Ileostomy

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Indications
Routine

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Special Preparation
Mark stoma site

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Prep
Routine

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Operative Notes

Terminal Ileostomy
Grasp skin with moynahans and elevate.
Excise a disc of skin about 3 cm in diameter and related subcutaneous fat down to fascia.
I perform a linear incision through the fascia, and a muscle splitting approach.
Diathermy through peritoneum, ensuring ultimate defect is just large enough to fit two fingers.
Pass stapled end of ileostomy through this defect, to lie about 6-8 cm out of abdomen with good mobility.
I do not fix ileostomy to fascia
Close main abdominal wound.
Trim stapled ileostomy end with diathermy.
The stoma is then everted to lie with a pout of around 3cm from the abdominal surface.
This is done with 3-0 monocryl sutures, picking up seromuscular bowel around 2-3 cm back from the orifice, then a small bite at the orifice, before taking dermal layer and tieing.
With 3-4 interrupted sutures the ileostomy will roll back on itself.
This can be encouraged with forceps or babcock if reqd.
Clean and dry and place stoma appliance

Loop
Same but:
Deliver a loop of bowel into the defect.
Open the bowel loop close to skin level on the distal aspect.
Suture mucosa of distal bowel to skin.
Proximal bowel is sutured as above, everting mucosa.
Can also place a plastic rod through the mesentery to form a bridge that prevents bowel from slipping back into the abdomen.
This is removed in 7 days.
Clean and dry and place stoma appliance

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Post-Operative Issues
Stoma therapist

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Complications
Retraction
Ischaemia, stenosis.
Hernia
High output
- bulking agents,

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Alternatives and Controversies
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