A Comprehensive Guide to Colostomy Surgery in India

According to various studies, Colostomy or stomas are generally temporary but about 74% of the patient cases become permanent. The  Colostomy Surgery Costs in India is from USD 3014 to USD 6000 in India. This is dependent on factors like age, patient’s co-existing diseases, and rectal stump size. It can take up to 8 weeks to recover and a patient can live up to 70 years with a colostomy.

What is Colostomy?

A colostomy is a surgery in which an opening is created through the abdomen in the large intestine or colon. It is generally done after bowel injury or surgery and can be temporary or permanent. It can be done in any part of the colon.

Cost of Colostomy Surgery in India

 

• Temporary or loop colostomy– In this, the side of the colon is attached to the abdominal wall. It can be easily reversed later by detaching the colon from the wall of the abdomen and closing the openings to resume stool flow through the colon, stool will be excreted through the anus again. The healing process takes a few weeks. Months or even years. The cost for temporary or loop colostomy is $2,000 – $5,000
• Permanent or end colostomy– In this, the colon end is carried through the wall of the abdomen, where it may get turned under, like a cuff. The ends are later stitched to the abdomen wall skin to create an opening called a stoma. The excreta or stool drains from this opening into a pouch or bag attached to the abdomen. The cost for permanent or end colostomy is $5,000 – $10,000
• Transverse Colostomy– It is done in the upper abdomen, either in the right side or middle of the body. If there are problems in the lower bowels, that portion may need some time to heal. It is done to keep the stool away from the affected area that may be infected, newly operated on, infected or inflamed. It is normally temporary. A permanent transverse colostomy is done when the lower part of the colon is removed or permanently attached to the abdomen wall, or the patient has health problems that make further surgeries impossible. The cost for transverse colostomy is $3,000 – $7,000

1. • Loop transverse colostomy: It looks like one very large stoma, but it usually has two openings. One is for stool expulsion and the other expels out mucus. The large intestine makes small amounts of mucus normally which makes bowel movements easier. Despite a colostomy, the resting portion of the colon makes mucus that drains out through the stoma or through the rectum and anus. It is normal.
   • Double-barrel transverse colostomy: In this, the intestine is divided completely. Each of the openings is brought to the surface as individual stomas. They may or may not have separate skins. The smaller stoma, mucus fistula, expels out the mucus and other expels stool. There is only one stoma when the inactive portion of the bowel is stitched up and left inside the belly. The mucus comes out of the anus through the resting part.

• Ascending Colostomy– It is done on the right side of the belly. Only a limited part of the colon is active. The output is liquid consisting of various digestive enzymes. A drainable pouch should be worn all the time and the skin should not come in contact with the output. However, it is rarely performed. The cost for an ascending colostomy is $3,000 – $7,000
• Descending Colostomy– It is done on the lower left portion of the abdomen. The excreta is firm and can be managed. The cost for a colostomy is $3,000 – $7,000
• Sigmoid Colostomy– It is the most common kind of colostomy. It is done in the sigmoid colon, a few inches below descending colostomy. Since it is on the more operative colon, the expulsion is solid and more regular. The cost for sigmoid colostomy is $3,000 – $7,000

Symptoms indicating to Colostomy

• Vomiting and /or nausea
• Not passing stools or excreting watery stools
• Swelling and bloating in the abdomen
• Contractions and cramps in the abdomen

Diagnostic Tests for Colostomy Surgery

• Colonoscopies– In this, the patient is asked to lie down on the left side and a long and flexible tube is inserted in the rectum all the way through the large intestine. This tube transmits pictures of the large intestine linings so the doctor can check for possible abnormalities. The patient may feel mild cramping. The procedure lasts about 30 to 60 minutes.
• X-ray scans– IBDs are difficult to diagnose with only X-ray, but Ulcerative Colitis and Crohn’s Disease can easily be detected with X-rays. The machine will be placed in such a way that is correct and aimed at the right body part. Some dietary changes may be necessary before a scan.
• Blood Tests– They may not be able to diagnose Crohn’s Disease, cancers, or Ulcerative Colitis but aid in eliminating other possibilities of diseases. They are used as routine testing.
• Stool sample test– They are used to diagnose specific conditions in the digestive tract. In this, the stool sample of the patient is collected in a sterile container. Lab tests consist of chemical testing, microbiological testing, and microscopic examination. The stool sample will be checked for consistency, shape, presence of mucus, and color.

