A Short History of Ostomy Surgery

Ostomy surgery creates a stoma — a surgically formed opening of bowel or urinary tract onto the abdominal wall. From eighteenth-century last-resort colostomies to twentieth-century ileostomy and urostomy techniques, the specialty moved from high mortality to planned, often elective, life-saving care. Advances in anaesthesia, antisepsis, spout construction and skin-protective appliances made long-term living with a stoma realistic. This article outlines that surgical history in brief.

Last-resort operations of the eighteenth century

Surgeons have long known that an opening between bowel and skin can relieve obstruction. Classical and medieval texts describe intestinal wounds and rare fistulas, but the records are fragmentary. Later authors sometimes credited ancient physicians with deliberate ostomies. Evidence for those claims is mixed, and most historians treat planned ostomy surgery as an eighteenth- and nineteenth-century development.

In 1710 the French anatomist Alexis Littré proposed bringing bowel to the groin to treat infants born without a functioning anus. He did not perform the operation. Documented colostomies in living patients followed later that century. In 1776 Pillore of Rouen created a caecal opening for obstructing rectal cancer; the patient survived several weeks. In 1793 Duret of Brest constructed a left iliac colostomy in a newborn with an anorectal malformation; reports from the period said the child survived into adult life. These were desperate procedures, undertaken without modern anaesthesia or antisepsis. Peritonitis, dehydration and wound failure were common.

Nineteenth-century colostomy: avoiding peritonitis

As abdominal surgery expanded, infection of the peritoneal cavity became the central obstacle. Opening the peritoneum to reach the colon often killed the patient even when obstruction was relieved.

Extraperitoneal and loop techniques

In 1839 Jean Zulema Amussat described a lumbar, extraperitoneal colostomy, approaching the descending colon from the flank so that the peritoneal sac might be left intact. The aim was to drain faeces while lowering the risk of peritonitis. Lumbar colostomy enjoyed a period of use, especially for malignant obstruction, but exposure was awkward and the stoma was difficult to manage on the flank.

By the late nineteenth century, surgeons including Maydl had developed loop colostomy: a loop of colon is lifted through the abdominal wall, supported, opened and left to divert stool. Exteriorisation of obstructing tumours, associated with Mikulicz and others, allowed decompression without an immediate intraperitoneal join. Anaesthesia, Listerian antisepsis and later aseptic technique slowly made planned colostomy less lethal. Even then a colostomy remained a grim prospect. Bulky dressings, odour, leakage and social isolation were usual, and many operations were still performed only when obstruction was already advanced.

Ileostomy: from desperation to a constructed spout

Ileostomy — bringing the small bowel to the skin — was harsher than colostomy. Small-bowel effluent is liquid, enzyme-rich and continuous. Early ileostomies, performed from the late nineteenth century and more often in the early twentieth for severe ulcerative colitis, frequently failed because output digested the abdominal skin. Mortality after colectomy and ileostomy in the 1930s and 1940s was high in many published series. That reflected both the severity of the colitis and the lack of a reliable spout and appliance.

The Brooke principle and specialist centres

A decisive change came in 1952, when Bryan Brooke in the United Kingdom described everting the ileum and suturing mucosa to skin, creating a protruding spout. The Brooke ileostomy directed liquid output into an appliance rather than across the skin. Independently, surgeons at centres such as the Cleveland Clinic refined end and loop-end ileostomy and organised systematic aftercare.

Once a spout could be fitted with an adhesive bag, elective colectomy and permanent ileostomy became a realistic treatment for ulcerative colitis and familial adenomatous polyposis, rather than a last gasp. From the late 1960s Nils Kock in Sweden developed a continent ileostomy — an internal reservoir emptied by catheter. In 1978, work at St Mark’s Hospital, London, by Alan Parks, John Nicholls and colleagues established restorative proctocolectomy with an ileal pouch–anal anastomosis. That operation allowed selected patients to avoid a permanent stoma after the colon and rectum were removed. Continent reservoirs and pouch surgery carry their own complications. They expanded choice; they did not make the end ileostomy obsolete, and it remains a standard, durable operation.

Urinary diversion and the ileal conduit

Parallel work addressed the bladder. Nineteenth-century ureterosigmoidostomy joined the ureters to the sigmoid colon so that urine mixed with stool and left via the anus. It could divert urine after bladder removal or in some congenital anomalies, but long-term problems included infection, electrolyte disturbance and cancer at the anastomosis. In 1950 Eugene Bricker described the ileal conduit: a short isolated loop of ileum brought out as a urostomy, with the ureters implanted into that loop. The Bricker conduit became the reference incontinent urinary diversion after cystectomy and is still widely used. Later continent urinary pouches and bladder reconstructions added options for selected patients, with trade-offs that need individual counselling from a urological team.

Appliances, enterostomal therapy and patient voices

Surgery alone did not make life with an ostomy sustainable. Until the mid-twentieth century people relied on dressings, sponges, metal or rubber collectors and harsh adhesives. Adhesive rubber pouches devised in the 1940s, often by patients themselves, then natural gum barrier rings, and later hydrocolloid skin barriers and two-piece pouch systems, transformed skin protection. None of this replaced careful fitting by a trained clinician.

In 1958 Norma Gill, herself living with an ostomy, began work at the Cleveland Clinic that is widely regarded as the start of enterostomal therapy as a nursing specialty. Specialist stoma care nursing emerged in the United Kingdom from the 1970s. Patient associations, including the Ileostomy Association founded in Britain in 1956, challenged stigma, shared practical knowledge and pressed for better appliances and trained nurses. The partnership of surgeon, stoma care nurse and patient is now the expected model of care.

Techniques continue to evolve, including laparoscopic and robotic stoma formation, more consistent preoperative siting, and better recognition of parastomal hernia and high-output problems. The core anatomy of an end or loop stoma would still be recognisable to Brooke or Bricker. Anyone living with a stoma, or preparing for one, should discuss their own operation, appliance and follow-up with their stoma care nurse or clinician. History explains how modern ostomy care arose; it is not a guide to an individual’s treatment.

The bottom line

Ostomy surgery moved, in little more than two centuries, from rare emergency colostomy to a family of planned operations — colostomy, ileostomy and urostomy — that save lives in cancer, inflammatory bowel disease, congenital anomalies and trauma. The turning points were not only operative: spout construction, urinary conduits, skin-protective appliances and specialist nursing made long-term health possible. Personal advice on any stoma still belongs with a stoma care nurse or clinician.