Recent advances in stapling technique have enabled surgeons to reduce the incidence of permanent stoma.

A low colorectal anastomosis in areas that are otherwise accessible only with great difficulty is possible. In the Department of Colorectal Surgery, SGH, we are creating more temporary ileostomy instead of permanent colostomy.

For tumour as low as 3 cm from the anal verge, we can perform an ultra-low anterior resection with a colo-anal anastomosis with a protective temporary defunctioning ileostomy. Patients who required an abdominal perinal resection (AP resection) or a Hartmann’s Procedure will still require a permanent end colostomy.

A transverse or sigmoid colon loop colostomy is usually done for palliative reasons (for example, to relieve any distal obstruction), or for patients who are undergoing neo-adjuvant chemo-radiotherapy.

Loop colostomy usually has a supporting stoma rod in the first postoperative week to prevent retraction while awaiting the formation of peristomal adhesions that will support the loop of bowel. The rod can be removed from 5 th to 10 th post operative day onwards.

Care of the Colostomy includes skin care, dietary control, medication for diarrhea or constipation, with an aim in rehabilitation towards the patient’s normal life routine.

Colostomy patients will experience less skin problems compared to the ileostomy patients. This is because the colostomy faecal effluent is less acidic since most of the water content is absorbed in the large intestine. They will still need to put on a wafer and change it on a weekly basis to protect the skin. The patient can have a choice of a one-piece or two-piece system with drainable or disposable pouches.

Management of food consumption can have a significant impact in the patient with a colostomy. Food that causes odour or flatus are best avoided. The table below illustrates examples of foods that produce odour and gas, and the type of food that can counter the effect.

Foods that may cause wind: green beans, baked beans onion, garlic sweet corn, peas apricot, bananas cabbage family vegetable, spinach cucumbers mushrooms eggs, dairy product beer, carbonated beverages

Food that can produce odour: eggs cheese some spices fish asparagus onion cabbage family vegetable

Tips to avoid wind: charcoal tablet to be chewed peppermint oil in hot water to drink peppermint tea parsely yoghurt drink

Before surgery, the “colostomate” patient at times will still experience constipation and diarrhea. Increasing fluid and fibre intake will prevent constipation. Drinking up to eight glasses of water and fruit juices per day is recommended. Fresh fruits and vegetables in the diet as well as fibrous food like whole-grain breads and cereals should be included in the daily diet.

Viruses, medications and intolerance to certain foods can cause diarrhoea. Fibre and bulk should be avoided to reduce diarrhoea. Eating foods that will thicken the stool - such as white rice, bananas, yoghurt, pasta and bread - is an alternative. Continual diarrhoea can cause dehydration, and thus drinking more water is essential.

Rehabilitating patients back to their daily routine requires a period of time to adapt to their new stoma. Usually, during the one-month of home recuperation, patients are encouraged to experiment with different types of foods that will give them different outcomes. Almost all-acute care hospitals have their own stoma support group besides the main programme offered at the Singapore Cancer Society. Ostomates can meet and share their experiences with new patients during the meeting.

It is useful to keep in mind the long-term complications, which may arise from the colostomy. These include retraction, prolapsed and parastomal hernias.

By Ong Choo Eng
Nurse Clinician / Stoma
Dept of Colorectal Surgery
SGH