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HOW I DO IT / HOW I DID IT SURGICAL PROCEDURES |
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ILEOSTOMY
OPERATIVE TECHNIQUE: ¶Patient lying supine ¶Asepsis/antisepsis done ¶Sterile drapes placed ¶Midline incision done ¶Identify the distal ileum and identify the segment selected for ileostomy ¶Select proper site in the right lower quadrant and excise a nickel‑size circle of skin ¶Expose anterior rectus fascia and make a 2‑cm longitudinal incision in it ¶Retract and separate rectus fibers with a large hemostat ¶Vertical incision in the peritoneum ¶Stretch the ileostomy orifice by blunt dissection ¶Arrange ileum so that the proximal segment will emerge on the cephalad side of the ileostomy and the distal ileum leaves the stoma at its inferior aspect ¶Grasp ileum with a Babcock clamp ¶Deliver loop of ileum into the aperture made in the right lower quadrant ¶Transect anterior half of ileum at a point 2 cm distal to apex of loop ¶Mature ileostomy ¶Interrupted sutures of 4‑0 silk to approximate the full thickness of the ileum to subcuticular portion of the skin ¶Closure by layer ¶abdominal wall with interrupted vicryl 1-0 sutures ¶skin with interrupted silk 4-0 ¶Betadine ¶DSD ¶Patient tolerated procedure well |