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Review
. 2017 Jul;30(3):162-171.
doi: 10.1055/s-0037-1598156. Epub 2017 May 22.

Technical Considerations in Stoma Creation

Alia Whitehead  1 , Peter A Cataldo  1
Affiliations
Review

Technical Considerations in Stoma Creation

Alia Whitehead et al. Clin Colon Rectal Surg. 2017 Jul.

Abstract

Creating an intestinal stoma is commonly the final aspect of an often emergent and complicated operation under difficult circumstances. While creation of a protruding, tension-free, and well-vascularized stoma is often straightforward, one must be prepared for challenging situations such as a thick abdominal wall and short, thickened mesentery. A successful stoma starts with attentive preoperative planning including site marking, thoughtful consideration of alternatives, and attention to technical detail. The tips provided in this article should facilitate the process of selecting the appropriate intestinal segment, identifying the correct stoma site, and creating a functional stoma even in the most challenging situations. Constructing a high-quality stoma will decrease complications and improve the patient's quality of life. Stoma creation is frequently the only component of an operation that the patient will have to live with for the remainder of his/her life.

Keywords: colostomy; ileostomy; stoma; surgery; surgical repair.

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Figures

Fig. 1
Fig. 1
Excision of skin disc at stoma site.
Fig. 2
Fig. 2
Cruciate incision in anterior fascia.
Fig. 3
Fig. 3
Splitting of rectus muscle in direction of fibers.
Fig. 4
Fig. 4
Incision of posterior rectus sheath.
Fig. 5
Fig. 5
Delivery of bowel through stoma site.
Fig. 6
Fig. 6
Loop ileostomy creation. Ileum is elevated through stoma site with a Penrose drain. Care is taken to avoid twisting.
Fig. 7
Fig. 7
Loop ileostomy creation. Eighty percent of the antimesenteric circumference is transected between Allis clamps.
Fig. 8
Fig. 8
Loop ileostomy creation. Proximal end of the ileum is everted with standard three part sutures.
Fig. 9
Fig. 9
End-loop colostomy creation.
Fig. 10
Fig. 10
Potential port locations for laparoscopic ostomy creation.
Fig. 11
Fig. 11
Creation of passage and tunneling of end colostomy.
Fig. 12
Fig. 12
Steps in stoma creation for PREVENT trial.
Fig. 13
Fig. 13
Steps in stoma creation for stapled mesh stoma reinforcement technique trial.
Fig. 14
Fig. 14
An Alexis Wound Protector facilitates passage of bowel through the abdominal wall.
Fig. 15
Fig. 15
Pseudoloop colostomy creation.
See this image and copyright information in PMC

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