Division of Colon and Colostomy Construction

The implementation of this stage prior to rectal mobilisation decreases the probability of contamination, simplifies access to the rectum, provides optimum conditions for stoma construction and prevents paracolostomy complications. Adequacy of the blood supply to the proposed site of division of the colon is assessed. In order to prevent contamination, the colon is divided with the use of GIA in the plane of sigmoid-descending colon junction. The abdominal surgeon clamps the peritoneum of the lateral abdominal wall in the area of the upper edge of the incision at the left of sigmoid. Then the peritoneum is separated from the posterior and lateral abdominal walls up to the plane of the proposed place of stoma construction. A circular portion of skin and subcutaneous fat, 2.5-3.0 cm in diameter depending on the colon thickness, is excised with the electrocautery down to the fascia of abdominal rectus. If excess fat is excised, the stoma may "settle" and the skin edges will be somewhat concave. A cruciate incision is made in the anterior fascia of the rectus and the muscle fibres are separated longitudinally. The posterior leaf of the rectus fascia is incised in a circular manner, so the abdominal wall defect will accommodate entirely to the circumference of the colon. Usually, two fingers properly fit this defect. Next the colon is fed through the extraperitoneal canal and the abdominal wall defect with care taken to avoid a twist in the colon or mesentery. It is ideal to have the colon protruding about 2.0 cm above the skin level. This method of stoma construction provides the absence of lateral paracolostomy space. Therefore, there is no need to place suture on it.

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