Circumferential peristomal incision is made in the skin and dissected to the level of the fascia.
All adhesions to the fascia should be dissected to free the colon.
Loop colostomies should have the edges freshened and closed transversely with running sutures or reestablish continuity with a side-to-side stapled anastomosis.
Loop colostomy reversals can be performed solely through a transfascial incision.
End colostomies require the same mobilization and further intraabdominal dissection to mobilize the colon requiring an open or laparoscopic mobilization of the colon to reach the rectal stump.
The left colon is mobilized off Gerota fascia, and if more mobilization is required, the splenic flexure can be takedown.
Colorectal anastomosis is then performed using a circular stapler most commonly or a hand-sewn anastomosis.
Educational aid only. Verify every dose, indication, and guideline against current institutional protocol. This is not a substitute for clinical judgment.
