Colorectal - Surgery which may result in Stoma

You are being given this leaflet because you are being listed for an operation which could mean you have a stoma. A stoma is when a piece of the bowel is brought through your abdominal wall, you wear a stoma bag over this to collect waste.

There are several different operations which can result in a stoma, these will all be explained in this leaflet, your nurse will highlight which of these operations you are going to be having done.

This leaflet will also explain what will happen next and what you can expect in the coming days/weeks/months.

Stoma Care Team - 0161 656 1554

Surgery Types

Anterior resection/left hemicolectomy

• Carried out to remove part of the left side of your large bowel
• Depending on your past medical history, the surgeon may be able to re-join the two ends of bowel. This join is known as ‘anastomosis’- in this case you will not have a stoma
• If the surgeon is not able to join the two pieces of bowel, they will give you a permanent stoma (colostomy) this would be on the left side of your abdomen (A)
• If the surgeon can join the two pieces of bowel, but wants to give the join a rest, they may give you a stoma (ileostomy) on the right side of your abdomen (B). This could possibly be reversed at a later date- depending on recovery and other factors
• The stoma nurse will mark both sides of your abdomen prior to your surgery, as it is not usually known what the outcome will be, until the surgeon is operating

Defunctioning colostomy 

• This is usually performed prior to radiotherapy or chemotherapy for a rectal or low bowel cancer. The aim is to act as a diversion so that your stool no longer passes through the back passage - as having therapy can cause symptoms such as incontinence, pain and urgency. The defunctioning colostomy helps to avoid these symptoms
• A stoma nurse will site you on your left side for a colostomy
• This can also be performed as a palliative treatment to avoid bowel obstruction when no further treatment is going to take place

Defunctioning Ileostomy 

• This is usually performed prior to radiotherapy or chemotherapy for a colon cancer. The aim is to act as a diversion so that your stool no longer passes through the large bowel- as having treatment can cause symptoms such as incontinence, pain and urgency. The defunctioning ileostomy helps to avoid these symptoms
• A stoma nurse will site you on your right side for an ileostomy
• This can also be performed as a palliative treatment to avoid bowel obstruction when no further treatment is going to take place

Abdominal Perineal Resection (APR/APER)

• Carried out to remove some of your bowel, rectum and anus, for low rectal cancers
• This surgery always results in a permanent stoma (colostomy) (A) and your back passage is closed using stitches
• A stoma nurse will site you on your left side for a colostomy

Pan proctocolectomy 

• Carried out to remove your whole large bowel, rectum and anus
• This surgery always results in permanent stoma (ileostomy) (A) and your back passage is closed using stitches
• A stoma nurse will site you on your right side for an ileostomy

Subtotal colectomy 

• Carried out to remove most of the large bowel, leaving your rectum in situ
• Sometimes the two ends of bowel can be joined back together. If this is the case, there would not be any need for a stoma
• Sometimes you would have a stoma on your right side (ileostomy)
• A stoma nurse will site you on your right side for an ileostomy

Right hemicolectomy 

• Carried out to remove part of the right side of your large bowel
• The surgeon will usually be able to join the two ends of the bowel back together. This join is known as ‘anastomosis’ - in this case you would not have a stoma
• Sometimes, depending on your past medical history, the surgeons may not be able to join the two pieces of bowel, and this would result in you having a stoma on your right side (ileostomy) (A)
• The stoma nurse may mark the right side of your abdomen prior to this surgery, if your surgeon thinks the stoma could be a possibility

What to expect in the coming day/weeks/months

• After this appointment, you will be listed for the appropriate surgery - meaning you are put on the waiting list. As soon as a date for your surgery becomes available you will be informed
• Prior to your surgery, you will be seen in the preoperative (pre- op) department at Oldham Hospital
• Your colorectal nurse specialist will refer you, with your consent, to a community stoma nurse
• They will contact you by phone and arrange to see you either in your home or in their clinic
• They will provide you with some pre-operative counselling (information about stomas, dietary advice, living with a stoma etc)
• They will also give you some products which you can practice with in the run up to your surgery
• On the morning of your surgery, you will be sited by a stoma nurse in the admission ward. This means marking your abdomen in the best position for the stoma. They will also be able to answer any questions you may have
• Whilst you are in hospital, the stoma nurses will teach you how to manage your stoma and prepare you for discharge before you go home