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COMMON OSTOMY RELATED SURGERIES OF THE COLON & RECTUM

SURGICALPROCEDURE DESCRIPTION

TYPE OFSTOMA INDICATIONS

Abdominal perinealresection of therectum with end

descendingcolostomy (AKAAPR/Miles procedure)

Wide resection of the rectum,surrounding tissues and lymph nodesvia an abdominal and perineal

approach.Abdominal and perineal woundspresent

PermanentEnd descendingColostomy

Very lowrectal cancer

Low AnteriorResection (LAR)

Wide resection of the upper rectum;colon and distal rectum anastomosed

Usually no stoma Cancer in mid toupper rectum

Low Anterior

Resection (LAR) plusColonicJ-pouch

Wide resection of the upper rectum;

a colonic reservoir(J-pouch) is formed to anastomosedto rectum

Temporary loop

ileostomy x 3months to allowdistalanastomosis toheal

Cancer in mid to

upper rectum

LAR with Coloplasty Wide resection of the upper rectum.

Distal colon cut longitudinally thensewn transversely to expand capacity

May or may not

requiretemporary loopileostomy

Cancer in

low-mid to upperrectum

HartmannsProcedure

End stoma is created from proximalbowel; distal bowel is closed andremains in pelvis. Will have mucus

drainage from rectum

End colostomyPotential for re-anastomosis

Diverticulitis,obstruction,perforation

Colectomy Colon removed usually primaryanatomosis

Usually no stomaneeded

Crohns DiseaseColon cancerDiverticular

Subtotal Colectomy Most of colon removedusually primary anastomosis, but mayhave end ileostomy with subsequentrestorative procedure possible

Usually no stomaneeded

Crohns DiseaseColon cancerDiverticulardisease

Left Hemicolectomy Left colon resected usually primaryanastomosis

Usually no stomaneeded

Crohns DiseaseColon cancerDiverticulardisease

Right Hemicolectomy Right colon resectedusually primary anastomosis

Usually no stomaneeded

Crohns DiseaseColon cancerDiverticulardisease

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SURGICALPROCEDURE DESCRIPTION

TYPE OFSTOMA INDICATIONS

Ileoanal anastomosi Colon and rectum are removed.Ileum connected to anal canal

None NotrecommendedIntractablediarrhea

Rarelyconsidered in

MUC, FAP oratonic colon

Total protocolectomywith end ileostomy(AKA panproctocolectomy)

Colon, rectum and anus removed.Perineum closed

Permanent endileostomy

MUC, CrohnsDisease, FAP

Totalproctocolectomy withcontinent ileostomy

Colon, rectum and anus removed.Internal intestinal reservoir createdfrom distal ileum. Continence

achieved by intusseption of bowel inefferent limb

Flush endIleostomy; mustinsert catheter

into stoma todrain internalreservoir

MUC, FAP

Ileal pouchanal anastomisis(IPAA)

Usually done in 2 stages: MUC, FAP

A. Ileoanal reservoir(Totalproctocolectomywith ileal pouchanal anastomosis)(AKA Pelvic pouch,J-pouch, S-pouch)

Stage1Colon and most of rectum removed,pouch constructed from distal ileum;anastomosed to rectal stump;proximal loop ileostomy

Temporary loopileostomy(usually 3months)

Stage 2

Take down of loop ileostomy (stomaclosure)

(If patient unstable may be done in 3stages with a subtotal colectomy &end ileostomy first, followed byStages 1 & 2 as noted above)

No stoma,patient evacuatesper anus

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COMMON OSTOMY RELATED SURGERIES OF THE URINARY TRACT

SURGICAL

PROCEDURE DESCRIPTION

TYPE OF

STOMA INDICATIONS

Ileal conduit(AKA Bricker loop)

Bladder usually removed. A 6-8"segment of terminal ileum is isolated.Mesentary left intact. Uretersimplanted into ileal segment,proximal end closed; distal endbrought up as abdominal stoma

End or loop endileal conduit(ileal segmentacts as a conduitfor urine)

Bladder cancer,congenitalanomalies,neurogenicbladder, other

Jejunal conduit Same as above only segment of

jejunum is used

End or loop end

jejunal conduit

Used only if

ileum notavailable

Sigmoid conduit Same as above only segment ofsigmoid colon is used. Able to tunnelureters to prevent reflux

End or loop endsigmoid conduit.Larger stomathan with ileal orjejunal conduit

Used only ifileum notavailable

Continent urostomy:Ileal cecal reservoir(AKA Indiana Pouch)

Bladder usually removed; portion ofterminal ileum, cecum and right colonisolated and reservoir formed andureters implanted to prevent reflux.Continence achieved through ileo-cecal valve and plication of exit

conduit

End stoma;Stoma is verysmall and may bebrought throughto umbilicus.Must insert

catheter intostoma to drain

Same as for ilealconduit

Continent urostomy:Kock Pouch(Urinary K-pouch)

Bladder usually removed.Segment of terminal ileum is isolated.2 nipple valves fashioned - uretersimplanted into 1 to prevent reflux;the other valve brought to the

abdomen and stoma formed

End stomarequires insertionof catheter todrain thereservoir

Same as for ilealconduit

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OROTHOTOPIC URINARY DIVERSIONS

SURGICALPROCEDURE

DESCRIPTION TYPE OF STOMA

Studer Pouch Bladder removed; reservoirconstructed from isolated ilealsegment

Anti reflux achieved by passingureters through 15 - 20cm of

afferent ileum

No stomaContinence achievedwith external urethralsphincter

LeBag Bladder removed; reservoirconstructed from isolatedsegment of ileum and cecumUreters tunneled to prevent refluxneobladder sutured to urethra

No stomaContinence achievedwith external urethralsphincter