Stomas
- All stomas should be externalized through the rectus abdominis to prevent parastomal hernia formation.
- A disk of skin is removed.
- Muscle-splitting technique is used to approach the fascia.
- A fascial incision is created allowing two fingerbreadths to easily slide through.
- A Babcock is used to pull the stoma through, and the bowel is visualized again for adequate perfusion.
- All other incisions are closed before maturation of the colostomy to prevent surgical site infections.
- Although the colonic effluent is not toxic to the skin, like ileostomies, creating some protrusion of the colostomy above the skin level leads to easier stoma pouching.
- The marginal artery should not be disrupted during mobilization.
- Adequate perfusion to the colostomy can be confirmed by pulsatile blood flow to the cut end of the colostomy.