How to Prepare Yourself for Ileostomy Surgery

Any surgery is going to bring a certain amount of fear and anxiety. Ileostomy surgery is no different when it comes to causing uncertainty, but in many cases, an ileostomy is a life-saving surgery that can increase a person's quality of life.

Broadly put, ileostomy surgery is an opening in the belly, or abdominal wall, that's usually needed when the ileum, which is part of the small intestine, isn't working properly. The end of the ileum exits through the abdominal wall so that fecal matter is diverted away from the anus. All or part of the colon (large intestine) may be removed as part of the surgery.

There are several variations on the different forms ileostomy surgery can take, which are explained below. An ileostomy might be done for several reasons, including Crohn's disease, ulcerative colitis, familial polyposis, or colon cancer. In some cases, the ileostomy might be reversed during subsequent surgery.

What's an Ostomy?

An ostomy is when surgery is used to create an opening from an organ to the outside of the body. In most cases, this is done in order to provide an alternate way for the body to dispose of waste material (urine and stool). This includes colostomy, ileostomy, and urostomy surgeries. Sometimes, an ileostomy might also be referred to as a small bowel diversion.

During ileostomy surgery, the large intestine is usually removed. In some cases, the rectum (last part of the large intestine) and the anus are left inside the body, but in other cases, they may also be removed. With the colon (and possibly the anus and/or rectum) gone, another way must be devised for stool to exit the body. In an ileostomy, part of the small intestine (the ileum) is brought through the abdominal wall to the outside of the body.

In certain other cases, the ileostomy might be done with all or part of the colon is left intact. In most cases, this would be for a temporary reason, such as damage or disease to the colon.

In order to connect the ileum to the outside of the body, an opening, or stoma (the Greek word for "mouth"), must be made in the abdominal wall. That small section of the ileum is brought through the abdomen and it is where stool will leave the body.

Types 

All ileostomies are not created equally; there are different types of ileostomies used for the treatment of specific diseases or conditions.

Standard or Brooke Ileostomy. This is the type of ileostomy that is most often done, especially in cases of ulcerative colitis, Crohn's disease, familial polyposis, and cancer. It was originally named after the English surgeon, Bryan Nicholas Brooke, who developed some techniques that are still being used in ileostomy surgery today. In a Brooke ileostomy, the stoma is created by turning part of the ileum back over itself, similar to folding back the cuff of a sweater and suturing it to the abdomen. Waste is usually of a liquid or paste-like consistency and is collected in an ostomy appliance attached to the abdomen over the stoma.

Continent ileostomy (Kock or k-pouch). A continent ileostomy has several differences from a Brooke ileostomy, but the biggest one is that patients with a continent ileostomy do not wear an ostomy appliance. Instead, a reservoir and a valve are created from the ileum. This valve is inside the abdominal wall (instead of a stoma, which is outside). To drain waste, a small tube — a catheter — is inserted into the abdomen to drain out waste. A cap is worn over the valve until it is time to empty the reservoir. A continent ileostomy might be done in cases of ulcerative colitis, familial polyposis, and cancer.

Pelvic pouch surgery (j-pouch). Included here because an ileostomy is one step of the process, but when complete, this surgery actually requires neither an external appliance nor a catheter to catch or remove waste. In this type of surgery, a reservoir is made from the terminal ileum. Often this reservoir is made in the shape of a "j", but also may be made in the shape of an "s" or a "w." Part or all of the rectum and the anus are preserved in this type of surgery. Pelvic pouch surgery is often done in 2 or 3 steps, with a Brooke ileostomy being the first step. The ileostomy is then later reversed, and the internal reservoir is attached to the rectum or anus, and stool can then leave the body without the use of an external appliance.

Caring for an Ostomy

With the stoma in place, an ostomy appliance will be needed to collect stool as it leaves the body through the stoma. An enterostomal therapy (ET) nurse is the healthcare provider that helps ostomy patients care for their stoma. Patients with a new ileostomy will be instructed on how to change an ostomy appliance. The flange of an ostomy appliance needs to properly adhere to the abdomen in order to protect the skin around the stoma from coming into contact with stool. In some cases, regular contact with stool can cause the skin around the stoma (peristomal skin) to become damaged or to break down.

There is an assortment of ostomy appliances available from a variety of ostomy supply companies. They range from open-ended pouches that might be used on a daily basis, to small, one-use pouches that might be used for a special occasion or for swimming. Some patients might try several different types of appliances before settling on the ones that work best.

What to Expect From Ileostomy Surgery

Getting an ileostomy is major surgery and the hospital stay will be anywhere from several days to a week. The recovery period could be up to six weeks, depending on several different factors including the type of ileostomy surgery and your health before admission.

Meeting With the ET Nurse

In the days before surgery, you and your healthcare team will take care of several different tasks related to your arrival at the hospital for surgery. You will meet with an ET nurse, who will discuss a few different topics with you. The first topic will be the location of your stoma. This is an important consideration in ostomy surgery and requires the understanding of everyone on the healthcare team. Your ET nurse will take your lifestyle, typical clothing, how you wear your clothes and your preferences into consideration for stoma placement.

Next, you will talk about how you will care for your ileostomy after the surgery. For a standard ileostomy, you will get recommendations on the types of ostomy appliances that might work best for you. Your ET nurse may provide you will sample from several different companies, as well as information on where to obtain more when necessary. For a continent ostomy, you will talk about how to empty the reservoir, as well as how often it should be done, and how to care for the valve.

Your Hospital and Your Surgeon

You can expect to undergo some testing before you are admitted for surgery. A few tests that might be done include blood tests and chest x-rays. Your colorectal surgeon and/or your gastroenterologist will go over your current medications with you and determine if any changes need to be made before surgery.

You will also find out from your surgeon how you will prepare your colon for surgery. You will likely need to prepare as though you were going to have a colonoscopy. The prep might be done in one of several different ways, but the goal is to clear your colon of all stool. You may also be given other medications to take in the days before surgery, such as antibiotics.

The Surgery

The day of surgery you will be admitted to the hospital and started on IV fluids. Your surgery will last several hours. When you awaken in recovery, you will find that you have a stoma or a valve on your abdomen, with an appliance over it. You may have surgical drains and a nasogastric (NG) tube in place. There may be other medical equipment that will aid you in your pain management and recoveries, such as a morphine drip or pneumatic compression cuffs on your legs.

The Hospital Stay

Your surgeon will closely monitor your condition while you are hospitalized. Before you are able to eat or drink, your medical team will listen to your abdomen for bowel sounds. If you are recovering as expected, you may graduate to a liquid diet in a few days, and then be given more solid food slowly, in stages. Your nurses will likely get you out of bed and walking as soon as possible because moving is important to get your body on the road to recovery.

Your Recovery at Home

Once you are released from the hospital, you will continue your recovery at home. You may receive a visit or two from a visiting nurse or a hospital volunteer in the days immediately following your discharge. You will have scheduled appointments with your surgeon so that your surgical site and your recovery can be assessed. You might also have an appointment with your ET nurse, either at the hospital or at home, to help you through your first ostomy appliance change.

Getting back to regular activity will take several weeks, and your surgeon should give you clearance at regular intervals for resuming activities such as household chores, exercise, sex, and going back to work. Your diet may be restricted in the first weeks at home, possibly with a restricted fiber diet or other diet plans as outlined by your surgeon.

If your ileostomy is temporary and going to be reversed, you will discuss scheduling a second surgery with your medical team.