Loop vs End Ileostomy

Hi Pouch4wf: I am not sure that I really know the answer to your question but I can offer some thoughts. I had an end ileostomy which, as you say, was rather non-problematic. Following surgery this past February to create my J-pouch in preparation for a reversal, I now have a loop ileostomy which is very problematic. My surgeon warned me that it could have a very high output (which it certainly does) because it is closer to the stomach and food waste has less travelling distance. As a result of the high liquid volume, I had been readmitted to hospital as well as 2 separate days in the ER because of dehydration and electrolyte imbalance. I have also had a lot of trouble with my skin. I am taking enough medication to constipate an elephant and all it does is slow the output down and thicken it enough that I can keep up with the fluid replacement and prevent the electrolyte imbalance. I have also managed to get the skin problem under control. I was not getting a lot of nutrient absorption and subsequently lost almost 30 pounds. Finally, my weight has stabilized and I just have to maintain the status quo until my reversal procedure in 4-5 weeks. I know I didn't really answer your question but you aren't alone.

Loop ileostomies tend to lay flatter or in an uneven way and are more likely to recess, so getting a good seal can often be much more difficult. It is sort of a structural defect caused by. The intestine "tugging" from two directions.

Jan

Kathy got the main reason, it's higher up in the intestine and therefore your output is digested less and less liquid is absorbed from it. Therefore you have more output, it is more liquidy/corrosive to the skin, and it is much harder to stay hydrated and keep from losing weight.

The distal end of the loop ileostomy sometimes puts out mucus, and this can cause leaks because people who are used to the end ileo often place their wafer OVER the distal opening, so the mucus comes out under the wafer and loosens the adhesive.

Finally, the loop ileostomy is under more tension, so it tends to be more retracted/flush with the skin. Additionally, the increased tension can make one more prone to blockages (I had many partial blockages with my loop ileostomy). Anecdotally I had very bad back pain while I had the loop ileostomy that my surgeon attributed to the unnatural conformation of the small bowel caused by the loop. As soon as the ileostomy was closed, my back pain disappeared 100%.