Background Information:

What are the other Names for the Procedure?

• End Colostomy
• Hartmann’s Procedure
• Loop Colostomy

What is Colostomy surgical procedure?

Colostomy is a surgical procedure that involves creating an artificial opening or stoma, by redirecting the large intestine to the abdominal wall, for eliminating feces from the body.

What part of the Body does the Procedure involve?

A Colostomy procedure involves the large intestine and the abdominal wall.

Why is the Colostomy surgical procedure Performed?

There could be various reasons for performing a Colostomy. Some of these include:

• Perforation of the colon
• Peritonitis; diagnosed from colon pathology
• Injury to the colon due to trauma
• Anal, rectal, or colon cancer
• Scarring of the large intestine due to a severe infection
• Blockage of the large intestine
• Radiation therapy

What are some Alternative Choices for the Procedure?

To treat and diagnose any ailment related to the large intestine, a Colostomy procedure remains the gold standard technique.

What are the Recent Advances in the Procedure?

The recent advances are in the use of minimally invasive (laparoscopic) techniques for Colostomy.

What is the Cost of performing the Colostomy surgical procedure?

The cost of Colostomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Colostomy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.nlm.nih.gov/medlineplus/ency/article/002942.htm (accessed on 24th July, 2012)

http://www.nhs.uk/conditions/Colostomy/Pages/Introduction.aspx (accessed on 24th July, 2012)

Prior to Colostomy surgical procedure:

How is the Colostomy surgical procedure Performed?

• During the Colostomy surgical procedure, an incision is made in the abdomen
• Next the muscles, tissue, and the abdominal organs, are placed aside to locate and isolate the affected part of the colon or large intestine
• The affected colon is then divided from the rest of the large intestine after dividing and closing the major blood vessels that supply blood to the affected area. The divided portion is then removed along with the attached fatty tissue
• The healthy portion of the colon is checked for any signs of cancer or disease. It is then brought through a hole in the abdominal wall and connected to the skin with sutures
• A bag is attached around the colostomy and is used to collect the feces. The underlying tissue and incised skin are then closed in layers, with sutures

Where is the Procedure Performed?

A Colostomy surgical procedure is performed in a hospital. The individual is admitted, undergoes the procedure and discharged, as per the physician’s instruction.

Who Performs the Procedure?

A Colostomy procedure is performed either by a general surgeon or a colorectal surgeon, along with an anesthesiologist.

How long will the Procedure take?

The procedure may take anywhere between 2-4 hours, depending upon the pathology of the colon.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however, do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• Sometimes laxative is given on the previous day of surgery to clean the colon
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

• A physician will request your consent for the Colostomy procedure using an Informed Consent Form.
• Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
• You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Colostomy surgical procedure?

The individual has to undergo certain tests prior to a Colostomy procedure, such as:

• Routine blood and urine analysis
• Gastrointestinal x-rays
• Colonoscopy
• Ultrasound
• CT scan of the abdomen and pelvis
• The physician may suggest further tests depending on the health of the individual and their medical history. Do note that sometimes, only a few of the above mentioned tests, or all of the tests may have to be taken.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Colostomy procedure?
• Why is this procedure necessary? 
• What does the procedure involve?
• How will this procedure help?
• How soon should I get it done? Is there an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• Are there any lifestyle restrictions or modifications required, after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• How many such procedures have you (the physician) performed?
• What are the costs involved?

During the Colostomy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure, the individual is administered general anesthesia.

How much Blood will you lose, during the Procedure?

Colostomy is a complex and open surgery; there could be a considerable loss of blood involved, depending on the particular nature of the problem. It also varies from case to case.

What are the possible Risks and Complications during the Colostomy surgical procedure?

The possible risks or complications that may arise during the surgery are as follows:

• Excessive bleeding
• Infection
• Accidental injury to the neighboring tissue or bone
• Problems with colostomy
• Cardiopulmonary complications
• Accidental damage to the ureters
• Blood clot formation in the legs

What Post-Operative Care is needed at the Healthcare Facility after the Colostomy surgical procedure?

• After the surgical procedure, the patients will be sent to an area of the hospital, called the postoperative recovery area (PACU)
• The patient’s vital signs (blood pressure, heart rate, and respiration) are monitored for a short period of time, and is then transferred to the inpatient floor
• The duration of the hospital stay is dependent on various factors and is ultimately decided by the surgeon/physician

After the Colostomy surgical procedure:

What are the possible Risks and Complications after the Colostomy surgical procedure?

Post Colostomy surgical procedure, the following complications may arise:

• Infection in the surgical wound
• Bowel leakage inside the abdomen.
• Urinary tract infection
• Loss of blood supply to the stoma, after colostomy
•  Loss of voluntary control over bladder
• Bowel blockage
• Hernia around colostomy
• Adhesions leading to intestinal obstruction

What is the Prognosis after the Surgery?

• The recovery from the procedure is usually excellent
• However, it is dependent on the pathology of the colon, the reason for which the surgery was performed

When do you need to call your Physician?

Do contact your surgeon/physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling and redness
• Bleeding or drainage
• Constipation
• Fever
• Dizziness
• Muscle ache
• Nausea or vomiting
• Signs of infection
• If any new symptom or discomfort is observed

What Post-Operative Care is needed at Home after the Colostomy surgical procedure?

At home, the following post-operative care is recommended, post Colostomy procedure:

• Keep the wounds clean and dry
• Avoid eating foods that may irritate your stomach
• Consume liquid diet, per your physician advise
• Avoid any strenuous exercise
• Elevate your feet while resting
• Complete the course of medication, prescribed by your surgeon/physician
• Be aware and understand the kind of care that need to be taken post Colostomy

How long does it normally take to fully recover, from the Procedure?

It may take around 6 weeks to fully recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and is later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Colostomy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• The general surgeon or the colorectal surgeon
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)
• The patient is advised to inquire and confirm the type of billing, before the Colostomy procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA