rectal instruments

The formation of ileostomy following resection

By • Дек 18th, 2010 • Category: For surgery

The ileal stump is freed from its mesentery for a distance of 9—10 cm with preservation of circulation. Initially, a round opening 2—2.5 cm in diameter is cut out on the anterior abdominal wall by making an inci­sion through all layers at the external edge of the right rectus muscle 2 cm below the umbilicus level. This is fol­lowed by fixation of the free edge of ileac mesentery in the abdomen so as to obliterate a slotshaped space bet­ween the mesentery of the ileac stump and the parietal peritoneum. (Hardy-Goligher technique). Otherwise a loop of small gut may be strangulated in this space.

The surgeon then strongly pulls the right edge of the middle laparotorny wound upwards and applies a silk purse-string silk suture, from the inside, starting from the peritoneal ileostomy opening (Fig. 189.1) and continuing it along the peritoneum of the anterior abdo­minal wall (Fig. 189,11) as far as the former (now clo­sed) bed of the cecum (Fig. 189.111). The purse-string su­ture is then carried on along the posterior parietal peri-teneum including in it the bulk of the free edge of the mobilized mesentery (Fig. 189.IV). By tightening this su­ture the space between the free mesenteric edge and the abdominal wall is completely obliterated. The ileac stump (closed with a cap) is now pulled to the outside through the hole previously made in the abdominal wall (see Fig. 188.5). The wound is closed and an ileostomy is for­med as indicated above (Fig. 189,2 and 3). A suture is then applied in layers to the medial wound, followed by-fixation of the sigmoidostomy in the left iliac wound (Fig. 189.4).

One-end ileostomy in ulcerative colitis

Fig. 189. One-end ileostomy in ulcerative colitis:

1. Purse-string suture of the peritoneum fixing the ileal mesentery to the stoma. I — Ileostomy opening; II— peritoneum of the anterior abdominal wall. Ill—closed bed of the cecum and ascending colon; IV— purse-string suture including the edge of ileac mesentery.

2. Formation of terminal ileostomy.

3. The stump has been formed.

4. Fixing the sigmoidostomy in the iliac wound.

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