The success rate of colostomy varies from 65% to 80%. Patients aged 70 or more undergo comparatively more permanent colostomy surgeries than younger patients, along with increase in the risk of infections and prolonged hospital stays. There are, however, few restrictions for patients after colostomy like adjusting their diets, exercise, work, social and personal relations management, etc. A colostomy surgery may extend a life span of a person.

Factors Affecting Cost of Surgery in India

• Location: In both public and private facilities, patients are offered excellent healthcare services. A patient can choose a private hospital if there is an urgent need for a colostomy as the waiting period is longer in public hospitals.
• Currency: The Indian currency is comparatively cheaper than other countries that offer colostomy surgery.
• Doctors: Indian doctors and surgeons are highly skilled and deliver efficient treatment. As the currency is low, the doctor’s fee is lower as well.
• Pre and post-testing and medications: Before colostomy, some medications may be given to treat the condition without surgery. If unsuccessful, surgical intervention is the only option.

Conditions that lead to Colostomy

• Diverticulitis– is the development of small pouches or sacs in the colon that are prone to infection and inflammation. It results in vomiting, pain and fever. The doctor treats this condition with antibiotics and diets before progressing further in cases of severe infections or repeated occurrences of diseases. In extremely serious cases colostomy is performed by taking out a portion of the colon. One may need a colostomy if there is a colon blockage or severe bleeding.
• Inflammatory Bowel Disease (IBD)– It consists of Ulcerative colitis and Crohn’s disease. In this, the digestive system is inflamed. This causes rectal bleeding, fatigue, pain and diarrhea. It is primarily treated with medications and diet. One may need a colostomy if there is a colon blockage or severe bleeding.
• Colorectal Cancer– In this, polyps develop in the colon and become cancerous. The symptoms include abdominal pain, rectal bleeding, and change in bowel movements. The affected parts are removed and the remaining healthy ones are reconnected. Patients with colostomy still need to be examined for cancer recurrence. People with insulin and diabetes have a higher risk of colon cancer
• Bowel Obstruction– In this, the passage through which the food passes is blocked. It can be caused by tumors, adhesions, hernias, paralysis of the colon, problems from previous abdominal operations, and extreme constipation. Symptoms include abdominal pain, swelling, and fever.
• Injury– Trauma or injury can critically damage the colon, anus, and rectum. The doctors try to repair the damaged organs through surgery. If it becomes impossible, the colostomy may be performed for severe cases where all or some parts of the organs are excised. In less serious cases, a temporary colostomy may be performed.
• Genetic disorders and birth deformities– An infant born with missing or blocked opening of the anus (imperforate anus) may undergo colostomy. A genetic disorder called Hischsprung’s disease in which there are missing nerves that control the muscles of the colon, leading to a severe blockage. The defective portion is removed with Colostomy.

How to Prepare for the Colostomy Procedure?

It is a major procedure and requires prior preparation.

Before the procedure:

• The surgeon will explain the procedure and make the patient understand the risks involved and the changes in lifestyle that would need to be done post-surgery. Blood tests and EKG tests would be done to assess the patient. Pain management options will be discussed.
• On the day of the procedure- The patient would need to avoid drinking or eating for 6 hours prior to surgery. Sometimes the patient will be given bowel prep or enema.

During the procedure: Colostomies are either performed through open or laparoscopic surgery.

• Open surgery– A single long opening is created to access the abdominal cavity. This gives better access to internal organs. However, it takes a longer operating and recovery time.
• Laparoscopic surgery– It is comparatively less invasive than open surgery. In this, a lighted tiny camera, called a laparoscope, is inserted in the abdomen through a small incision. It shows the image of the internal organs. It is quicker and less painful due to the small incision size.

