Key principles
• May be end or loop • Indications: o Diversion to protect distal GI tract or divert from diseased/obstructed segment o After colonic resection o Patient too unwell to form anastomosis after resection
Specific preoperative preparation
• Preoperative marking if possible • If have to site yourself o Examine lying, sitting and standing o Observe for skin folds, belts, bony prominences o Ideally place within triangle formed by ASIS, pubic symphysis and umbilicus o Identify and mark rectus abdominis o Any concerns place high
Operation Details
• Generally performed open as part of another procedure. • Excise a circular disc of skin over the pre-marked stoma site approx. 3cm in diameter • Dissect down to fascia • Retract fascia and skin with Littlewoods to ensure aligned • Open anterior rectus sheath in cruciate fashion. Split recuts muscle and open posterior sheath • Enlarge to admit 2 fingers • Deliver bowel through trephine – either loop or end ensuring not twisted • Close abdomen • Enterotomy to fashion stoma • If loop ileostomy spout afferent limb • Mature stome with 3/0 vicryl • Stoma appliance
Intraoperative complications & challenges
• Unable to achieve length with end ileostomy o Generally, only a problem in morbid obesity o Consider bringing up as loop to allow extra length
Post-operative complications
• Early o Bleeding o High output o Abscess/fistula o Skin irritation • Late o Parastomal hernia o Prolapse o Retraction o Stenosis
Specific post-operative care
• Stomal therapist • Monitor fluid and electrolytes • Fluids, increase oral intake once stoma working