Ileostomies both save and change patients’ lives.  Over the last two decades, doctors have developed a number of procedures to accomplish the work of an ileostomy.  Understanding the ileostomy alternatives currently available can help reduce the stress associated with major surgery.

What an Ileostomy Does

Patients who require removal of their colon (large intestine) via a colectomy and those whose rectums must also be removed in a proctocolectomy need an alternative for waste to exit the body.  The procedure known as a traditional or Brooke ileostomy came about in the 1950s, according to BCIRhistory.com.

Some patients today still undergo this kind of surgery, either on a temporary or a permanent basis.  According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the main reasons it might be necessary include:

• Inflammatory bowel diseases like ulcerative colitis and Crohn’s disease
• Bowel cancer in the large intestine or rectum
• Bowel obstructions that completely block the large intestine
• Familial adenomatous polyposis
• Bowel injuries such as punctures
• Diverticulitis

Surgeons perform an ileostomy by forming a new path for waste to exit.  They create an opening in the abdomen called a stoma, then direct the end of the small intestine through it.  Waste exits the body and collects in a removable bag the patient empties periodically.

Surgical Options

Surgeons recommend an ileostomy, or an alternative procedure based on whether the patient requires removal of both the colon and the rectum and whether the surgery is intended to be temporary or permanent.

NIDDK indicates that these are the current options:

• The Brooke ileostomy still requires patients to wear a bag, or appliance attached to them and to empty it at specified intervals.  Many individuals who had this surgery years ago are now opting for revision surgery for convenience.  Today, surgeons most often recommend the procedure for individuals with rectal cancer or Crohn’s disease.  For a Crohn’s patient who requires removal of the colon, this is the only surgical option, the Crohn’s & Colitis Foundation of America reports.  This is due to the high risk these individuals face as far as developing strictures, abscesses, and fistulas and to the tendency of the disorder to flare periodically.

• Internal pouch surgery is also called the J-pouch procedure.  It does not require a stoma.  The surgeon creates an internal reservoir in which waste collects.  The procedure connects the end of the small bowel to the anus.  Doctors most often recommend this surgery for patients with ulcerative colitis or familial adenomatous polyposis.

• Continent ileostomies include an internal pouch with a valve, enabling patients to drain them each day using a catheter through the stoma.  The Kock pouch was one version used extensively.  The most recent improvement, known as the Barnett Continent Intestinal Reservoir, features an improved design created to give patients more control and convenience, according to BCIRhistory.com.