Ileostomy, construction of

  • Universität Witten/Herdecke

    Prof. Dr. med. Gebhard Reiss

Single Access

Access to this lecture
for 3 days

€1.99 inclusive VAT

payment

full access to all lectures
price per month, cancellable on a monthly basis

for the modul: General Surgery

€9.90 inclusive VAT

payment

full access to all lectures
price per year, cancellable on a yearly basis

for the modul: General Surgery

€98.00 inclusive VAT

(You save more than 20,00 Euro compared to the monthly membership)

payment

hospitals & libraries

for the modul: General Surgery

from 390,00 euros

  • Klinikum Augsburg

  • Gemeinschaftspraxis Diedorf

    Michaela Rose

Single Access

Access to this lecture
for 3 days

€1.99 inclusive VAT

payment

full access to all lectures
price per month, cancellable on a monthly basis

for the modul: General Surgery

€9.90 inclusive VAT

payment

full access to all lectures
price per year, cancellable on a yearly basis

for the modul: General Surgery

€98.00 inclusive VAT

(You save more than 20,00 Euro compared to the monthly membership)

payment

hospitals & libraries

for the modul: General Surgery

from 390,00 euros

  • Indications

    Paid content (image)
    Paid content (text)
  • Contraindications

    Paid content (text)
  • Preoperative diagnostic work-up

    Paid content (text)
  • Special preparation

    Paid content (text)
  • Informed consent

    Paid content (text)
  • Anesthesia

    Paid content (text)
  • Positioning

    Paid content (image)
    Paid content (text)
  • Operating room setup

    Paid content (image)
    Paid content (text)
  • Special instruments and fixation systems

    Paid content (text)
  • Postoperative management

    Paid content (text)
date of publication: 17.09.2012
  • Klinikum Augsburg

  • Gemeinschaftspraxis Diedorf

    Michaela Rose

Single Access

Access to this lecture
for 3 days

€1.99 inclusive VAT

payment

full access to all lectures
price per month, cancellable on a monthly basis

for the modul: General Surgery

€9.90 inclusive VAT

payment

full access to all lectures
price per year, cancellable on a yearly basis

for the modul: General Surgery

€98.00 inclusive VAT

(You save more than 20,00 Euro compared to the monthly membership)

payment

hospitals & libraries

for the modul: General Surgery

from 390,00 euros

  • Stoma site marking

    88-5

    Ideally, the stoma should be marked and the subsequent instructions for stoma care given by specially trained stoma nurses or an experienced surgeon.

    1. Trial marking, with the patient supine or already sitting, within the right rectus abdominis (level of the umbilicus) in a 10×10cm skin area, preferably without folds and creases, scars and bony prominences.
    2. Check of the planned site with the patient in motion (standing, stooping down).
    3. The selected  site should be easily accessible to the patient and within his/her visual field and away from the natural beltline.
    4. To allow for intraoperative complications marking a secondary location is recommended.
    5.  Dressing the markings with sensitive skin bandages.

    The site of the ileostomy deeply affects its management and thus the patient’s quality of life!

  • Locating the loop of the terminal ileum

    88-6

    After opening the abdominal cavity or completion of the major procedure, locate the loop of the terminal ileum with which to construct the loop ileostomy. The loop selected for the stoma should be at least 20cm proximal to the ileocecal valve.

  • Taping the ileum loop

    88-7

    Pass a silicone tape through a mesenteric window created close to the bowel preferably in an avascular area.

  • Skin incision for stoma and dissection down to the fascia.

    Paid content (video)
    Paid content (image)

    While lifting up the skin with, e.g., a towel clamp make a circular skin incision at the preoperatively marked site. The diameter of the skin incision should not exceed 3cm. Then dissect the subcutaneous tissue down to the fascia.

  • Dividing the anterior lamina of the rectus sheath

    Paid content (video)
    Paid content (image)

    After excision of skin and subcutaneous tissue, open up the anterior lamina of the rectus sheath in cruciform fashion. Stretching the fascia hereby will help avoid overlapping

  • Splitting the muscles

    Paid content (video)
    Paid content (image)

    Split the rectus muscle in the direction of its fibers until the posterior lamina of the rectus sheath is exposed.

  • Dividing the posterior lamina of the rectus sheath and the peritoneum

    Paid content (video)
    Paid content (image)

    Also divide the posterior lamina of the rectus sheath, together with the peritoneum, in cruciform fashion creating an opening just large enough to pass three fingers through ("three-finger test").

  • Delivering the ileum through the abdominal wall

    Paid content (video)
    Paid content (image)

    Pass the tape through the abdominal wall trephine and deliver the bowel loop, with the proximal limb located inferiorly. Some surgeon secure the loop with a rod.

  • Enterotomy and eversion of the proximal limb

    Paid content (video)
    Paid content (image)

    After closing the laparotomy and sterile draping (to avoid fecal contamination), perform a transverse enterotomy, e.g., with diathermy. Do this asymmetrically centered on the distal limb because this will evert the proximal limb which then is sutured to the skin.

  • Suturing the ileum to the skin

    Paid content (video)
    Paid content (image)

    Suture the bowel to the skin with interrupted monofilament sutures (e.g., PGA) 3/0. The inferior (proximal) limb is markedly everted and then secured to the skin in order to prevent contact of the aggressive intestinal juice with the skin.

  • Stoma care

    Paid content (video)
    Paid content (image)
    Paid content (text)
  • Klinikum Augsburg

  • Gemeinschaftspraxis Diedorf

    Michaela Rose

Single Access

Access to this lecture
for 3 days

€1.99 inclusive VAT

payment

full access to all lectures
price per month, cancellable on a monthly basis

for the modul: General Surgery

€9.90 inclusive VAT

payment

full access to all lectures
price per year, cancellable on a yearly basis

for the modul: General Surgery

€98.00 inclusive VAT

(You save more than 20,00 Euro compared to the monthly membership)

payment

hospitals & libraries

for the modul: General Surgery

from 390,00 euros

  • Intraoperative complications

    Paid content (text)
  • Postoperative complications

    Paid content (text)
  • Klinikum Augsburg

  • Gemeinschaftspraxis Diedorf

    Michaela Rose

Single Access

Access to this lecture
for 3 days

€1.99 inclusive VAT

payment

full access to all lectures
price per month, cancellable on a monthly basis

for the modul: General Surgery

€9.90 inclusive VAT

payment

full access to all lectures
price per year, cancellable on a yearly basis

for the modul: General Surgery

€98.00 inclusive VAT

(You save more than 20,00 Euro compared to the monthly membership)

payment

hospitals & libraries

for the modul: General Surgery

from 390,00 euros

  • Literature summary

    Paid content (text)
  • Ongoing trials on this topic

    Paid content (text)
  • References on this topic

    Paid content (text)
  • Literature search

    Literature search under: http://www.pubmed.com