CLOSURE OF TEMPORARY COLOSTOMY

index

table of contents

my operations

How I did It?

Operative Technique

Ø      Patient supine under SAB/CLEA/GA

Ø      Asepsis and antisepsis technique

Ø      Colostomy occluded by inserting a small sponge packing moistened with betadine solution

Ø      Sterile drapes placed

Ø      Incision made on skin around the colostomy site, about 0.5cm margin

Ø      Allis forceps applied to the lips of the colostomy and lifted upwards

Ø      With sharp dissection incision extended deep until the seromuscular coat of colon is identified

Ø      Serosa and surrounding subcutaneous fat separated by metzenbaum/electrocautery dissection carried meticulously down to the point where colon meets the anterior rectus sheath

Ø      Fascial ring identified

Ø      Colon dissected away from the fascial ring until peritoneal cavity is entered

Ø      Peritoneal cavity entered and identified, transverse colon dissected away from adjoining peritoneal attachments

Ø      Colostomy freed

Ø      Rim of skin incised from the colon

Ø      Colostomy defect closed in transverse direction with continuous chromic 3-0 Connell suture followed by interrupted silk 4-0 Lembert sutures to invert first layer

Ø      Abdominal wall defect closed

      Posterior Rectus Fascia including peritoneum – continuous vicryl 0 sutures

      Anterior rectus sheath – continuous vicryl 0 suture

      Skin – silk 4-0 interrupted suture

Ø      Betadine paint

Ø      Dry sterile dressing placed