Anus praeter – treatment, effects & risks

application and function

The anus praeter is most frequently placed to protect the intestine after surgical removal of the tumour. This allows the intestines to heal over several months, and the stoma can then be moved back. Patients with chronic intestinal inflammation (Crohn’s disease) benefit permanently from an anus praeter, as this simplifies the complicated natural elimination for them.The anus praeter can also be necessary for diseases such as diverticulitis or familial adenomatous polyposis (FAP). Rare indications for the anus praeter are accidents and injuries that have affected the intestine so badly that it needs time and rest to heal.

Creating an anus praeter is always about temporarily or permanently relieving a section of the intestine for healing or treatment purposes.

methods and procedures

The way in which an anus praeter is created depends on which part of the intestine is affected and whether a relocation is planned. In principle, this can only be carried out 6 months after placement of the anus praeter. A terminal stoma is an option when the colon and rectum are affected. The remaining end of the intestine is tightly closed and the anus praeter is usually permanent.

With a double-barreled stoma, two bowel outlets can be seen, one coming from the stomach and the other forming the rest of the bowel in the direction of the anus. The small intestine is usually affected and the anus praeter is planned to be moved back. It protects a healing section of intestine or protects particularly delicate seams, which is why the double-barreled stoma can often be moved back after a few weeks.

Furthermore, a distinction is made between permanent and temporary anus praeter, regardless of the intestinal site.

What does the patient have to consider?

An anus praeter means a drastic change for the patient. It is therefore best to consult a stoma specialist weeks before the procedure. After the operation, you have to learn how to deal with the stoma care, which comes in one and two parts.

There is a protective plate for the anus praeter, which lies directly on the stomach, and a bag that is either firmly attached to the protective plate and can be changed with it or can be detached from it.

The stoma patient can generally shower and bathe without a stoma supply. Since the patient can see the anus praeter, the aftercare can be stressful for him at first. Adequate care of the patient, which shows him the hygienic care of the anus praeter, is all the more important.

process and implementation

The creation of an anus praeter is done surgically and under general anesthesia. Since it is usually applied as a measure in the course of cancer treatment, the tumor is removed as far as possible during the operation.

In advance, the correct position of the anus praeter is determined together with the patient: the pouch must not hang too high or too low later, and the stoma must not sit in a crease. The effects on the everyday life of the patient would otherwise be too restrictive.

Depending on the affected section of bowel and the repositioning, the anus praeter is either created in such a way that it can be repositioned again, or it is permanent and the remaining end of the bowel to the anus is tightly closed.

Self-service or health insurance – who bears the costs?

The installation of an anus praeter is done to treat serious illnesses, which is why the operation is fully covered by health insurance. Basic stoma care is also covered by the health insurance company on prescription from the doctor. If the patient needs a different, more expensive or more ostomy care product, this must be medically justifiable, otherwise they will have to bear the additional costs for the ostomy care themselves.

There are also aids for changing ostomy care that are not covered by every health insurance company. These are, for example, gauze bandages for cleaning, skin protection products or adhesive solvents for the protective plate on the abdomen.

Risks, dangers and complications

When applying the anus praeter there is a risk of injury to the surrounding organs. Sutures on the intestines that later become leaky can also tear after the anus praeter has been attached and lead to complications. The risk is significantly minimized by the fact that the patient does not carry more than 10 kg, and hernias at the exit point of the intestine can also be avoided in this way.

The bowel protruding from the abdominal wall may retract into the abdominal cavity (retraction) or protrude too far (prolapse), necessitating repositioning. Stenosis , in which metabolic products can no longer be excreted, is dangerous ; the anus praeter patient often only suffers from abdominal pain and recognizes the stenosis too late.

Severe bleeding from the anus praeter can indicate necrosis , which is one of the rarer complications. Care should be taken around the anus praeter with razors and sharp objects, since the stoma is not sensitive to pain and injuries would not be noticed.