Last updated: 02/17/2009

Some disease or conditions may require a minimally invasive surgery. Other diseases such as inflammatory bowel disease and colorectal cancer may require an ostomy, a more drastic procedure. Determining whether this surgery is necessary is a decision...

the physician makes based on a number of factors, including patient history, the amount of pain the patient is experiencing, and the results of several diagnostic tests. Due to the lifestyle impact of ostomy surgery, surgeons make that decision with careful input from the patient. Sometimes, though, an immediate decision may be necessary in emergency situations involving injuries or puncture wounds in the abdomen, or intestinal perforations related to diverticulear disease, ulcers, or cancer, which can be life-threatening.

Diagnostic tests

Colonoscopy, flexible sigmoidoscopy, and a lower GI (gastrointestinal) series help determine the condition of the intestinal tract. These tests can identify masses and perforations on bowel walls.

A lower GI series is a series of x rays of the colon and rectum, which can identify ulcers, cysts, polyps, diverticuli (pouches in the intestine), and cancer. The patient is given a barium enema; the barium coats the intestinal tract, making any signs of disease easier to see on x rays.

Flexible sigmoidoscopy, a flexible tube with a miniature camera, is inserted into the rectum so the physician can examine the lining of the rectum and the sigmoid colon, the last third of the intestinal tract. The sigmoidoscope can also remove polyps or tissue for biopsy.

A colonoscopy is a similar procedure to the flexible sigmoidoscopy, except the flexible tube looks at the entire intestinal tract. For the patient's comfort, a sedative is given.

Magnetic resonance imaging (MRI), used both prior to and during surgery, allows physicians to determine the precise margins for resections of the colon, so that they can eliminate all of the diseased tissue. MRI can also identify patients who could most benefit from adjuvant therapy such as chemotherapy or radiation.

Preoperative preparation

The doctor will outline the procedure, possible side effects, and what the patient may experience after surgery. As with any surgical procedure, the patient will be required to sign a consent form. Blood and urine studies, along with various x rays and an electrocardiograph (EKG), may be ordered. If necessary, an enterostomal therapist will be contacted to mark an appropriate place on the abdomen for the stoma and offer preoperative education on ostomy management.

In order to empty and cleanse the bowel, the patient may be placed on a restricted diet for several days prior to surgery. A liquid diet may be ordered for at least the day before surgery, with nothing by mouth after midnight. A series of enemas and/or oral preparations (GoLytely, Colyte, or senna) may be ordered to empty the bowel of stool. Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) may be ordered to decrease bacteria in the intestine and help prevent postoperative infection.