Intestinal Stomas are surgically constructed opening of part of
intestine on the anterior abdominal wall aiming at decompression or
diversion of normal intestinal passage due to wide range of diseases .
Intestinal stomas can be classified into; temporary stomas to
protect a distal anastomosis or a pouch, defunction distal diseased or
injured bowel, relief an obstruction and protect anal operations e.g
anal fistulas or sphincter repair while Permanent stomas are created
after resection of bowel for benign disease, e.g proctocolectomy for
Crohn’s disease, after resection of bowel for pre-malignant disease, e.g
Familial adenomtous polyposis, after resection of bowel for malignant
disease.
A decompressing stoma does not necessarily provide diversion of
feces. These stomas are constructed most often for distal obstructing
lesions causing massive dilation of the proximal colon without ischemic
necrosis, severe sigmoid diverticulitis with phlegmon, and for select
patients with toxic megacolon, while diverting stoma is constructed to
provide diversion of intestinal content. It is performed when the distal
segment of bowel has been completely resected because of known or
suspected perforation or obstruction of the distal bowel or because of
destruction or infection of the distal colon, rectum, or anus.
Continent perineal colostomy after APR can be constructed using
many techniques including; Graciloplasty (single or double),Electrostimulated
(dynamic) graciloplasty, Gluteoplasty with pudendal nerve
anastomosis, Smooth muscle wrap, Artificial neosphincter implantation
or Lazaro di Silva technique. |
