CLOSURE OF TEMPORARY COLOSTOMY

Operative Technique

Patient supine under SAB/CLEA/GA

Asepsis and antisepsis technique

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

Sterile drapes placed

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

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

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

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

Fascial ring identified

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

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

Colostomy freed

Rim of skin incised from the colon

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

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

Betadine paint

Dry sterile dressing placed