Descending Colostomy for Anorectal Malformations Dr. Tamer Ashraf Wafa
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The target part of the colon to create the stoma is in the most proximal part of the sigmoid colon, as high as possible close to the descending colon, to avoid future stoma prolapse.
The site of the proximal stoma is in the center of a triangle between the anterior superior iliac spine, costal margin, and the umbilicus.
The distal colon is brought out at the medial end of the incision as a mucous fistula that is made as narrow as possible.
The incision is oblique and about 5 to 6 centimeters in length.
The layers are carefully opened to avoid bowel injury due to the colonic distension.
The distal and proximal limbs are carefully identified to avoid stoma reversal.
A purse-string suture is applied around the stoma site using a 4-0 suture.
A 12-French catheter is introduced through a small puncture for suction of meconium and emptying the distal colon.
Saline is used to help liquefy the thick meconium during washing and suction until the colon is completely cleaned out.
A window in the mesentery is created with preservation of the marginal vessels.
Bipolar diathermy is applied to the vessels distal to the marginal vessels, with coagulation kept close to the colonic wall, creating a 2 cm window.
Two fine bulldogs are applied to occlude the colonic lumen before the colon is divided.
Additional division of the mesenteric vessels is done to ensure adequate placement of the two stomas at the two ends of the wound.
The colon is fixed to the peritoneum using 4-0 absorbable sutures starting on both ends.
The peritoneum in between the stomas is approximated with interrupted sutures.
The distal stoma is made as narrow as possible.
The muscles are approximated using interrupted sutures, followed by closure of the skin with interrupted subcuticular sutures.
The stoma edges are fixed to the skin with 5-0 sutures.
The stoma bag shall be applied to the proximal stoma only.