End colostomy

General remarks

• 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

1. Prepare colon for colostomy (temporarily closed with suture or staples)
2. Place traction clamps on dermis and fascia and align them
3. Excise disk of skin of about 3 cm
4. Incise subcutaneous fat (or excise just a very narrow portion)
5. Incise anterior rectus sheath (fascia)
6. Divide muscle fibers and beware of the crossing superficial epigastric vessels
7. Open peritoneum
8. Pull colon through the opening
9. Check if torsion is avoided
10. Close abdominal wound and protect it
11. Excise staple (or suture) line from colon
12. Place sutures between full thickness of colon and skin
13. Apply stoma appliance

References	Early local stoma complications in relation to the applied suture material: comparison between monofilament and multifilament sutures. Bagi P et al. Dis Colon Rectum 1992 Aug;35(8):739-42 The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification. Moreno-Matias J et al. Colorectal dis. 2009 Feb;11(2):173-7.