Colostomy

Indications
Divert a fecal stream
Protect an anastomosis
Palliate a bowel cancer.

Special Preparation
Nil.

Prep
R/B/I explained
Time out, Prophylactic ABs, prep drape in supine position

Incision
Where should I site a stoma?
~10cm toward umbilicus from ASIS for L stomas
Not in a skin fold.

Key Operative Points : General End Colostomy

Key Operative Points : End Sigmoid Colostomy


Key Operative Points : Loop Transverse Colostomy

Post-Operative Issues

Remove bridge device in 7 days
Longer if obesity and difficulty in bringing up the stoma.


Complications
1. Retraction due to inadequate mobilization of the bowel.
- can cause disruption of the mucocutaneous suture line, subcutaneous contraction and progressive stenosis.
2. Ischaemia
- Leave out enough 'anchor warp' for when the tide goes out.
- i.e. allow laxity for oedema / stretch post op.
3. Bringing out wrong end.
- oops.

Alternatives and Controversies
- Note that stoma nurses dislike Abcarian stomas
- distal end pulls in, retracting the stoma and leaving problematic form