The creation of a stoma is always necessary when the trachea, urinary bladder, or bowel is closed by some process and air, urine, or stool cannot be transported naturally. Accordingly, a distinction is made between different types of stoma.
Tracheostoma
The tracheostoma provides a permanent connection between the upper portion of the trachea and the skin. It is created below the larynx, and various procedures exist for the tracheotomy, or tracheotomy. The connection between the trachea and the skin is usually maintained by a rigid plastic tube, the tube. When the tube is removed, the opening between the trachea and the skin gradually closes. Only in the case of a laryngectomy is a permanent connection made between the skin and the trachea, for which the end of the trachea is sewn into the skin – breathing is then only possible through this opening. A tracheostomy is created either when the larynx is so constricted by an inflammation or tumor that not enough breathing air reaches the lungs, or when a patient must be ventilated for a long period of time due to a serious illness. For short-term ventilation, a breathing tube can be placed past the vocal folds through the mouth or nose and ventilation can be delivered that way. However, for prolonged ventilation, the ventilation tube causes irritation of the vocal folds and laryngeal mucosa, so a tracheostomy is needed.
Urostomy
A urostomy involves creating an artificial connection between the urinary bladder and the surface of the body. There are several procedures for this as well. Rarely, both ureters (uretero-uretero-cutaneo stoma) or connected in series with an opening (TUUC, trans-uretero-uretero-cutaneo stoma) are sewn directly into the skin; usually, a piece of small intestine (ileum conduit) or large intestine (colon conduit) is removed from the intestinal structure during surgery and connected in between. Conduit procedures have the advantage that they can still be performed well in patients who are very compromised by their disease. As another variant, a kind of replacement bladder (Mainz pouch I) can be made from a piece of intestine. The opening of this device is usually hidden in the navel and is continent – every 4 to 6 hours the bladder is emptied with a thin catheter. In the case of a urostoma, there is a drainage obstruction in the urinary bladder or urethra. Most often, it is extensive bladder or prostate cancer that leads to complete obstruction of the urinary stream.
Ileostoma and colostomy
The ileostomy and colostomy are also called artificial bowel outlet or anus praeter(naturalis). Again, different forms exist: A connection between the small intestine (ileum) and the body surface is an ileostomy, and between the colon and the skin is a colostomy. Depending on the location of the colostoma, a distinction is made between a cecostoma (stoma in the area of the appendix), transversostoma (the middle section of the colon is used for the stoma) or – the most common form – the sigmoidostoma in the area of the colon. In addition, there are terminal and double-barreled stomas: In the double-barreled form, the intestinal section coming from the stomach and the intestinal section leading to the anus are sewn into the skin; in the terminal form, the intestinal section leading downward is either surgically removed or closed and only the intestinal section coming from the stomach is sewn into the skin. The creation of an ileo or colostomy is common. Currently, about 100,000 stoma carriers live in Germany. An ileostoma is usually created either after an intestinal injury, for example in the course of a serious traffic accident, or after the complete removal of the colon, which is sometimes necessary after many years of chronic inflammatory bowel disease. After an injury, a double-barreled ileostomy is often created, which can be repositioned after some time. A colostomy is placed either to relieve pressure on the bowel in the presence of an intestinal tumor (usually a terminal sigmoid ostomy) and intestinal obstruction (usually a double-barreled cecostomy or transversostomy) or in the presence of congenital anus malformations (as a terminal sigmoid ostomy).
PEG (percutaneous endoscopic gastrostomy).
Percutaneous endoscopic gastrostomy, or PEG for short, is a special type and is often placed in elderly patients who are no longer able to take in food and fluids independently due to their illnesses, for example after a severe stroke or in cases of pronounced dementia.Food and fluids are then supplied via the PEG. The patient often finds it less disturbing than a feeding tube placed through the mouth or nose. With the PEG, a thin tube connects the stomach to the abdominal skin.
