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Colostomy Surgery Complications.Modern colostomy surgery, with all the marvelous progress of the last twenty years, still occasionally produces some unfortunate results in a small number of patients. The most frequent complication to arise in colon surgery is infection. This is understandable because intestinal surgery carries the potential of contamination of the area of operation with bacteria from the colon. There is also the ever-present hazard of infection from the air, skin, and other sources of bacteria. For this reason thorough preparation of the bowel along with administration of antibiotics before, during, and after surgery are important to prevent infection. Postoperative infections, when they occur, can cause serious problems, but most often they only delay discharge from the hospital and healing of the site of the operation until the antibiotics can eradicate the bacteria. Other kinds of complications are relatively unusual and include such problems as an opening of a presumably healed incision, slow closure of the wound (most often this occurs in incisions made in the perineal area), and slow recovery from the surgery.
In some instances the surgeon will discover that the cancer has spread so extensively that it cannot be totally removed. In these cases the surgeon removes as much as possible to prevent blockage of the colon. Anticancer drugs and radiation may then be administered postoperatively to arrest or slow tumor growth. Still, these complications are exceptions; colon surgery is a safe and successful procedure for the vast majority of patients.
COLOSTOMY CARE
The colostomy, when needed, is ordinarily constructed in the lower left area of the abdominal wall; occasionally it is constructed within the main incision. Ordinarily the colostomy is constructed at the time of the cancer operation in the manner in which it will remain provided, of course, that a permanent one is needed. It appears as a small, reddish, round opening of healthy-looking mucosal tissue the type of tissue that lines the mouth and throat, for example on the abdominal wall. A plastic bag called a colostomy pouch
is placed over the opening, and within a few days after the operation, as the bowel recovers its normal function, intestinal secretions will begin to exit from the opening, which is called a stoma.
Several days after the operation, when the patient is beginning to move around and walk, the surgeon and nursing staff will start teaching the patient how to manage the colostomy. During the next few days in the hospital, the patient will be helped to achieve independence. In many instances the help of a specialized stomal therapist will be valuable. These therapists are well-trained nurses who provide advice on techniques of irrigation or cleansing of the stoma. A number of modern plastic devices have been developed that greatly simplify care and help the patient achieve confidence and security in living with a colostomy. Thousands of active people from all walks of life have colostomies and engage in a full range of professional, social, sexual, and athletic activities without awkwardness, embarrassment, or accident.
As a rule, patients in the United States are taught to irrigate their colostomy. Daily irrigation is not always necessary or desirable, but on the whole, most patients feel more satisfied when they are able to irrigate the colostomy each morning or every other morning and then wear a patch over the colostomy until the next irrigation.
The time each patient requires to adjust to a colostomy varies. If the patient has had regular bowel movements in the past, this pattern will continue after a colostomy. With a set routine of irrigation, the daily bowel movement will, in effect, be eliminated by the irrigation and the patient will be free of "spillage" in between. In the beginning, the irrigation takes much more time until the patient becomes accustomed to the procedure, but eventually it should be accomplished within an hour. In any instance, it is extremely important that the patient manage the colostomy and not let the colostomy manage the patient.
A time should be chosen for irrigation that is most convenient for the patient and family. The patient should be able to take over a bathroom for about an hour without interruption, so that the procedure can be accomplished smoothly and systematically. It may help to have the telephone nearby or else shut off until the irrigation is completed. It is important to be able to relax during the procedure. Most colostomy patients, or "colostomates" as they are called, are expert in self-care before they leave the hospital, although some may require minimal assistance from a family member in the beginning. The sooner the patient accomplishes his or her own care, the faster will be the return to a normal way of life. Should special problems connected with the irrigation or wound care arise, the services of a visiting nurse are available in most communities.
The irrigation technique requires enough water to accomplish a good evacuation of the bowel. One quart of lukewarm water is the average volume needed, and up to two quarts is always sufficient. Each person needs to make his or her own adjustments for volume. A well-lubricated catheter or cone should be inserted into the stoma to a depth of no more than one or two inches to help the water enter the intestine. The cone method, which gently opens the stoma, is gaining in popularity and appears to be safer than the catheter.
The patient should be sure that the irrigation bag is not hung too high; otherwise the water will enter too fast at too high a pressure, resulting in cramps. The bottom of the bag should be at shoulder level. Air should be expelled from the tubing and the water should be lukewarm, neither too cold nor too hot. If cramps do occur, it sometimes helps to sit back against a chair and take several slow, deep breaths or rock back and forth until relief is obtained.
Mucus is normally produced by the colostomy stoma because it is a natural product of the bowel surface, acting as a lubricant. The patient should keep a waterproof dressing over the stoma to prevent undergarments from being stained. Any rubbing or irritation of the stoma may cause a slight abrasion, an additional reason to keep a lubricated gauze dressing over it. Redness or roughening of the skin around the stoma is sometimes seen during bouts of diarrhea or whenever the stool is in contact with the skin longer than normal. The problem is akin to a baby's diaper rash. Meticulous skin care will prevent most skin problems—a shower or tub bath after the irrigation is helpful. Diaparene, stoma barrier cream, or some other soothing medication may be used to heal the skin and prevent further irritation during bouts of diarrhea or intestinal flu. When diarrhea occurs the patient may need to wear a temporary appliance, such as a drainable Hollister karaya bag, for a few days to protect the skin from irritating enzymes until the diarrhea ceases.
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