Colostomy Surgery in Ankara, Turkey

A colostomy is a procedure in which the large intestine is brought out through the abdominal wall via a stoma. This surgical method is performed to maintain continuity of the digestive system in conditions such as bowel obstruction, cancer, or injuries.

A colostomy can be temporary or permanent. Temporary colostomies allow the intestines time to heal, while permanent colostomies are preferred when bowel function cannot be maintained. This distinction determines the treatment plan.

A colostomy bag is a medical device that enables bowel contents to be expelled outside the body. Patients changing the bag regularly and following hygiene rules is an important factor that directly affects quality of life.

Psychological adaptation after a colostomy is also important. Patients may receive professional support for dietary habits, daily activities, and social life to adapt to new living conditions. Education and counseling are facilitating in this process.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Colostomy Surgery in Ankara, to get information about Colostomy Surgery prices, the process, and the hospital where Colostomy Surgery is performed.

Which diseases require colostomy surgery?

The need for a colostomy can arise from a very wide range of medical conditions, from an emergency injury to a planned cancer treatment. The main reason behind this decision determines both the type and the timing of the surgery.

We can list the conditions that require colostomy surgery under the following main headings:

Cancer diseases

Inflammatory and infection-related conditions

Traumas and injuries

Congenital anomalies

Other special situations

• Cancer Diseases

Colon cancers are among the most common reasons for creating a colostomy. In cancer treatment, a colostomy can be used for different purposes. For example, in emergency situations where the tumor obstructs the bowel, a colostomy may be created to decompress the bowel and prepare the patient for major cancer surgery. Sometimes, the cancer surgery itself requires a colostomy. Especially in rectal cancers located very close to the anus, it may be necessary to remove the anus together with the tumor tissue. In this case, a permanent colostomy is created to allow stool to be expelled from the body. Another purpose is to protect the ends of the bowel that are sutured together after the cancerous segment is removed. Especially to temporarily prevent stool from passing over high-risk suture lines and ensure safe healing of that area, a temporary colostomy is created.

• Inflammatory and Infection-Related Conditions

Severe inflammation or infection of the intestines may also require a colostomy. Diverticulitis, in which small pouches in the bowel wall become inflamed and rupture, can cause a life-threatening infection in the abdomen (peritonitis). In such emergencies, the inflamed bowel segment is usually removed, and a colostomy is created to avoid a risky anastomosis in an infected environment. Similarly, in perforations caused by inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis, or in severe infections affecting the anal region such as Fournier’s gangrene, a temporary colostomy may be a solution to keep the area clean and promote healing.

• Traumas and Injuries

In cases such as gunshot wounds, stab wounds, or severe traffic accidents, the colon may be damaged. In these injuries, it is vital to prevent stool leakage from the repaired bowel and the development of infection inside the abdomen. To eliminate this risk, especially if the patient’s condition is critical or intra-abdominal contamination is extensive, creating a protective colostomy may be preferred.

• Congenital Anomalies

Sometimes babies may be born with problems in the digestive system, and this may require a colostomy. One of the most common conditions is being born without an anal opening (anorectal malformation). In the newborn period, a colostomy is created so that the baby can pass stool and grow stronger for the definitive corrective surgery. In conditions such as Hirschsprung disease, where a segment of the bowel does not function due to the absence of nerve cells, a colostomy is created from the healthy part of the bowel to relieve the obstruction. In these cases, a colostomy serves as a bridge on the way to definitive treatment.

• Other Special Situations

In severe fecal incontinence cases that do not respond to any other treatment and completely end the patient’s social life, a permanent colostomy may be offered as an option to restore quality of life. In addition, in patients who previously received radiotherapy for cancer treatment, colostomy may be used to relieve symptoms in cases of rectal damage that appear years later, such as uncontrollable bleeding or pain.

What kind of preparation process is experienced before colostomy surgery?

A successful colostomy surgery is not a process that ends only in the operating room. Careful preoperative planning and preparing the patient both physically and psychologically directly affect long-term quality of life.