Transverse, descending, sigmoid, or ascending colostomies can be done based on the below-mentioned parameters:

• • Transverse colostomies– It is done in the middle portion of the colon and the stoma is located in the upper abdomen. It is usually temporary and done in cases of IBDs, cancer, injury, blockage, etc. There are two openings in the stoma.
  • Ascending colostomies– It is done on the right side of the abdomen. In this, only a small part of the colon is active. Usually, it is performed in cases of severe diseases or blockage.
  • Descending colostomy goes on the right side of the abdomen and Sigmoid colostomy (most common type) is done a few inches lower than this.

After the procedure:  

• The stoma is moist and appears red or pink colored. It appears swollen and dark red along with bruises. Within a few weeks, the stoma color should lighten and bruises should fade.
• Depending on the kind of operation one has had, they may need to stay in the hospital anywhere between three to ten days, as long as there are no additional problems. The patient needs to stay in the hospital until the stoma starts working and is comfortable with it.
• Immediately after surgery, the patient can only be able to consume fluids. One will have a tube going down from the nose and into the stomach, to prevent vomiting. After some time, the patient will be able to have soft, easily digestible foods. The patient should try everything in small quantities to see how the body reacts.
• The nurse will show the patient how to clean the stoma. Once the patient goes home, they have to clean it with warm water only every day. Then gently pat dry it, it is okay if a little blood is noticed.
• If a transverse or ascending colostomy is done, the patient will need to wear a lightweight, drainable, and slim pouch always. There are different kinds of pouches of varying costs and are made from order-controlling materials. If the rectum and anus have been removed (posterior wound), it is covered with pads and dressings. The doctor or nurse will show how to care for the wound till it heals. If complications occur, the patient should contact the doctor.
• It is crucial to be as mobile as possible. This will help the lungs to start working again fully, prevent infections in the chest and get the bowel to work quicker. It may take a few days to pass excreta after a certain amount has been collected. The average output of colostomy is about 200 ml to 700 ml.
• The patient should not lift anything heavy for the first eight weeks. This can lead to the formation of a hernia behind the stoma.

What is the difference between a colostomy and an ileostomy?

The ileum and colon are two distinct parts of the bowel system, called intestines. The ileum is part of the small intestine and the colon is part of the large intestine.

• The last part of the small intestine is called the ileum which helps in digesting food and absorbs water and nutrients as well. In an ileostomy, the ileum is attached to the abdominal wall and a stoma is created on the abdominal surface. It can be permanent or temporary. Since there are no sphincter muscles, one may not be able to control bowel movements or excretion. The patient needs to wear a pouch at all times for stool collection. The stool has a liquidy to a pasty consistency.
• In Colostomy, a similar procedure is done. The Large intestine is operated on instead of the small intestine. The stool excreted is soft. It can be temporary, permanent, or transverse surgeries.

Who can perform Colostomy?

General and colon and rectal surgeons can perform colostomies. General surgeons have specializations in a variety of disorders, conditions, and diseases of the colon. Rectal and colon surgeons are general surgeons who have advanced training in related diseases.

How is Colostomy performed?

• A colostomy consists of an opening in the abdomen made surgically due to conditions that cause the colon to not work properly or diseases that affect a part of the colon. The end of the large intestine, the colon, is brought via this opening in the skin to create a stoma. A stoma is the lining of the intestine and appears pink or red. It is moist and warm and secretes little amounts of mucus.
• It can be temporary (3 to 6 months) or permanent (for the rest of your life). The stoma creation depends on which part of the colon is affected. It can be on the right, middle or left side of the abdomen. The higher the stoma, the quicker will be stool expulsion. Since the colon is cut short, it gets less time to absorb water and hence, the stool is liquidy or soft. A colostomy that is lower in the abdomen will excrete firmer stools.
• After the surgery, there may be some discharge through the anus which is normal. This discharge can be blood, mucus, and sometimes even stool (left behind after surgery). Since there are no nerve endings and sphincter muscles, a person does not feel pain in the stoma itself and can have unpredictable stools at times.

What are the advantages of colostomy?

