Colostomy - How a colostomy is performed

There are several different ways a colostomy can be formed. The specific technique used will depend on your circumstances.

The two main surgical techniques are:

• open surgery (laparotomy), where the surgeon makes an incision in the abdomen to access the colon
• laparoscopic (or keyhole) surgery, where the surgeon makes several smaller incisions and uses a miniature video camera and special surgical instruments to access the colon

Where possible, keyhole surgery is the preferred choice. This is because research has shown that patients recover quicker and have a reduced risk of complications.

However, in emergency situations, such as a bowel obstruction, the staff and equipment needed for a keyhole operation may not be available, so an open operation will need to be performed.

All colostomy formation procedures are carried out under general anaesthetic, which means you are asleep during surgery.

Types of colostomy

There are two main ways a colostomy can be formed, called a loop colostomy and an end colostomy. These are described below.

Loop colostomy

To form a loop colostomy, a loop of colon is pulled out through an incision in your abdomen. This section of colon is then opened up and stitched to the skin to form an opening called a stoma. The stoma will have two openings, but they will be close together and you may not be able to see both.

One of the openings is connected to the functioning part of your bowel. This is where waste products will leave your body after the operation. The other opening is connected to the "inactive" part of your bowel that leads to your rectum. This opening only produces small amounts of mucus.

The position of the stoma will depend on which section of the colon is diverted, although it is usually on the left-hand side of your abdomen, below your belt line. You will meet a specialist stoma nurse before the operation to discuss possible locations for the stoma.

The stoma will appear large at first as the effects of surgery cause it to swell. It usually shrinks during the weeks after surgery, reaching its final size after about eight weeks. The stoma will be red and moist. It has no nerve endings so it isn't painful to touch. It may bleed when touched, but this is entirely normal and no cause for concern.

In some cases, a support device (called a rod or bridge) may be used to hold the loop of colon in place while it heals. This will usually be removed after a few days.

A loop colostomy is usually formed temporarily to treat conditions such as diverticulitis, Crohn’s disease and bowel cancer.

End colostomy

To form an end colostomy, one end of the colon is pulled out through an incision into your abdomen and stitched to the skin to create a stoma.

Like when a loop colostomy is formed, the position of the stoma will depend on which section of the colon is diverted. However, it is usually on the left-hand side of your abdomen, below your belt line. You can discuss possible stoma sites with a stoma nurse before the operation.

The stoma will have one opening, which waste products will pass through. The other end of the colon which goes down to your rectum is sealed and left inside your abdomen.

End colostomies are often permanent, although temporary end colostomies are sometimes formed as an emergency to treat bowel obstructions, colon injuries or bowel cancer.

Read more about recovering from a colostomy.