The need to cure a disease or condition by removing the entire colon (large intestine) and rectum requires creating a way to evacuate the intestinal waste. The three options available include the conventional Brooke ileostomy, the ileoanal J-pouch, or the continent ileostomy.
Conventional Brooke ileostomy surgery requires a permanent external appliance to collect the intestinal waste because the small intestine is a continuous flow system. Material is produced continuously, even when not eating. The end of the small intestine is brought through an opening in the abdominal wall and sewn to the skin to form a spout or nipple-like projection. This allows the waste to flow into the appliance without contact with the skin. The waste from the small intestine is corrosive to skin, so the appliance must be cemented onto the skin and worn at all times. While most people with a Brooke ileostomy lead a normal life, a significant number will have episodes of leakage with skin irritation, allergies to the adhesives, problems with "bag bulge", limitation in activities, and difficulty making the emotional adjustment to life with an appliance especially regarding intimate relations and dating. In fact, 11% of people with a Brooke ileostomy will require a surgical revision during their lifetime. This may be for retraction of the stoma with inability to maintain a seal, prolapse (a stoma that becomes very long and rubs against the bag), or hernia.