After total mesorectal excision and mesentery artery ligation the rectum is removed, including the anus and levator muscles. The pudendal branches to the bladder and prostate or uterus must be spared accurately in oncologically feasible cases. The right and left colonic flexures and the descending colon must be fully mobilised in order to allow the remaining colonic stump to be lowered to the perineum through the pelvic cavity without traction. An interrupted muco-cutaneous absorbable suture is then performed to create the perineal colostomy. In cases of deferred perineal colostomy, the left abdominal colostomy must be mobilised, leaving a ring of skin and subcutaneous fat of at least 1 cm around the stoma in order to allow a skin-to-skin suture at the perineum.
This operation could be performed laparoscopic-ally to reduce patient discomfort and for cosmetic reasons.
The fashioning of a protective ileostomy could be useful to prevent the high risk of perineal wound infection, particularly when the electrode implantation is performed at the same time of perineal colostomy .
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