the inside of your belly (tummy). It fits in by coiling up in loops. The upper part of the bowel is called the small bowel. It joins the lower part of the bowel (the colon) just to the right of the waistline. This is where the appendix pouches out from the colon. The colon runs up to the right ribs and loops across the upper part of the belly. Then it passes down the left side to run backwards into the pelvis towards the back passage, where it is called the rectum.
Your lower colon and rectum are diseased. You need to have a bypass operation to keep the waste away from the diseased part. A loop of colon is brought out onto the skin so that the waste runs into a special bag stuck over the opening. This is the colostomy. Often the diseased part can be taken out later, when the bowel has recovered from infection or being overstretched by a blockage. Then the colostomy can be closed off. Sometimes it is too risky for you to have the diseased part taken out. You can keep a colostomy for decades without coming to any harm. Sometimes a colostomy is needed so that x-ray treatment can be given to the lowest parts of the bowel safely.
You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin 25 cm (10 inches) long. The colon is freed inside your tummy. A loop of colon is brought out and stitched to the skin. The opening of the bowel is covered with a special bag. The original wound is closed up. Sometimes, if the colon is free enough, a colostomy can be made without the first big wound. This is a bonus for you. You should plan to leave hospital 2 weeks or so after the operation.
Leaving things as they are is risky. A blocked lower colon is a life-threatening condition. You must have a bypass operation. it is not safe for you to have the diseased bowel taken out now. Drug and x-ray treatment are not helpful by themselves.
Before the operation
Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you. On the ward, you may be checked for past illnesses and may have special tests, ready for the operation. Please tell the nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You will have a drip tube in an arm vein connected to a plastic bag on a stand containing a salt solution or blood. You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. Swallowing may be a little uncomfortable. You may have a fine tube (catheter) passing into the bladder through the front passage. This lets the bladder stay empty and small during the operation and helps control your body fluids afterwards. You will have a dressing on your wound and possibly a drainage tube nearby, connected to yet another plastic bag. You will have the colostomy with a plastic bag over it. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. Do not make important decisions, during that time.
You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The second day after operation you should be able to spend an hour or two out of bed. By the end of four days you should have little pain. The colostomy may not work for a day or two. It is always runny at first and rather smelly. It quickly gets better. You will get special advice and help from the Stoma Nurses. Because of the drainage tube (catheter) in the bladder, passing urine is not a problem. Usually there are no stitches in the skin. The wound is held together underneath the skin and does not need further attention. The drain tube is removed after 4 days or so. There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor matchhead sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bath as often as you want. You will be given an appointment to visit the Out Patient Department for a check up about one month after you leave hospital. The Stoma Nurse will arrange to visit you at home. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rests 2 or 3 times a day for a month or more. You will gradually improve so that by the time 3 months has passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks. You can restart sexual relations within 2 or 3 weeks when the wound is comfortable enough. You should be able to return to a light job after about 6 weeks. A heavy job may not be possible due to the colostomy.
Complications are unusual but are rapidly recognised and dealt with by the nursing and surgical staff. If you think that all is not well, please ask the nurses or doctors. Chest infections may arise, particularly in smokers. Do not smoke. Occasionally the bowel is slow to start working again. This requires patience. Your food and water intake will continue through your vein tubing. Sometimes there is some discharge from the drain by the wound. This stops given time. Wound infection is sometimes seen. This settles down with antibiotics in a week of two. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months. The colostomy can sometimes swell, or shrink or irritate the skin. The Stoma Nurses will help you here.
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