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Ostomía

Una ostomía, o estoma, es una abertura creada quirúrgicamente entre los intestinos y la pared abdominal. Los tipos más comunes de ostomía conectan el intestino delgado (ileostomía o jejunostomía) o el intestino grueso (colostomía) a la pared abdominal. Las ostomías pueden ser temporales o permanentes.

RAZONES PARA UNA OSTOMÍA

  • Cáncer
  • Trauma
  • Enfermedad inflamatoria intestinal (EII), como la enfermedad de Crohn o la colitis ulcerosa.
  • Obstrucción intestinal
  • Infección
  • Incontinencia fecal (incapacidad para controlar los movimientos intestinales)
  • Enfermedad diverticular (pequeñas protuberancias o sacos que se forman en la pared del intestino grueso)

TIPOS DE OSTOMÍA

Pregúntele a su cirujano si no sabe qué tipo de ostomía tiene.

  • Ileostomía: Conecta la última parte del intestino delgado (íleon) con la pared abdominal.
  • Colostomía: Conecta una parte del colon (intestino grueso) con la pared abdominal.
  • Ostomía temporal: Se trata de una ostomía que se puede extirpar quirúrgicamente en un momento posterior. Generalmente se hace a partir del intestino delgado (ileostomía). Previene el paso de heces a través de los intestinos por debajo del estoma. Una ostomía temporal se crea para permitir que los intestinos curen después de la cirugía o de una enfermedad tal como enfermedad diverticular o enfermedad de Crohn.
  • Ostomía permanente: es una ostomía que se usa cuando se han eliminado partes del recto, ano y colon por enfermedad o tratamiento de una enfermedad. Generalmente se hace a partir del intestino grueso (colostomía). También se puede hacer cuando los músculos que controlan la eliminación se eliminan o ya no funcionan correctamente. Una ostomía permanente puede ser eliminada bajo ciertas circunstancias.

Figura 1: Una ostomía conecta el intestino pequeño o el intestino grueso a la pared abdominal.

EL BOLSO DE OSTOMIA

Después de una ostomía se crea, los movimientos intestinales se producen a través de la apertura en la pared abdominal o estoma. El aparato de ostomía consiste en una oblea y una bolsa. La oblea se adhiere a la pared abdominal con adhesivo y está hecha de plástico. La bolsa coge y sostiene las heces. La bolsa es desechable y vaciada o reemplazada según sea necesario. Este sistema es seguro, libre de olores y los accidentes son infrecuentes.

COLOCACIÓN DE OSTOMÍA

Antes de la cirugía, su cirujano o enfermera de heridas, ostomía y continencia examinará su abdomen para encontrar un lugar adecuado en su pared abdominal para la apertura o el estoma. Una ostomía se coloca mejor en una porción plana de la parte frontal del abdomen que es fácil de ver. Una colostomía se coloca generalmente a la izquierda del ombligo y una ileostomía a la derecha.

Figura 2: Un aparato de ostomía es una bolsa de plástico. Se sostiene al cuerpo con una barrera adhesiva de la piel que proporciona un control seguro y libre de olores de los movimientos intestinales.

CUIDADO POSQUIRÚRGICOS

  • Se le enseñará cómo usar la bolsa de ostomía por una enfermera o terapeuta enterostomía y su cirujano de colon y recto. Los doctores y las enfermeras trabajarán con usted en cualquier cambio necesario a su dieta.
  • La frecuencia y el volumen de evacuaciones varían de persona a persona. Sus evacuaciones dependerán de la frecuencia con la que fue al baño antes de la cirugía, el tipo de ostomía que se realizó, el tipo de cirugía que se realizó y sus hábitos alimenticios.

Un aparato de ostomía es una bolsa de plástico. Se sostiene al cuerpo con una barrera adhesiva de la piel. Proporciona un control seguro y libre de olores de los movimientos intestinales.

