- An end colostomy is usually located on the left lower quadrant through the rectus muscle
- If a colostomy is being performed proximal to an obstructed lesion (thus to decompress the colon and divert the flow of stool), it is critical that the distal limb of the colon is being vented. If not there is a substantial risk of distension and subsequent perforation.
- The incidence of mucocutaneous complications seems higher when a braided suture is used compared to a monofilament suture.
- Parastomal hernia is a common complication of end colostomy, and found in over 50% of patients.
Step by step
- Prepare colon for colostomy (temporarily closed with suture or staples)
- Place traction clamps on dermis and fascia and align them
- Excise disk of skin of about 3 cm
- Incise subcutaneous fat (or excise just a very narrow portion)
- Incise anterior rectus sheath (fascia)
- Divide muscle fibers and beware of the crossing superficial epigastric vessels
- Open peritoneum
- Pull colon through the opening
- Check if torsion is avoided
- Close abdominal wound and protect it
- Excise staple (or suture) line from colon
- Place sutures between full thickness of colon and skin
- Apply stoma appliance