,

Colostomy/Stoma Creation/Ileostomy mayo stand and back table surgery setup

Diana Lei-aloha Avatar

setup author

Surgery setup images for Colostomy/Stoma Creation/Ileostomy

Colostomy/Stoma Creation/Ileostomy surgery instruments

Clamping & Occluding instruments

Curved Hemostat
Curved Hemostat
Tonsil Clamp
Tonsil Clamp

Cutting & Dissecting instruments

Metzenbaum Scissor
Metzenbaum Scissor
Curved Mayo Scissor
Curved Mayo Scissor
Straight Mayo Scissor
Straight Mayo Scissor

Grasping & Holding instruments

Toothed Forcep
Toothed Forcep
Bonney Forceps
Bonney Forceps
Adson Forceps
Adson Forceps
Forester Sponge Forceps
Forester Sponge Forceps
Babcock
Babcock
Allis Forceps
Allis Forceps

Retracting & Exposing instruments

Army-Navy Retractor
Army-Navy Retractor
Senn Retractor
Senn Retractor
Richardson Retractor
Richardson Retractor

Suctioning instruments

Poole Suction Probe
Poole Suction Probe

Suturing & Stapling instruments

Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Colostomy/Stoma Creation/Ileostomy

A colostomy, stoma creation, or ileostomy is a surgical procedure that involves creating an opening in the abdomen and bringing a part of the large or small intestine through the opening to create a stoma. The stoma allows stool to pass out of the body and into a colostomy bag or pouch, which is attached to the skin around the stoma. This procedure is usually done after a colon resection or colectomy, and it is performed when the normal route for stool to exit the body is blocked or damaged.

Positioning
Supine

Drapes
Folded towels or 4 utility drapes, laparotomy drape

Step 1: 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.

Step 2: 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.

Step 3: 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.

Step 4: 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.

The Surgery Sparknotes

  1. 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.
  2. Create stoma incision through anterior rectus sheath, pull cut bowel through with a Babcock or an Allis.
  3. Cut staple line with fresh blade, clamp/loosely suture edges, and suture the stoma with absorbable sutures.
  4. Attach colostomy bag to the patient by cutting it with curved or straight Mayo scissors.

3 responses to “Colostomy/Stoma Creation/Ileostomy”

  1. Shirley Jackson Avatar
    Shirley Jackson

    If the colostomy bag is not sterile, how does the circulator open it up to me on the sterile field??

    1. Diana Lei-aloha Avatar
      Diana Lei-aloha

      When the colostomy bag is being opened up to the tech the surgery has been completed and the mayo stand can be contaminated. Some people choose to keep some scissors, dressings, and supplies for clean up on their mayo stand so that they don’t have to contaminate the back table until the patient has been woken up.

    2. carrmommyof3 Avatar
      carrmommyof3

      When we do them our circulator will leave the bag out on the cautery machine & once the surgery is complete the surgeon will grab it or ask for it & it will be handed to them. At this point, we no longer need to stay sterile. Then we will take the drapes down. They may want scissors to cut the bag.

Leave a Reply

Your email address will not be published. Required fields are marked *