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The type of ostomy is classified according to the segment of the GI tract utilized to create the ostomy and the method of surgical construction. Depending on the manner of the disease or the site of the obstruction, the surgeon will determine the optimal location to establish the ostomy.

An ileostomy is created when it is necessary to bypass the entire colon and rectum. In general, patients with ileostomies have watery frequent stooling patterns since they do not possess large bowel function. It is usually created within the rectus sheath, in the infraumbilical fat pad, and can be temporary or permanent. In a diverting loop ileostomy, a loop of terminal ileum is brought out through the abdominal wall, opened, and sutured to the dermis. This is the most common type of temporary diversion ostomy and is used in patients who are considered high risk for anastomotic breakdown. A mucous fistula, which will be described in more detail in the next paragraph, can also be created within the construct of a loop ileostomy. An end‐ileostomy is an ostomy in which the ileum is delivered through the interior abdominal wall and sutured in place with everting sutures to create an end stoma.

A colostomy is created when it is necessary to bypass or remove the distal colon, rectum, or anus. As with other ostomies, they can be temporary or permanent and can be created in the loop or end fashion. In general, loop ostomies are easier to reverse and are more frequently used when a temporary ostomy is required. Patients with colostomies usually have semi‐formed stools because the absorptive and storage function of the large bowel is preserved. A mucous fistula is sometimes created during an end‐colostomy. Usually, the distal end of the colon is oversewn or stapled and left in the abdominal cavity as a nonfunctional stump. However, in cases where there is a high likelihood of breakdown of the stump, which can then lead to abdominal sepsis, or if the anus is strictured to a degree that does not allow rectal mucous to drain freely, it can be secured in place adjacent to colostomy as a mucous fistula in the subcutaneous tissue but not matured out to the skin. The mucous fistula does not pass stool but does allow passage of mucous or gas from the nonfunctioning portion of the distal colon or rectum.

The spit fistula is rarely used anymore, but may be created in the setting of an esophagectomy where part of the esophagus is excised, such as in esophageal cancer, swallowing disorders, and trauma. If an anastomotic leak occurs, an ostomy can be created that will allow drainage to be diverted outside the body to the lower neck or clavicle region.