Ileostomy reversal (without resection) with skin closure using the gunsight technique

First, physiological saline solution is injected into the subcutaneous tissue around the stoma to facilitate the subsequent dissection of the stoma-bearing small intestine loop. The operation begins with a circular skin incision in the area of the stoma.

Subcutaneous preparation of the stoma with scissors until the fascial edges are exposed. Careful exposure of the stoma-bearing small intestine loop from the fascia, preserving the intestinal wall and the underlying small intestine loops. The edema caused by the injected saline solution aids in the preparation. Digital palpation of the abdominal wall to exclude further adhesions.

The stoma-bearing small bowel loop is now exposed and is luxated in front of the abdominal wall. Then eversion of the stoma and resection of the skin margin.

Check for serosal lesions and suture them with Monosyn 4-0.

NOTE:

In cases of extensive or multiple injuries to the intestinal wall, a resection of the small intestine segment with new anastomosis should be performed if necessary.

The anterior wall is now continuously and seromuscularly sutured with Monosyn 4-0. Overstitching at individual points with single button sutures, if necessary.

Note:

The anastomosis should be well patent and tension-free with direct serosa-serosa contact throughout the entire length.

Rinsing of the small intestine with saline solution and checking for blood dryness. Subsequently, repositioning of the intestine into the abdomen and mobilization of the fascial edges.