Stoma formation

Stoma formation can be performed as part of a more major procedure such as bowel surgery or as a single procedure. It is usually performed to protect a surgical joint (anastomosis) further downstream in the bowel or to divert intestinal contents from a blockage downstream. When undertaken as a single operation is usually performed laparoscopically (keyhole). This is a minimally invasive procedure requiring a general anaesthetic. The operation takes place through small incisions on your abdomen, 0.5-1cm typical size, through which gas is inflated in order to create space and make internal organs easy to see. A tiny camera (laparoscope) is then inserted into the abdomen guiding the insertion of further specialised laparoscopic instruments which are used to identify the loop of bowel which will be used to form the stoma. An opening is created in the abdominal wall through which a part of the bowel is opened and attached so that bowel waste can empty into a bag securely attached around the opening.

Benefits of laparoscopic stoma formation

The benefits of a laparoscopic procedure compared to an open procedure are:

• have less discomfort following the procedure and return back to normal activities much faster
• reduced risk of bleeding and wound infections,
• less scarring inside the abdomen with the subsequent risk of bowel obstruction,
• smaller abdominal scars offer a better cosmetic result with a smaller risk of developing a hernia at the scar site

Before the procedure

Sometimes you may need to follow a special diet and use some strong laxatives to empty your bowel 24 hours prior to your procedure. On other occasions an enema may be given approximately 1 hour prior to your procedure. You will be advised whether any special bowel preparation is needed at the clinic.

Recovery

The operation normally takes 30-60min. After the procedure you will wake up in a hospital room. The usual stay in hospital after this procedure is 3-5 days but sometimes this may be longer. You are typically expected to go home once you are eating and drinking, are able to manage the pain and walk unaided, have passed some urine and are able to manage your stoma without any help. It normally takes about two weeks to fully recover from a laparoscopic stoma formation but it varies from person to person. You should avoid any heavy object lifting or strenuous exercise for at least 6 weeks to reduce the risk of developing a hernia.

Risks of the operation

A laparoscopic stoma formation is a reasonably safe procedure. Risks include complications common to all surgical procedures such as infection, bleeding, blood clots, heart problems, pneumonia, urinary retention, risk of injury to organs inside the abdomen and anaesthetic risks. Complications specific to this operation include an initial risk of bowel twisting and risk of developing a hernia around the stoma, or stoma related complications such as narrowing, retraction and prolapse. Open stoma formation requires the use of general anaesthesia. A skin incision is made in the middle of the abdomen or over the loop of bowel which is to be brought out. An opening is created in the abdominal wall through which a part of the bowel is opened and attached so that bowel waste can empty into a bag securely attached around the opening. Recovery after an open stoma formation is slower and may take a number of weeks before you can return back to normal activities.