RESTRICCIONES DE LA DIETA

Depender del tipo de ostomía, puede que tenga que cambiar lo que come para controlar el número y la consistencia de los movimientos intestinales. Usted aprenderá a controlar el efecto de los alimentos en la función de ostomía. Después de un período de tiempo, muchos pacientes son capaces de introducir lentamente alimentos de nuevo en sus dietas. Ayuda a masticar bien los alimentos, beber mucho líquido y evitar ciertos alimentos ricos en fibra celulósica, como verduras de hoja verde. Después de recuperarse de la cirugía, la mayoría de los pacientes no tienen limitaciones dietéticas.

RESTRICCIONES FÍSICAS

Todas las actividades incluyendo deportes recreativos y actividades pueden ser reanudadas una vez que la curación de la cirugía es completa. Figuras públicas, artistas famosos e incluso atletas profesionales tienen ostomías que no limitan sus actividades.

La mayoría de los pacientes con ostomías son capaces de reanudar su actividad sexual habitual. Algunos pacientes se preocupan de que su pareja sexual no los encontrará atractivos debido a la bolsa de ostomía. Este cambio en la imagen corporal puede ser superado. Una relación fuerte, tiempo, paciencia y grupos de apoyo ayudan a resolver estos problemas.

¿LA GENTE SABE QUE TENGO UNA OSTOMÍA?

A menos que le digas a alguien, no sabrán que tienes una ostomía. Una ostomía se oculta fácilmente por la mayoría de la ropa. Probablemente usted ha conocido gente con una ostomía y no le has dado cuenta.

PROGNOSIS POST-OSTOMÍA

Una ostomía puede tener complicaciones. Al principio, puede tomar algún tiempo adaptarse a la forma en que el aparato encaja y se vacía. Durante este tiempo, pueden ocurrir accidentes, o fugas de la bolsa. Una vez que esté acostumbrado a la oblea de estoma y la bolsa, los problemas más comunes, como la irritación local de la piel, son fáciles de tratar. Los cambios importantes en la pérdida o ganancia de peso pueden afectar la forma en que se asienta la ostomía en el abdomen. Algunas personas desarrollan una hernia (debilitamiento de la pared abdominal alrededor de la ostomía) o prolapso (una protrusión del intestino). Estos problemas requieren cirugía sólo si causan síntomas importantes.

Vivir con una ostomía requiere un período de aprendizaje y ajuste. Su cirujano de colon y recto y la enfermera proporcionarán la ayuda y el apoyo necesarios. Con un poco de tiempo, descubrirá formas de vivir una vida activa y plena con una ostomía.

¿QUÉ ES UN CIRUJANO DE COLON Y RECTO?

Cirujanos de colon y recto son expertos en el tratamiento quirúrgico y no quirúrgico de las enfermedades del colon, recto y ano. Han completado el entrenamiento quirúrgico avanzado en el tratamiento de estas enfermedades, así como la formación en cirugía general completa. Cirujanos certificados por la junta de colon y recto completan residencias en cirugía general y cirugía de colon y recto, y pasan los exámenes intensivos llevados a cabo por la Junta Americana de Cirugía y la Junta Americana de Cirugía de Colon y Recto. Ellos están bien versados en el tratamiento de enfermedades tanto benignas como malignas del colon, recto y ano. Ellos son capaces de realizar exámenes de detección rutinas y de tratar quirúrgicamente condiciones, si está indicado para hacerlo.

AVISO LEGAL

La Asociación Americana de Cirujanos de Colon y Recto está dedicada a asegurar la atención al paciente de alta calidad, al avance de la ciencia, la prevención y el tratamiento de los trastornos y enfermedades del colon, recto y ano.  El propósito de estos folletos es proporcionar información sobre los procesos de enfermedades, y no la de indicar una forma específica de tratamiento. Están diseñados para el uso de  los médicos, trabajadores sanitarios y pacientes que deseen información sobre la gestión de las condiciones tratadas. Estos folletos no incluyen o excluyen otros métodos apropiados de atención médica de estas enfermedades. La última palabra sobre el tratamiento a seguir le corresponde al médico basándose en las circunstancias  de cada paciente.


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