Mark stoma site
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
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
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.
and dry and place stoma appliance
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
- bulking agents,
Alternatives and Controversies