Fecal diversion refers to the creation of an ileostomy or colostomy. An ileostomy is an opening between the surface of the skin and the small intestine, while a colostomy is an opening between the surface of the skin and the colon. This opening is called a stoma. Fecal diversion is used to treat:
Complex rectal or anal problems (especially infections)
Poor control of the bowels (incontinence)
The stoma can measure from 1 to 1 1/2 inches around. Unlike your anus, the stoma has no sphincter muscle (the muscles that control bowel movements), so most people cannot control the exit of waste. You will need to wear a pouch (ostomy collecting device) at all times to collect the waste flow.
In general, rectal carcinoids smaller than 1 cm can be safely removed by endoscopic excision. Excised specimens should be examined histologically to exclude muscularis invasion.[2,3,4,5]
Tumors measuring 1 cm to 2 cm should be investigated by transanal endosonography or magnetic resonance imaging. Absence of muscularis invasion or regional metastases may justify local excision. The outcome from treating a lesion between 1 cm and 2 cm is unclear. The metastatic risk is between 10% and 15%....
Stomas can be permanent or temporary. A temporary stoma may be made when a diseased section of bowel is removed, rejoined, and needs time to heal. Once the reconnection site (anastomosis) has healed, the stoma can be removed. If the anus and rectum have been removed, the stoma must be permanent.
What Happens During Fecal Diversion Surgery?
The term "laparoscopic" refers to a type of surgery called laparoscopy. Laparoscopy allows the surgeon to perform the procedure through very small, "keyhole" incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is placed through an incision near the bellybutton. Images taken by the laparoscope will be projected onto video monitors placed near the operating table.
A laparoscopic fecal diversion requires only a few incisions. The first incision will be made at the intended site of the stoma. A second incision will be made opposite this area and will be used to place the laparoscope. In some cases, additional incisions will be made so that more of the large intestine can be reached.
How Is the Stoma Made?
There are two main types of stomas: the end stoma and the loop stoma.
An end stoma can be made in the ileum (end of the small intestine, called "end ileostomy") or colon ("end colostomy"). First, a small disk of skin will be removed from the stoma site. Next, your surgeon will bring 1-2 inches of healthy bowel up through the abdominal wall to skin level. If you are having a colostomy, the end of the intestine will be stitched to your skin. If you are having an ileostomy, the small intestine will be stitched to your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed.
A loop stoma can be made in the ileum ("loop ileostomy") or colon ("loop colostomy"). A loop stoma often is made when the stoma will be temporary. However, not all loop stomas are temporary.
To make the loop stoma, a small loop of intestine will be brought up through the abdominal wall to skin level. A plastic rod will be passed underneath the loop to keep the new stoma in place. The loop will be cut half way through to make the site for the bowel opening. Each open end of the bowel created by this cut will appear as two openings in the stoma. If you are having a loop colostomy, the end of the intestine will be stitched to your skin. If you are having a loop ileostomy, the loop will be turned back on itself like a small cuff and then stitched just below your skin. The abdominal cavity will be carefully inspected and the incisions will be stitched closed. The rod will be removed several days after surgery.