Colostomy
Reversal
Indications
Reversal
- wait 6 weeks at least: safer and easier as swelling / inflammation
has subsided.
Special Preparation
Ensure
distal anastomosis is satisfactory if definitive operation was
performed
And no obstruction distally.
Prep
R/B/I explained
Time out, Prophylactic ABs, prep drape in supine position
Incision
In the mucocutaneous border
Key Operative Points
- Insert 6 stay sutures (e.g. 2/0 silk) into the mucocutaneous
junction
- Each is held in an artery forceps to allow good retraction
while dissecting
- Deepen incision to reveal colon and external rectus
- Dissect colon loops off abdo wall, until whole loop freed and
can easily be drawn out of abdo cavity.
- Excise mucocutaneous junction.
- Close colostomy transversely : a single layer of seromuscular
sutures; e.g. 3/0 vicryl or PDS.
- Replace in abdo, cover with omentum, site away from the
incision.
- Close wound, single layer, e.g. Nylon interrupted.
- If obese consider a wound drain.
- Close skin
Post-Operative Issues
As for any colonic anastomosis.
Complications
As for any colonic anastomosis.
Alternatives and Controversies
-