• Colostomy is usually the final stage of a more convoluted surgery like colectomy. It serves as a life-saving intervention. A colostomy allows the body to maintain functioning without losing an important organ.
• Sometimes the colon requires time to heal from injury or illness. Colostomy allows healing to occur safely so that there is no further danger to the organ.
• The sense of urgency is reduced. For someone who has chronic bowel diseases, can find relief with a colostomy. They don’t have to live life by their bowels.
• After colostomy, the patient feels less pain. Having IBD can be problematic and the patient has to take several trips to the bathroom. The inflammation itself can cause severe pain in the abdomen and hence, the colostomy can be a temporary or a permanent solution.

What are the potential risks and complications of a Colostomy?

A colostomy is a common procedure and is usually safe. But like any other major surgery, there are some risks and complications involved.

• Mild to severe reactions and breathing problems because of anesthesia
• Injury or infection to surrounding organs.
• Bowel obstructions (slow-moving bowels)
• Irritations in the skin (due to acidic stool)
• Parastomal hernia (loops of bulging bowels)
• Prolapse and stoma retraction (stoma sinks back inside)

Top Hospitals for Colostomy Surgery in India

1. Fortis Hospital, Bangalore

Fortis hospital has been accredited by NABH and ISO. It has 24×7 emergency services. An in-house pharmacy is also provided. International patient care centers aid international patients to avail excellent treatment.

2. Sarvodaya Hospital and Research Centre, Faridabad

Sarvodaya hospital has been accredited with NABL and NABH. It has 500-bed capacity. Technologies like 128 Slice CT Scan, 1.5 Tesla MRI, Mammography facility, and 500 MA X-ray.

3. Ruby Hall Clinic, Pune

Ruby Hall Clinic is accredited with NABH. There are 550 in-patient beds and 130 ICU beds. Imaging advances are used in the hospital like Positron Emission Tomography. Cobalt therapy is employed in cases of cancer.

4. Apollo Spectra Hospitals, Delhi

Apollo Hospital has been accredited with JCI. It has advanced technology and world-class infrastructure. It consists of 5 modular modern Operation Theatre. It has 115+ healthcare professionals and 70 inclusive specialists.

5. Yashoda Hospital, Hyderabad

Yashoda hospital is accredited with NABL and NABH. It has multi-specialty facilities, modular operation theaters, and high-tech labs. It consists of a comprehensive cancer care unit with a multi-modality and trans-disciplinary approach.

Top Surgeons for Colostomy Surgery in India

Qualification: MBBS, MRCP (UK), FRCP

• He has been certified FICP and FACP
• He has published over 100 academic chapters and papers in well reputed national and international journals
• He has performed numerous diagnosis and treatment of hepatic and gastroenterological diseases. 

Qualification: MBBS, MD, DM

• He has a fellowship of Uttar Pradesh Medical Council
• He has treated conditions like Celiac disease, Inflammatory Bowel Disease (IBD), Crohn’s disease, gastrointestinal cancer, abdominal pain, gastrointestinal bleeding, etc.

Qualification: MBBS, DNB (General surgery), DNB (Surgical Gastroenterology)

• He can provide treatments for chronic diseases, structural and functional diseases, celiac disease, gastritis, etc.
• He is an active researcher and aims to bridge the gap between medical practice and research.

Qualification: MBBS, MS

• She has been certified by FIAGES and FAIS
• She is a member of IAGES, IMA, MMS, and ASI
• Disease and conditions treated by her include colon cancer, bowel diseases, pancreatic head cancer, morbid obesity, cholecystitis, chronic pancreatitis, etc.

Qualification: MBBS, DNB, MD

• He is a member of MCI
• He has successfully treated diseases and disorders like IBD, liver cancer, Celiac disease, abdominal pain, Crohn’s disease, etc.
• He has performed procedures like ERCP (diagnostic) and Endoscopy (UGI Endoscopy)

Recovery: Most patients are able to leave the hospital within 3 to 10 days after colostomy surgery. Heavy lifting should be avoided for some time as it can put a strain on the abdomen. Instructions on cleaning and managing the stoma are given by the doctor or the nurse. At first, only gas will pass through the stoma and after 2-3 days, the stool will be excreted. Recovery typically takes a minimum of 3 months.

Frequently Asked Questions