After the decision for surgery is made, the patient’s general health status is evaluated in detail. Heart, lung, kidney functions and nutritional status are reviewed. One of the most important steps in this process is comprehensive education of the patient and family. Since the idea of living with a stoma can be frightening at first, training provided by the surgeon and especially by a stoma care nurse specialized in this field is very valuable. During these consultations, issues such as why the surgery is necessary, whether the stoma will be temporary or permanent, and how postoperative care will be performed are discussed clearly.

Perhaps the most critical step in this preparation process is determining the stoma site before surgery. A stoma opened in the wrong location can cause lifelong leakage, skin wounds, and care difficulties. There are several golden rules when determining the ideal stoma site:

• It should pass through the abdominal muscle (rectus muscle)
• It should be easily visible to the patient
• It should be in a place the patient can reach comfortably
• It should be away from bony prominences
• It should not lie over skin folds
• It should be away from old surgical scars
• It should not coincide with the belt line

To determine this site, the abdomen is carefully examined while the patient is lying down, sitting, and standing. Because skin that is flat when lying down may end up under a fold when sitting. Although it is not always possible to perform this ideal planning in emergency surgeries, the surgeon still tries to choose the most appropriate site according to these principles during the operation. Today, modern approaches called “Enhanced Recovery After Surgery (ERAS)” aim to help patients overcome surgical stress more easily. These programs include avoiding prolonged fasting, effective pain control, and getting the patient mobilized and fed as soon as possible after surgery. In this way, patients recover faster and can start stoma care training earlier.

What are the types of colostomy and what are the differences between them?

Colostomies vary according to where they are created and the surgical technique used. Which type is chosen is determined by the surgeon depending on the reason for the surgery and whether the stoma will be permanent or temporary.

• Types of Colostomy According to Location in the Bowel

Where in the colon the stoma is created directly affects the consistency of the stool that comes into the bag.

Ascending Colon Colostomy: Created on the right side of the abdomen, and the stool is quite liquid.

Transverse Colon Colostomy: Located in the upper abdomen, and the stool is generally soft and mushy.

Descending Colon Colostomy: Located on the left side of the abdomen, and the stool is more solid.

Sigmoid Colostomy: The most common type, located in the lower left abdomen. The stool is solid and formed like normal stool.

• Types of Colostomy According to Surgical Technique

End Colostomy: In this technique, the bowel is completely divided and only the functioning end is sewn to the abdominal wall. The other end of the bowel is either completely removed or closed and left inside the abdomen. Permanent colostomies are generally created with this method.

Loop Colostomy: A loop of bowel is brought out through the abdomen, and an incision is made on its front surface while keeping the back wall intact. There are two openings side by side within a single stoma. They are usually created temporarily because they are easier to close.

• The Distinction Between Temporary and Permanent Colostomy

This is one of the most important distinctions for both the patient and the surgeon. A temporary colostomy is created with the intention of closing it later. Its purpose is to temporarily divert stool away from a suture line, inflammation, or injury in the lower parts of the bowel. After healing is complete, it is closed with a second surgery, usually within 3–12 months, and bowel continuity is restored.

A permanent colostomy is a stoma planned to remain for life. This most commonly occurs when the anus and rectum must be completely removed due to cancer. Permanent colostomy may also be necessary in cases where the anal sphincter muscles are irreversibly damaged or nonfunctional. Before surgery, whether the stoma will be temporary or permanent is discussed clearly with the patient. However, it should also be known that sometimes a stoma created temporarily may become permanent due to deterioration in the patient’s general health or progression of the underlying disease.

How is a colostomy surgery technically performed?

A colostomy surgery is a procedure that requires meticulous adherence to surgical principles. The operation can be performed with a traditional open approach or with minimally invasive (laparoscopic/robotic) approaches. In planned surgeries, minimally invasive techniques are often preferred due to advantages such as faster recovery and less pain. In emergency situations, open surgery may be more appropriate to provide rapid and full access to the abdomen.

