Colostomy Surgery

A colostomy brings the colon to an opening on the abdomen, where stool collects in a pouch. Many are temporary, and the operation that closes them is now done through keyhole cuts.

Colostomy surgery creates a stoma, an opening on the abdominal wall, so stool leaves the body into a pouch instead of through the rectum. Surgeons make one after removing the lower rectum for cancer, in emergencies such as a perforated bowel, or to let a join or a wound heal, and many are closed again months later. This page explains the types of colostomy, when an emergency operation can avoid one, how marking the site and mesh lower complications, what daily life looks like, how reversal works, and what to send for a free review.

Types of colostomy

In an end colostomy, the surgeon divides the colon and brings one end through the abdominal wall, and the bowel below is removed or closed off inside, as in the Hartmann procedure. A loop colostomy brings a loop of colon to the surface and opens it, which diverts stool while leaving the bowel in one piece. It is the simpler of the two to close. A sigmoid or descending colostomy sits on the left side of the abdomen. Its stool is formed. An ileostomy uses the small bowel instead and passes liquid output.

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What remains below the stoma decides whether it is permanent or temporary.

Why a colostomy is made

• Low rectal or anal cancer that needs removal of the anal sphincter
• A perforated colon from diverticulitis or a tumor, with infection in the abdomen
• A blockage of the colon that cannot be joined safely at once
• Protecting a fragile join or a complex fistula while it heals
• Severe incontinence, pelvic radiation injury or spinal cord injury, where a stoma eases daily care
• Injury to the colon or rectum

The reason sets whether the stoma is meant to stay or to be closed.

Emergency surgery and the Hartmann procedure

When diverticulitis bursts and spreads pus or stool through the abdomen, the traditional operation is the Hartmann procedure, which removes the diseased colon, closes the rectal stump and leaves an end colostomy. In stable patients, a primary join, sometimes protected by a temporary stoma, is the alternative. Stability decides. Across four randomized trials and ten observational studies with 1,066 patients, a primary join gave higher odds of eventually living without a stoma, an odds ratio of 2.62 for reversal, with no difference in death or complications after the first operation. Safety was equal. A second review of 918 patients found a lower rate of permanent stoma after a primary join.

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Before a planned colostomy

The stoma nurse joins the team from the first visit.

Marking the stoma site before surgery, with you sitting, standing and bending, places the opening where you can see it and where a pouch seals. It takes minutes. Across 27 studies, marking cut stoma complications, with an odds ratio of 0.45, and lowered leakage and skin problems, though the evidence was weak.

Parastomal hernia and mesh

Prevention starts at the first operation.

What it is

A parastomal hernia is a bulge beside the stoma. Bowel pushes through the abdominal wall there. Reported series put it at 30 to 70 percent after an end colostomy. It makes the pouch harder to seal. Avoiding heavy lifting for the first months and keeping a steady weight both protect the abdominal wall.

Mesh at the first operation

Placing a synthetic mesh behind the muscle around the stoma at the first operation aims to stop the hernia forming. In seven randomized trials with 956 patients, clinical hernias fell from 312 to 213 per 1,000 with mesh, with no rise in infection, stoma necrosis or reoperation. The certainty was low. A European guideline review of 12 trials found fewer hernias with mesh, an odds ratio of 0.33, without a difference in quality of life or in repair operations. The decision is made case by case.

Living with a colostomy

Pouches and daily care

Pouches are changed or emptied once or twice a day for a colostomy that passes formed stool. Closed pouches suit a left-sided colostomy, while a flat or convex base plate follows the shape of the skin.

Food

No special diet is needed after the first weeks. Gas-forming foods, fizzy drinks and late meals raise noise and output, and a food diary shows which foods affect you.

Irrigation

Some people with a left-sided colostomy wash out the bowel every day or two with warm water through a cone, which empties the colon on a schedule and allows a small cap in place of a pouch. A stoma nurse teaches it once the stoma has settled.

Work, travel and intimacy

Office work resumes within weeks, and heavy manual work after three months with a support belt. Clothes need no change. Swimming works with a closed pouch and well-fitting swimwear. On flights, pack twice the supplies you expect to need in hand luggage, cut the base plates at home, carry a travel certificate for security and keep a spare pouch in a pocket, because cabin pressure can swell the bag and a quick change is easier with everything ready. Sexual activity resumes once the wound has healed, and an empty pouch, a pouch cover or a mini cap keep the stoma out of mind.

Work, travel and sport carry on with a colostomy.

Closing the colostomy

When and how

Healing comes first. Reversal follows three to six months after the first operation, once the bowel has healed, cancer treatment has finished and you have recovered your strength. A loop colostomy closes through the stoma site in a short operation. Reversing a Hartmann procedure means rejoining the colon to the rectal stump inside the abdomen, a larger operation. Pooled data from 65 studies with more than 10,000 patients found a hospital stay of 4.2 days after robotic reversal against 8.0 after laparoscopic reversal, with fewer wound infections at the cost of a longer operation, and most of that evidence came from indirect comparisons. When the Hartmann procedure itself is done by keyhole surgery, single-arm series report reversal in over 80 percent.

