Operative Technique

A small lower midline incision is performed, and the peritoneal cavity is inspected to ensure there is not a free perforation. Through a small right transrectal incision 3- to 5-cm long in the lower quadrant of the abdomen, a loop of ileum proximal to the ileocecal valve is brought out as a loop ileostomy. The distal loop is incised for about three quarters of its circumference; the ileum is everted and sutured at skin level with absorbable interrupted sutures. Through a vertical left paramedian incision 4- to 6-cm long, an antimesenteric transverse skin-level colostomy is performed in the upper abdomen. The "blowhole" colostomy is constructed by dividing the omentum and suturing it to the peritoneum. The transverse colon is sutured to the rectus sheath and deflated by inserting a large bore needle. The colonic wall is incised and sutured to the fascia and skin with interrupted absorbable sutures. No attempt is made to evert the colonic wall, as is usually done. A sigmoi-dostomy is sometimes created.

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