Types of Loop Ileostomy

In general terms, "ileostomy" refers to a surgical procedure wherein a portion of the small intestine is pulled through an incision in the skin of torso, partially cut and sutured to the edge of the incision so that fecal waste can exit the body without passing through the large intestine (a.k.a. the bowels). "Loop ileostomies" are a special class of ileostomy that are easier to reverse. For this reason, a loop ileostomy is often used as an intermediary procedure, setting the stage for future operations.

Standard Loop Ileostomy

In the standard loop ileostomy, the surgeon cuts a few inches of connective tissue between the folds of the small intestine and pulls the freed tube through an incision in the skin of the lower abdomen, creating a folded, "loop-like" protrusion. Next, a small plastic support rod is inserted under the loop to prevent the protruding intestine from slipping back into the body. Once the loop is secured, the surgeon makes a cut in the wall of the intestine, causing it to open into two separate holes or "stoma." One stoma leads into the upper part of the gastrointestinal tract and has a catheter bag attached to it for collecting fecal waste. The second stoma leads into the large intestine and is mainly used to expel excess mucous from the bowels. Note: even though the wall gets cut, the intestine is not completely separated. Rather, part of the wall is left intact, allowing for easier closing of the ileostomy in future operations.

Double-Barrel Ileostomy

While a standard loop ileostomy produces two stoma at a single incision site, a "double-barrel" ileostomy produce two stoma at two separate locations. This procedure begins much like the loop ileostomy, i.e. cutting the connecting tissue from the intestines and pulling a few inches out through an incision in the abdominal wall. However, if a section of the gastrointestinal tract beyond the stoma (yet above the lower part of the large intestine) is diseased, the surgeon will make a second incision site and pull a second section of the intestines (below the diseased section) through it. Once both protrusions are secured, the surgeon will cut each one completely in half, stitch each of end of the diseased section closed, remove the entire diseased section and then suture the remaining intestinal openings to their respective incision sites. The lower stoma will still expel mucous while the upper stoma will expel fecal waste; the main difference is that there are two separate sites.

Hartmann's Pouch

Essentially a hybrid of the standard and double-barrel procedures, the Hartmann's Pouch procedure may use either one or two incision sites. In the single incision version, the intestine is pulled through and severed completely. The section of the intestine leading to the large intestine is simply stitched or clamped closed and placed back inside the body. Meanwhile, the other stoma is sutured to the incision to allow for a catheter bag.

The two-incision version is essential a double-barrel procedure, except that the lower stoma is sealed and placed back inside the body instead of sutured to the surface.