The basic steps of the surgery are generally as follows:

• Entering the Abdomen: The surgeon enters the abdominal cavity using an open or minimally invasive approach.
• Preparing the Bowel: The segment of colon where the colostomy will be created is identified and carefully mobilized from surrounding tissues. If performed due to a disease (for example, cancer), the diseased segment is removed at this stage.
• Creating the Stoma Opening: At the pre-marked site, an opening is created by passing through all layers of the abdominal wall (skin, subcutaneous fat, fascial sheath, and muscle). The width of this opening is very important; it must be wide enough not to compromise blood flow to the bowel, yet tight enough not to allow herniation.
• Bringing the Bowel Out: The prepared end of the bowel is brought out through this opening. The most critical point of this step is ensuring that the bowel is absolutely not under tension. A tense bowel can compromise blood flow and lead to serious complications.
• Suturing the Stoma to the Skin: In the final stage, the end of the bowel brought out is carefully sutured to the skin edge with absorbable stitches. Keeping the stoma slightly elevated above the skin (about 1 cm) is ideal for the pouch to adhere to the skin without leakage.

What are the recovery process and possible problems after colostomy surgery?

The postoperative period is an important process in which the patient both recovers physically and learns to adapt to a new lifestyle. The support of a stoma care nurse is invaluable in this period. The patient and family receive hands-on training on pouch changing, skin care, and nutrition. The stoma usually starts functioning a few days after surgery. During this time, some issues may be encountered.

Early Problems (First 30 Days)

Some conditions that may be encountered in the first weeks after surgery are:

• Impaired blood supply to the stoma (ischemia)
• Separation of the stoma from the skin
• Skin irritation (dermatitis)
• Infection and abscess

The most urgent of these problems is impaired blood supply to the stoma. While a healthy stoma is pink-red, a stoma with impaired perfusion turns purple or black. This may require urgent intervention. Skin irritation is the most common problem and is usually caused by leakage from the pouch. With the selection and proper application of the right pouch system, this problem is largely resolved.

Late Problems (After 30 Days)

In the long term, some problems related to a colostomy may also develop.

• Parastomal hernia
• Prolapse of the stoma
• Retraction of the stoma
• Stomal stenosis

A parastomal hernia is a hernia that develops next to the stoma and is the most common late complication. It is usually managed with special support garments and is operated on only if it causes serious problems such as obstruction. Conditions such as prolapse or retraction may make it difficult to fit a pouch and may require surgical correction. Development of stenosis causes difficulty passing stool and may also need to be resolved with a surgical intervention. Most of these problems can be successfully managed with regular follow-up and the guidance of an experienced stoma care nurse.

When and how is a temporary colostomy closed?

Closing a temporarily created colostomy is a surgery that allows the patient to return to normal anatomy and improves quality of life. However, it is a second major surgery that carries risks and requires careful planning.

When deciding whether a patient is a suitable candidate for closure surgery, the following points are evaluated:

• The problem that required the first surgery has completely healed
• The patient’s general health condition is good
• Anal sphincter function is adequate
• Bowel integrity is intact

For closure surgery, it is usually necessary to wait at least 3–6 months after the first operation. This waiting period is needed for intra-abdominal adhesions and edema to decrease. Before surgery, tests such as a contrast study through the anus (contrast radiography) or endoscopy may be requested to ensure that the bowel line to be reconnected is healthy.

Closure of a loop colostomy is usually performed through the stoma site and is a simpler procedure. Closure of an end colostomy (Hartmann reversal) is more complex and is usually performed by entering through a new abdominal incision. It is normal for patients to experience an adaptation period after surgery. At first, complaints such as frequent bowel movements, gas, and mild leakage may occur. As the intestines adapt to the new situation, these symptoms gradually improve over months. It should not be forgotten that closure surgery also carries risks such as wound infection or leakage at the bowel anastomosis line, and therefore this operation must also be taken seriously.