Return to normal life
Preparation includes irrigoscopy/colonoscopy of the disconnected section, assessment of the anastomosis and sphincter, training of the disconnected intestine with enemas during a long break. The loop stoma closes from local access within an hour; after Hartmann's operation, the rectal stump is connected to the colon transanally with a circular stapler - in the adhesive process, the stage is performed laparoscopically. Nutrition according to the ERAS protocol, early activation; in case of parastomal hernia, the defect is strengthened with a mesh. Most patients completely return to their previous lifestyle.
Indications
- temporary stoma after resections, peritonitis, injuries - planned closure after 2–6 months;
- Hartmann's state - restoration of continuity;
- confirmed healing of the anastomosis/cause (contrast proctography, colonoscopy);
- the patient's desire to return to natural passage.
When and how to close a stoma
The timing of closure is determined by the healing of the primary problem area: usually 8–12 weeks after surgery, earlier with loop protective stomas, later after severe peritonitis. Before the operation, the disconnected section must be checked (contrast study, endoscopy) and sphincter function. Technically, loop stomas are closed with local access through a surrounding incision, single-barrel stomas (Hartmann) - with a full intra-abdominal stage and hardware colorectal anastomosis; Laparoscopic assistance reduces trauma. At the same time, a parastomal hernia, if present, is eliminated.
