When medical therapy fails to adequately improve a problem related to one of a number of digestive conditions, a physician might recommend an ileostomy. In this procedure, a surgeon diverts the bottom part of the small intestine – known as the ileum – through an opening created in the patient’s abdomen. This opening is called a stoma.
According to BCIRhistory.com, the first use of this type of surgery was in 1913. Modern ileostomies have as their parent the Brooke procedure, introduced in 1952. Today, patients have three basic surgical options when it’s necessary to eliminate waste after removing both the colon and the rectum:
Traditional Brooke procedure. The American Cancer Society reports that this surgery is often the result of conditions such as ulcerative colitis, Crohn’s disease, familial polyposis, and issues linked to cancer. Among ileostomies, it’s the procedure most often used. After the surgeon pulls the ileum through the abdominal wall, the tissue is turned inside-out and sutured to the patient’s skin to form a stoma. Placement of the stoma is usually in the lower right portion of the abdomen on a surface of flat and smooth skin. A pouch collects output. Patients’ primary management issues are emptying the pouch and protecting their skin.
Ileoanal J-pouch. The surgeon creates a pouch from the ileum and the rectum, puts it inside the pelvis and connects it to the anus. In order to avoid leakage, the patient’s sphincter muscle needs to be intact. Often this procedure requires more than one surgery to complete. Potential problems include managing the output by controlling the diet and/or using medication and protecting the skin surrounding the anus.
Barnett Continent Intestinal Reservoir (BCIR). This procedure followed wide use of the Kock (or Koch) pouch, which was a popular continent surgery. The surgeon creates a reservoir using the individual’s small intestine plus a nipple valve. This valve is connected to a stoma placed on the lower portion of the abdominal wall. Also created from intestinal tissue, it is self-sealing, which prevents output from exiting the stoma until the patient empties it several times a day in a restroom with a tube that drains into a commode. Patients wear a small covering over the flat stoma for mucous absorption. Unlike the Kock Pouch, the BCIR features a collar made from the intestine to help prevent valve slippage. The pouch configuration also has a different design to help avoid problems that can arise between the skin and intestinal tissue.
After a consultation, an experienced surgeon will recommend the best option for a potential ileostomy patient. The continuing development of improved techniques means that many patients are opting to inquire about reversal of older, more inconvenient ileostomies.