Insights into Ostomy and Stoma Care: An Expert Interview

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An interview with Dr. Gideon Kurigamba Kwikiriza.

Dr.Gideon (left): laparoscopic surgery

Understanding Ostomy: A Comprehensive Explanation.

Dr. Gideon: An ostomy is a surgery, to create an opening called a stoma to connect an inside hollow organ to the skin. Any hollow organ can be connected to the skin, and the kind of organ will determine the type of ostomy.

Exploring the varieties of ostomies.

Dr. Gideon: Well, there is;

  • Gastrostomy: where we create an opening from the stomach connecting to the skin.
  • Ileostomy: the opening is from the small intestines connecting to the skin.
  • Colostomy is a surgery to create an opening from the Large intestines connecting to the skin. And,
  • Ureterostomy: to create an opening from the ureters (kidneys) connecting to the skin.

Gastrointestinal Ostomy Expertise

Stoma bag/pouch around a stoma

Dr. Gideon: My expertise is in gastrointestinal ostomy, to be exact, this includes; ileostomy, colostomy, and gastrostomy. I have fashioned over 260 stomas throughout my career, successfully reversing over 90% of those.

Understanding Stoma Classifications: Temporary vs. Permanent Options.

Dr. Gideon: Absolutely, Sarah. Firstly, it is important to understand that having a stoma is not a death sentence; it is a treatment option. We may opt, therefore, for a patient to get;

  1. Temporary stoma; created to allow a distal portion to heal and thereafter reversed. Common indications addressed include; injury or trauma to the rectum, after surgery to the rectum, when a portion of the colon is “dead” (gangrenous), large intestinal obstruction, and genetic abnormalities (children and infants).
  2. Permanent stoma; is irreversible and opted for when the distal portion is severely diseased and cannot be salvaged. Common indications addressed include; the removal of the rectum and anus after surgery. 

Probability of Stoma Occurrence.

Dr. Gideon: Indeed, Sarah. Ostomies often serve as a secondary solution, typically considered promptly if other treatments prove ineffective. Interestingly, in my experience, they represent approximately 5% of gastrointestinal surgeries on average.

Temporary stomas are more likely to be used than permanent ones. The level of severity of the condition will dictate the kind to use. Permanent stomas are mostly used in advanced cases of rectum and anal canal cancer. 

Navigating the Stoma Decision.

Dr. Gideon: Indeed, it’s a challenging journey, as one would anticipate. The comfort, though, comes from knowing that a stoma is the best option, in their interest. Even in light of that, my observation has been that patients are naturally scared about the likelihood of getting a stoma. 

Counseling is available before each bowel surgery, highlighting the possibility of a stoma in case this is not part of the treatment plan. The decision to fashion a stoma is usually made while the patient is in surgery, especially for temporary stomas.

Every patient’s response to the stoma post-surgery is unique. Through observation, I have noticed that acceptance tends to occur more swiftly when accompanied by;

  • Comprehensive pre-surgery counselling.
  • A clear estimate of time to the stoma reversal in the case of a temporary one and benefits of the stoma.

Challenges in Stoma Care.

Dr. Gideon: Every role presents its own challenges. Through my work with numerous patients, I’ve come to understand that:

  • Fashioning a stoma marks the beginning of a journey that demands careful monitoring, especially for temporary stomas awaiting reversal. For permanent stomas, this journey becomes lifelong. This necessitates ongoing support and care.
  • Complications associated with stomas are often attributed to the quality of the post-surgery care administered.
  • Varied levels of understanding among patients can significantly impact the outcomes of stoma placement and post-surgery care.

Addressing Patient Concerns: Managing Challenges in Stoma Care.

excoriation, wounds, bleeding around the stoma

Dr. Gideon: Many patients understandably face challenges in adjusting to life post-surgery, as it often brings with it various challenges.

Those include; stoma-related diarrhea, skin itching, excoriation (wounds around the stoma), bleeding around the stoma, leakage of stoma bags, stoma prolapse, and retraction. However, these challenges can be effectively managed with medication, proper stoma care kits, and regular medical check-ups.

Parting Words of Wisdom: Navigating Life with a Stoma.

Dr. Gideon: It’s truly an honor to be here. When faced with the possibility of a stoma or when your doctor recommends one, it’s crucial to approach it with a positive mindset. The primary goal of your doctor is to improve your quality of life and ultimately save it.

It is important to remember that stomas are not life-threatening; rather, they often enhance the overall quality of life for many individuals.

Sarah
Sarah

3 Comments

  1. This is an excellent read. Very much desired information for patients walking the journey of an ostomy

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