腹腔镜粪便改道【英文讲义】

Laparoscopic Fecal Diversion

                               
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Laparoscopic Fecal Diversion

What's Fecal Diversion?

Fecal diversion refers to the advance of an ileostomy or colostomy. An ileostomy is an opening between the top of the skin and also the small intestine, while a colostomy is definitely an opening between patient's top of the skin and also the colon. This opening is known as stoma. Fecal diversion is used to treat:

* Complex rectal or anal problems (especially infections)
* Poor charge of the bowels (incontinence)

The stoma can measure from 1 to 1 1/2 inches around. Unlike patient's anus, the stoma has no sphincter muscle (the muscles that control bowel movements), so many people cannot control the exit of waste. patient will have to wear a pouch (ostomy collecting device) all the time to gather the waste flow. Stomas can be permanent or temporary. A temporary stoma might be made when a diseased portion of bowel is taken away, rejoined, and requires time for patient to heal. When the reconnection site (anastomosis) has healed, the stoma can be taken off. If the anus and rectum have been removed, the stoma must be permanent.

What Happens During Fecal Diversion Surgery?

The term "laparoscopic" describes a kind of surgery called laparoscopy. Laparoscopy allows the surgeon to do the process through really small, "keyhole" incisions in the abdomen. A laparoscope, a small, telescope-like instrument, is positioned with an incision near the bellybutton. Images taken by the laparoscope is going to be projected onto video monitors placed close to the operating table.

A laparoscopic fecal diversion requires only a few incisions. The very first incision will be made at the intended site of the stoma. A second incision will be made opposite el born area and patient will be accustomed to put the laparoscope. In some instances, additional incisions is going to be made so that more of the large intestine is available.

How's the Stoma Made?

There are two main types of stomas: the finish stoma and also the loop stoma.

End Stoma

A finish stoma can be made within the ileum end of the small intestine, called "end ileostomy" or colon "end colostomy". First, a small disk of skin will be removed from the stoma site. Next, patient's surgeon will bring 1-2 inches of healthy bowel up with the abdominal wall to skin level. If patient is having a colostomy, the finish from the intestine will be stitched for patient's skin. If patient is through an ileostomy, the small intestine will be stitched for patient's skin. The abdominal cavity will be carefully inspected and the incisions is going to be stitched closed.

Loop Stoma

A loop stoma can be created within the ileum "loop ileostomy" or colon "loop colostomy". A loop stoma often is created once the stoma is going to be temporary. However, not every loop stomas are temporary. To make the loop stoma, a little loop of intestine is going to be raised with the abdominal wall to skin level. A plastic rod is going to be passed beneath the loop to keep the new stoma in position. The loop will be cut half way through to result in the site for the bowel opening. Each open end from the bowel developed by this cut will appear as two openings within the stoma. If you are using a loop colostomy, the finish from the intestine will be stitched to patient's skin. If you're using a loop ileostomy, the loop will be turned back on itself like a small cuff and then stitched just beneath patient's skin. The abdominal cavity will be carefully inspected and the incisions is going to be stitched closed. The rod is going to be removed several days after surgery.

Recovery From Fecal Diversion

Hospital stays after fecal diversion average two to three days. You will be fitted with a pouch when patient's surgery is complete. It will take a couple of days for patient's digestive tract being active again. When it will start functioning, you will observe changes in the consistency of the stoma output. When you are recovering, patient's enterostomal therapist (ET), a nurse specially been trained in stoma care, will change patient's pouch for you personally. Become familiar with a lot about changing the pouch by watching the ET nurse. You also will be given instructions and coached through the process which means you are able to look after the stoma when you return home.

Patient is bound to go through many psychological and physical adjustments after surgery. It will require time to cope with all of these changes and, at times, you may feel overwhelmed. patient's ET nurse is a good resource. Don't hesitate to call him or her after surgery for support.