Stoma

• Artificial opening allowing connection between two surfaces

Uses

1. Input
   • PEG / gastrostomy / jejunostomy - allow feeding
   • Tracheostomy - allow air
2. Output
   • Ileostomy
   • Colostomy
3. Diversion
   • Nephostomy / urostomy - divert flow of wee
4. Decompression
   • Tube thoracostomy
   • Laparostomy

Complications of GI Stoma

1. Local
   • Skin irritation
   • Leakage
   • Odour
   • Prolaps
2. Systemic
   • Electrolyte imbalances
   • Malabsorption
   • Short gut syndrome
3. "Surgical"
   • Strangulation / ischaemia
   • Inadequate diversion and spillage
   • Stomal stenosis
   • Retraction
   • Stomal ulceration

Formation of End Ileostomy

Indications

• Permanent stoma after total colectomy

Terminal ileum has absorptive functions - try to preseve as much as possible

1. GA + NGT + Antibiotics + DVT
2. Incise 2cm circle of skin over appropriate area (LIF)
3. Dissect down to rectus and make cruciate incision
4. Deliver ileum
5. Stitch ileal serpsa and mesentry to anterior abdominal wall
6. 6-8 cm protrusion to form spout (ideal spout should be 2-3cm)

Formation of Loop ileostomy

Formation of Loop colostomy

Indications

• Defunction distal obstructed colon

1. GA + NGT + DVT + Catheter + supine position
2. Formation of stoma
   • Pick up skin, incise 2cm down to rectus sheath
   • Cruciate incision
   • Dissect down to peritoneum, avoid inferior epigastric artery
   • "Rubber sling" the colon with a cather, and draw out into wound
3. Fixation of stoma
   • Place colostomy bridge
4. Open bowel longitudinally along taeniae with knife (allow explosive gases to be release
5. Suture edges of stoma to skin using interrupted sutures
6. Clean skin + apply colostomy appliance

Closure of Loop colostomy

Indications

• Restore bowel continuity after temporary diversion
• When stoma has "matured" (at least 2-3 months)
• Recovered from primary pathological process necessitating stoma

1. NGT + GA + Antibiotics + DVT + catheter
2. Release stoma / free bowel
   • Incise around stoma about 0.5cm from the mucocutaneous edge
   • Apply traction upwards
   • Deepen incision and angle towards colon
3. Close defect
   • Excise old stoma
   • Close colon with interrupted 2/0 full thickness sutures
4. Close wound in layers