Ostomy surgery

Lecture on steps on ostomy surgery for medical students. Provides a step-by-step instruction on ostomy creation which might be beneficial for junior surgical doctors learning to perform this relatively common procedure.

1. Ostomy surgeries Chea Chan Hooi General Surgeon Sibu Hospital

2. Content Anatomy Definition Types Technique Colostomy Ileostomy

3. Anatomy

4. Stoma Surgically created opening of a hollow viscus out to skin surface Types Anatomy GI tract Colostomy Ileostomy Urinary tract Tracheostomy Configuration Loop stoma End stoma Double-barrel stoma

5. GI stomas Ileostomy Colostomy

6. Configurations Double-barrel stoma End stoma Loop stoma

7. Techniques in creating loop colostomy

8. Skin incision

9. Dissect down till anterior rectus sheath

10. Opening the anterior rectus sheath

11. Dissect thru rectus abdominus muscle

12. Opening the parietal peritoneum

13. Trephine two fingers breadth

14. Deliver out the bowel

15. Bridge inserted thru mesocolon using Ryle’s tube

16. Various other types of bridges

17. Bowel lumen opened

18. Bowel wall anchored to skin ± rectus

19. Initial anchoring sutures

20. Almost completed…

21. Check patency of afferent & efferent loops

22. Bridge in situ

23. Techniques in loop ileostomy

24. Ileal lumen entered

25. Everting the proximal loop

26. Anchoring

27. Principles of stoma siting Away from bony prominence Away from umbilicus Away from previous incision site Away from belt line At the apex of fat fold Within rectus muscle bulk Visible to patient when he stands/sits If two separate stomas are created, avoid the same horizontal plane

28. Principles of stoma formation Ileostomy Spouted at least 2cm from skin level Colostomy Mucosa level with skin

29. Thank you Q&A?