Intestinal Stomas Flashcards
Loop ileostomy vs loop colostomy
both effectively defunction the distal bowel, however loop ileostomy is associated with a lower incidence of complications related to formation and closure but may carry a higher risk of postoperative intestinal obstruction
If the main incision is used as a stoma site
there is a high incidence of wound infection and incisional hernia formation
Fundamental concept in stoma formation
a stoma is simply an anastomosis between a piece of bowel and the skin of the abdominal wall
In creation of a stomal aperture, a circular incision
2.5 cm in diameter is made at the marked site and the skin is excised
In creation of a stomal aperture, SQ fat
is parted with scissors and small retractors until the fascia of the abdominal wall is reached
In creation of a stomal aperture, a cruciate incision
is made in the rectus sheath, initially no more than 2 cm in each direction and muscle fibers are split, and a small cruciate incision is made in the posterior rectus sheath with electrocautery
End colostomy - typical site
left iliac fossa
End colostomy - colon used
sigmoid or descending colon
End colostomy - end of colon should sit
2 cm above the skin surface
End colostomy - to prevent wound contamination
the colostomy is constructed only after the skin incision has been fully closed and dressed
End colostomy - the spout
should not protrude more than 0.5 to 1 cm above the surface of the skin
Loop colostomy - usually performed as
a quick and temporary method of relieving acute colonic obstruction or to cover an anastomosis in the distal colon or rectum
Loop colostomy - usual site
RUQ (using the proximal transverse colon) or the L iliac fossa (using the L colon)
End ileostomy
most frequently performed after colectomy for inflammatory bowel disease, most distal segment of the ileum is used
In creation of an end ileosotmy, the ___ vessels are divided
ileocolic vessels are divided where they branch from the superior mesenteric vessels
In creating an end ileostomy, the ileocecal fold
(Treves’s fold) is dissected away from the terminal ileum
In creating an end ileostomy, the ileum and supporting mesentery are eased through the aperture
until 5 cm of ileum protrudes above the abdominal skin
Loop ileostomy is created to
rest the distal bowel or to protect an anastomosis
Loop ileostomy is created by
making a circumferential incision arounf 80% of the distal limb at the level of the skin, with the mesenteric side preserved
Divided loop ileostomy
the distal limb is divided with a linear cutting stapler after the loop is brought through the abdominal wall and the distal closed end is tacked to the side of the emerging spout of the proximal end below skin level
In a loop-end ileostomy, the vascular arcades are
left undisturbed
A split ileostomy is constructed by
bringing out the two cut bowel ends at different sites - proximal end is usually TI but the distal end may be either ileum or colon
A split ileostomy creates a
mucous fistula and completely defunctions the bowel without the risk of intra-abdominal leakage from a closed distal stump
A continent ileostomy involves
formation of a reservoir and placement of a nonreturn nipple valve, which is emptied regularly via a catheter
Retraction
generally results from poor adhesion between the serosal surfaces of the everted stoma
In creating a stoma, an incision that permits only
two fingers is appropriate for most elective indications
Surgical approaches to repair of parastomal hernias:
local repair, repair with prosthetic mesh, and stoma relocation