After closure

Across 17 studies with 2,899 patients, a hernia at the old stoma site followed in 16.8 percent, and the risk rose after a colostomy, an end stoma, a parastomal hernia or a higher body weight. Mesh at closure is considered for these patients. Bowel habits take weeks to months to settle. Patience helps. Over that time the remaining colon adapts, stools firm up and urgency fades, and a physiotherapist trained in pelvic floor exercises helps when the rectum has been through radiotherapy.

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Planning the visit

Published Istanbul packages for colon surgery list three to eleven nights in hospital, depending on the operation. Plan ten to fourteen days in the city, so the stoma nurse sees you after discharge and the pouch fits well before the flight.

1. Day one, examination, scans and blood tests
2. Day two, meeting the stoma nurse and site marking
3. Day three, surgery
4. Ward days, pouch changes with the nurse until you manage alone
5. Before the flight, a pouch fitting, a supply list and a travel certificate

A single coordinator looks after your plan on WhatsApp from the first message and remains your contact after you fly home, working in English, Arabic, French, Russian, Serbian, Romanian or Spanish, with an interpreter arranged for other languages. A family member stays every night on the companion bed in your room. The international patients office books the hotel around your admission, collects you at the airport and takes you to each appointment. A female surgeon is assigned on request wherever the rota allows. Halal, vegetarian and diabetic meals come from the hospital kitchen. There is a prayer room. Your visa invitation letter goes out ten days before travel. Stoma supplies for the flight are packed with you. Carrying luggage strains a new stoma, so the coordinator books help and a wheelchair at both airports. Call us the same day if the stoma turns dark or black, stops working for a day with pain and vomiting, or bleeds heavily. Back home, the stoma nurse answers pouch questions by message, and the surgeon reviews your progress by video call at two weeks and three months.

Cost of colostomy surgery

Cost depends on whether the colostomy is planned or part of a larger operation, laparoscopic or open surgery, mesh, the nights in hospital and stoma supplies for the first weeks. Supplies at home are extra. A quote comes after a surgeon has seen your reports and scans, and that review is free. Get it in writing. The table below shows how each factor moves the figure, and the written quote names every item it covers.

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Colostomy surgery FAQ

For a reversal review, add these.

• A contrast study or endoscopy of the rectal stump
• Your latest blood count and kidney tests
• Details of any chemotherapy or radiotherapy

References

1. Lambrichts DP, Edomskis PP, van der Bogt RD, Kleinrensink GJ, Bemelman WA, Lange JF. Sigmoid resection with primary anastomosis versus the Hartmann's procedure for perforated diverticulitis with purulent or fecal peritonitis: a systematic review and meta-analysis. Int J Colorectal Dis. 2020;35(8):1371-1386.
2. Ryan OK, Ryan EJ, Creavin B, Boland MR, Kelly ME, Winter DC. Systematic review and meta-analysis comparing primary resection and anastomosis versus Hartmann's procedure for the management of acute perforated diverticulitis with generalised peritonitis. Tech Coloproctol. 2020;24(6):527-543.
3. Ambe PC, Kugler CM, Breuing J, et al. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy: a systematic review and meta-analysis. Colorectal Dis. 2022;24(8):904-917.
4. Mirza W, Khan ME, Iqbal H, et al. Retromuscular (sublay) synthetic mesh reinforcement versus no mesh at end-colostomy creation to prevent parastomal hernia: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials. BMC Surg. 2026;26(1). doi:10.1186/s12893-026-03715-4.
5. Tzanis AA, Stabilini C, Muysoms FE, et al. Update systematic review, meta-analysis and GRADE assessment of the evidence on parastomal hernia prevention, a EHS, ESCP and EAES collaborative project. J Abdom Wall Surg. 2023;2:11550.
6. Abdelsamad A, Khalil Y, Mohamed K, et al. Does robotics add value in Hartmann's reversal? A PRISMA-based systematic review and meta-analysis of perioperative outcomes. Tech Coloproctol. 2026;30(1). doi:10.1007/s10151-026-03414-5.
7. Zhang Y, Liu C, Nistala KRY, Chong CS. Open versus laparoscopic Hartmann's procedure: a systematic review and meta-analysis. Int J Colorectal Dis. 2022;37(12):2421-2430.
8. Ramirez-Giraldo C, Van-Londono I, Monroy DC, et al. Risk factors associated to incisional hernia in stoma site after stoma closure: a systematic review and meta-analysis. Int J Colorectal Dis. 2023;38(1):267.