Intestinal Stomas

Question 1

Loop ileostomy vs loop colostomy

Answer 1

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

Question 2

If the main incision is used as a stoma site

Answer 2

there is a high incidence of wound infection and incisional hernia formation

Question 3

Fundamental concept in stoma formation

Answer 3

a stoma is simply an anastomosis between a piece of bowel and the skin of the abdominal wall

Question 4

In creation of a stomal aperture, a circular incision

Answer 4

2.5 cm in diameter is made at the marked site and the skin is excised

Question 5

In creation of a stomal aperture, SQ fat

Answer 5

is parted with scissors and small retractors until the fascia of the abdominal wall is reached

Question 6

In creation of a stomal aperture, a cruciate incision

Answer 6

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

Question 7

End colostomy - typical site

Answer 7

left iliac fossa

Question 8

End colostomy - colon used

Answer 8

sigmoid or descending colon

Question 9

End colostomy - end of colon should sit

Answer 9

2 cm above the skin surface

Question 10

End colostomy - to prevent wound contamination

Answer 10

the colostomy is constructed only after the skin incision has been fully closed and dressed

Question 11

End colostomy - the spout

Answer 11

should not protrude more than 0.5 to 1 cm above the surface of the skin

Question 12

Loop colostomy - usually performed as

Answer 12

a quick and temporary method of relieving acute colonic obstruction or to cover an anastomosis in the distal colon or rectum

Question 13

Loop colostomy - usual site

Answer 13

RUQ (using the proximal transverse colon) or the L iliac fossa (using the L colon)

Question 14

End ileostomy

Answer 14

most frequently performed after colectomy for inflammatory bowel disease, most distal segment of the ileum is used

Question 15

In creation of an end ileosotmy, the ___ vessels are divided

Answer 15

ileocolic vessels are divided where they branch from the superior mesenteric vessels

Question 16

In creating an end ileostomy, the ileocecal fold

Answer 16

(Treves’s fold) is dissected away from the terminal ileum

Question 17

In creating an end ileostomy, the ileum and supporting mesentery are eased through the aperture

Answer 17

until 5 cm of ileum protrudes above the abdominal skin

Question 18

Loop ileostomy is created to

Answer 18

rest the distal bowel or to protect an anastomosis

Question 19

Loop ileostomy is created by

Answer 19

making a circumferential incision arounf 80% of the distal limb at the level of the skin, with the mesenteric side preserved

Question 20

Divided loop ileostomy

Answer 20

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

Question 21

In a loop-end ileostomy, the vascular arcades are

Answer 21

left undisturbed

Question 22

A split ileostomy is constructed by

Answer 22

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

Question 23

A split ileostomy creates a

Answer 23

mucous fistula and completely defunctions the bowel without the risk of intra-abdominal leakage from a closed distal stump

Question 24

A continent ileostomy involves

Answer 24

formation of a reservoir and placement of a nonreturn nipple valve, which is emptied regularly via a catheter

Question 25

Retraction

Answer 25

generally results from poor adhesion between the serosal surfaces of the everted stoma

Question 26

In creating a stoma, an incision that permits only

Answer 26

two fingers is appropriate for most elective indications

Question 27

Surgical approaches to repair of parastomal hernias:

Answer 27

local repair, repair with prosthetic mesh, and stoma relocation