Our Summary

This research paper reports on a study carried out in France between 2013 and 2021. The study looked at patients with inflammatory bowel disease (IBD) who had undergone a surgical procedure called subtotal colectomy (STC) with ileostomy. This surgery involves the removal of part of the colon and rerouting the small intestine to an opening in the abdomen known as a stoma.

The study found that around a third of these patients ended up living permanently with a stoma, rather than having further reconstructive surgery. This was more likely in patients who were older, had Crohn’s disease or colorectal neoplasia, had postoperative complications after STC, underwent laparotomy (a more invasive way of accessing the colon), or were treated in a hospital that doesn’t do this type of surgery very often.

The researchers suggest that the rate of permanent stoma could potentially be reduced by avoiding laparotomy and treating patients in hospitals where this type of surgery is performed more regularly.

FAQs

  1. What is a subtotal colectomy with ileostomy surgery as mentioned in the study?
  2. According to the study, what factors made it more likely for patients to live permanently with a stoma?
  3. What suggestions did the researchers provide to potentially reduce the rate of permanent stoma?

Doctor’s Tip

One helpful tip a doctor might give to a patient undergoing colectomy is to follow a healthy diet after surgery to promote healing and prevent complications. This may include avoiding foods that can be difficult to digest, such as high-fiber or spicy foods, and focusing on eating smaller, more frequent meals. Additionally, staying hydrated and taking any prescribed medications as directed can help with recovery. It’s also important to follow up with your healthcare team regularly to monitor your progress and address any concerns.

Suitable For

Patients who are typically recommended colectomy include those with severe or refractory inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease) that cannot be controlled with medications, those with colorectal cancer or precancerous conditions (such as colorectal neoplasia), and those with severe complications of inflammatory bowel disease, such as toxic megacolon or perforation. Additionally, patients who have failed to respond to other surgical interventions or medical therapies may also be recommended for colectomy. Ultimately, the decision to undergo colectomy is made on a case-by-case basis, taking into account the patient’s individual circumstances and medical history.

Timeline

Before colectomy:

  • Patient undergoes various tests and evaluations to determine if surgery is necessary
  • Patient may experience symptoms such as abdominal pain, diarrhea, rectal bleeding, weight loss, and fatigue
  • Patient and healthcare team discuss the risks and benefits of surgery
  • Patient undergoes preoperative preparations, such as bowel preparation and fasting

After colectomy:

  • Patient wakes up from surgery with a stoma and may need time to adjust to this new way of living
  • Patient may experience pain, discomfort, and fatigue postoperatively
  • Patient begins a gradual recovery process, which may include physical therapy, dietary changes, and medication management
  • Patient may need ongoing follow-up care to monitor for complications and adjust their stoma care routine
  • Patient may experience improvements in their symptoms and quality of life postoperatively, but may also face challenges such as body image issues and psychological adjustment to living with a stoma.

What to Ask Your Doctor

Some questions a patient should ask their doctor about colectomy include:

  1. What are the reasons for recommending colectomy in my case?
  2. What are the potential risks and complications associated with colectomy?
  3. Will I need a permanent stoma after colectomy, or is there a possibility of further reconstructive surgery?
  4. What is the likelihood of needing a permanent stoma based on my specific medical history and condition?
  5. Are there alternative treatment options to colectomy that I should consider?
  6. How experienced is the surgical team in performing colectomy procedures, and how often do they perform this type of surgery?
  7. What is the recovery process like after colectomy, and what kind of support will be available to me during this time?
  8. What long-term effects or changes in lifestyle should I expect after colectomy?
  9. Will I need to make any dietary or lifestyle changes following colectomy?
  10. Are there any specific follow-up appointments or tests that I will need after colectomy to monitor my health and stoma function?

Reference

Authors: Deyrat J, Challine A, Voron T, O’Connell LV, Collard MK, Tzedakis S, Jaquet R, Lazzati A, Parc Y, Lefèvre JH; Saint‐Antoine IBD Network. Journal: Colorectal Dis. 2024 Jun;26(6):1203-1213. doi: 10.1111/codi.17020. Epub 2024 May 16. PMID: 38757256