How is an ostomy created during colon resection (colectomy)?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Preoperative marking is imperative. An ostomy site should be placed through the rectus abdominis rather than through the external oblique muscles. In addition, the patient should be marked while lying flat and while sitting to permit identification of folds of skin that may interfere with ostomy pouching. Avoid beltlines when placing the ostomy, and ensure that an obese patient can see where the ostomy will be.

The authors’ technique is to excise a disk of skin and divide the subcutaneous tissues and anterior rectus sheath vertically. The muscle is bluntly split and the posterior sheath incised. The authors perform Brook ileostomies to facilitate pouching. Colostomies need not be raised above skin level.


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