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Stoma: temporarily or forever?

May 25, 2020

After removal of the rectal tumor, patients often receive a stoma, which scares them more than the surgery itself.

Let's try to figure out what it is and in what cases one cannot do without a stoma.

What is a stoma?

A stoma is a hole created surgically on the anterior abdominal wall after removal of the intestine or part thereof, designed to divert the contents of the intestine. The specific location of the stoma is determined by the surgeon, taking into account the clinical situation and the anatomical features of the patient.

The stoma does not have a closure device, so a person does not feel the urge and cannot control the emptying process. The stoma is devoid of nerve endings, so pain is not felt. The resulting pain, burning or itching may be associated with irritation of the skin around the stoma or with increased intestinal motility (work).

Permanent or temporary?

Permanent stoma is excreted in patients whose tumor location does not allow the anus to be preserved. In this situation, a surgery is performed to remove the sphincter apparatus along with the tumor and a constant stoma is pulled out.

If the anus is preserved, then intestinal continuity can be restored by connecting the ends of the remaining parts of the intestine. The junction is called anastomosis, its healing is the most problematic part of such surgery. Leakage at the junction and ingestion of feces into the abdomen can cause fecal peritonitis and serious complications, including death.

Patients with a high risk of such a leak receive a temporary protective (protective) stoma to prevent the passage of feces through the anastomotic zone and ensure functional rest at the time of healing. Typically, such a stoma is excreted for 6 weeks. If, according to the results of proctoscopy, complete healing has occurred, a small 15-minute surgery is performed, and the temporary stoma closes. If the healing is incomplete, there are problem areas, then the recovery surgery is carried out in a few weeks.

Note! If the patient receives chemotherapy after surgery, then stoma closure is not performed due to chemotherapy, since healing during this period is poor. But sooner or later all protective stomas are closed.

Who should receive a temporary stoma?

The closer the anastomosis is to the anal area, the higher the risk of leakage in the postoperative period. For example, if the anastomosis is at a distance of 5 cm or closer to the anus, then the risk of leakage exceeds 10-15%. If the patient has diabetes, atherosclerosis, old age or other features, then the risk increases even more.

If the tumor size exceeds T2, then such patients require preoperative exposure to this area. Irradiation improves the results of cancer treatment, but worsens healing issues and increases the risk of leakage.

All such patients have a protective stoma, which allows them to save their lives in the postoperative period and to avoid life-threatening complications.

If the patient is young, his anus is preserved, the size of the tumor does not exceed T1-T2, there will be no radiation, then intestinal integrity can be restored without the formation of a protective stoma. But if the disease is more advanced, radiation is planned, the patient smokes or there are other disorders of the blood supply, then in such a situation it is better to perform the surgery in two stages.

Surgeries in LISOD

Surgeries to remove intestinal tumors, even the most complex ones, are performed laparoscopically at the LISOD Hospital of Israeli Oncology. This method helps to avoid scars, pain, many postoperative complications.

Previously, most patients after bowel surgery were forced to live with a stoma for the rest of their lives. But today, everything has changed. The latest technologies, laparoscopic surgery, and equipment for applying stapler anastomoses allow patients to provide a good quality of life. Surgeries to restore intestinal integrity in LISOD are carried out constantly, a lot of experience in their implementation has been accumulated. Our oncologist, surgeon, deputy chief medical officer for surgical work, Sergei Baido, is known all over the world. It is he who carries out such surgeries with jewelry accuracy, returning patients to a normal life.

Have a question? Call the LISOD Contact Center:

0-800-500-110 — free of charge from landline phones in Ukraine;

+38 (044) 277-8-277 — daily from 09:00 to 20:00.

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