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Ileostomy, construction of - general and visceral surgery
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Stoma site marking
Ideally, the stoma should be marked and the subsequent instructions for stoma care given by specially trained stoma nurses or an experienced surgeon.
- 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.
- Check of the planned site with the patient in motion (standing, stooping down).
- The selected site should be easily accessible to the patient and within his/her visual field and away from the natural beltline.
- To allow for intraoperative complications marking a secondary location is recommended.
- 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
Taping the ileum loop
Skin incision for stoma and dissection down to the fascia.
Dividing the anterior lamina of the rectus sheath
Splitting the muscles
Dividing the posterior lamina of the rectus sheath and the peritoneum
Delivering the ileum through the abdominal wall
Enterotomy and eversion of the proximal limb
Suturing the ileum to the skin