Tube Ileostomy Method in Colon Cancer Surgeries

During World War I, when the death rates were very high among people carrying intestinal viruses, an American general discovered the "stoma," and the 100-year story began that day.

During World War I, when the death rates were very high among people carrying intestinal viruses, an American general discovered the "stoma," and the 100-year story began that day. Thanks to this new practice, the intestine was brought closer to the abdominal wall, and the waste was expelled through a hole (diverting stoma), creating a new exit for food waste. This prevented waste from reaching the injured areas in the lower part of the intestine, removing it from the body and preventing poisoning in the patient. The "ostomy" method, which can be applied either temporarily or permanently, is still used in modern medicine. Particularly in the treatment of colon cancer, the ostomy has been a life-saving method. As it reaches its 100-year milestone, its story continues today with innovative perspectives. Associate Professor Dr. Vafi Atalay, a specialist in General Surgery and Colorectal Surgery at Anadolu Health Center, has developed this method to make the treatment process more comfortable for patients. From Dr. Atalay, we not only learn about the classic tube ileostomy method but also about his own developed technique, which was published in the international scientific journal Colorectal Disease, and how it has made a significant difference in the lives of colon cancer patients.

When is it needed?

As is known, colon cancer (large intestine cancer) is one of the types of cancer whose incidence has increased in recent years. According to statistics, it is the third most common cancer worldwide and ranks high among the leading causes of cancer-related deaths in both men and women. However, when diagnosed at an early stage and treated promptly, it is one of the most treatable cancers. In fact, the five-year survival rate is as high as 90% for those diagnosed and treated in the early stages. Symptoms of colon cancer include changes in bowel habits (diarrhea, constipation), bleeding or the presence of blood in the stool, pain during defecation, transparent discharge in the stool, abdominal pain, and swelling. Factors like genetics, age, and other conditions play a role, with the goal being to increase the patient’s lifespan and quality of life. While surgical treatments remove the tumor-affected parts in many patients, allowing the patient to defecate naturally becomes risky before the surgical area has fully healed. This is where the ostomy method comes into play, which is related to many factors such as chronic bowel diseases, tobacco use, and unhealthy eating habits. The ostomy method is typically used in the treatment of colon cancer diagnosed via colonoscopy. In addition to colon cancer, this method is also used for rectal cancer, trauma, bowel diseases, and some congenital defects that prevent defecation. It is sometimes used in cases of bowel injury caused by repeated cesarean sections. If the surgeon brings the large intestine to the abdominal surface to create an opening (stoma), it is called a colostomy. If the small intestine is brought to the abdominal wall and opened, it is called an ileostomy. The aim of the stoma, created by attaching the intestine to a bag (used for collecting and discarding waste), is to temporarily or permanently allow the contents of the intestine to exit through the abdominal wall opening. Once the recovery from the surgery is complete, a second surgery can be performed to reintroduce the intestine and close the stoma created in the abdomen.

Living with a colostomy is primarily a psychological trauma. Even with a small effort like straining or coughing, the intestine can protrude, and sometimes it can go back inside. Additionally, the hole in the abdominal wall may enlarge over time and develop into a hernia. There is also a risk of infection, and skin burns due to the stoma can occur. From this perspective, the care and daily cleaning can be exhausting and draining. When it is time to close the stoma, a very delicate surgery is required again. During this process, it is important to prevent any leakage from the bowel into the abdomen over time. Although there are difficulties, we must emphasize that the method plays a life-saving role in the aforementioned patient groups, meaning in mandatory cases.

What are the differences of the new method?

As an alternative to colostomy, 40 years ago, ideas were explored to place a tube into the abdomen through an opening. This idea, called "tube ileostomy," aimed to prevent the bowel from protruding and also avoid making it permanent. In fact, methods were tried where a balloon was inflated inside the bowel to prevent leaks. However, although these were supported by scientific publications at certain periods, they could not become widely used due to their inefficacy.

What is the tube ileostomy method?

In the newly developed method, different materials are used (as shown in the diagram above). The new material does not bend but has enough flexibility to not restrict the patient's movements, such as sitting or lying down, thanks to a special spiral inside the material. The second most important difference is a special maneuver system used to prevent the passage of food waste to the surgical area at the bottom by inflating a balloon. This is done using a special band passed through the bowel, ensuring that the food waste does not descend around the tube. After just a 10-minute surgery, no second operation is needed, and the bowel remains inside. This tube can be used in any surgery where a temporary bag will be used. The tube is removed after two weeks without the need for another surgery, and the opening heals in 2-3 days. The method, which has been successfully applied to many patients and can be used at any age, also shows successful follow-up results. The greatest comfort for the patient is undoubtedly going home without a bag.

Is early diagnosis important?

Colon (large intestine) cancer, the third most common cancer worldwide, is one of the most treatable cancers when diagnosed early. In fact, the five-year survival rate for patients diagnosed and treated in the early stages is as high as 90%.