Colostomy/Stoma Creation/Ileostomy
A segment of the large or small intestine is mobilized and exteriorized through an opening in the abdominal wall to create a stoma for the diversion of fecal matter.
Surgical instruments
16 on this table — tap a photo to zoom, the name for its full card.
The case
Spark notes
The 30-second rundown — scan this outside the room.
- Make incision in lower abdomen using a 10 or 15 blade and retract tissue with adsons or pickups and skinny retractors such as Richardsons or senns.
- Create stoma incision through anterior rectus sheath, pull cut bowel through with a Babcock or an Allis.
- Cut staple line with fresh blade, clamp/loosely suture edges, and suture the stoma with absorbable sutures.
- Attach colostomy bag to the patient by cutting it with curved or straight Mayo scissors.
Walkthrough
What the surgeon does — and what to have in your hand before they ask.
Making the Incision
To begin the procedure, the surgeon will make an incision in the lower abdomen using a 10 or 15 blade. The surgeon will then use a bovie with adsons with teeth or a heavier pickup such as rat-tooths or Bonneys to grasp the tissue. Small retractors such as skinny Richardsons or senns will be used to retract.
Creating the Stoma Incision
Once the initial incision is made, the surgeon will make another incision through the anterior rectus sheath using a fresh blade. A hemostat or tonsil will be used to separate the tissue, and the previously cut bowel will be pulled through the stoma incision using a Babcock or an Allis.
Cutting the Staple Line
The bowel would have been stapled and cut prior during the colon resection portion of the surgery. Now, a fresh blade will be used to cut that staple line off, and the edges can be clamped or loosely sutured to the stoma incision. Absorbable sutures can then be used to suture the stoma.
Attaching the Colostomy Bag
Finally, the circulator will open up the unsterile colostomy bag to you, and the surgeon will use curved or straight Mayo scissors to cut it to the appropriate circumference. The colostomy bag will be attached to the patient, and the stoma creation is complete.
Tips and tricks
As a surgical technologist preparing for a Colostomy/Stoma Creation/Ileostomy procedure, it's important to keep the dirty instruments separate from the clean ones. One best practice is to have a separate "closing table" for closing the abdomen. This table should include Mayo scissors, a variety of clamps, needle drivers, suture, irrigation, clean laps, and clean gloves. By keeping these items separate, you can ensure that the sterile field is maintained throughout the procedure.
Add your table
Every surgeon runs it a little differently. Submissions stay private, are reviewed by our team, and accepted contributions earn a credit in the contributor list.