ABSTRACT
The creation of an intestinal stoma is an almost purely technical endeavor. In most situations it is relatively simple and can be performed by any experienced surgeon. However, under some circumstances creating a well-perfused, properly placed colostomy or ileostomy can be very difficult. These circumstances include the morbidly obese, those who have been operated on multiple times, the patient requiring two intestinal stomas, and patients with spinal cord injuries. This article suggests preoperative planning strategies and technical tips that will potentially make difficult stoma creation safe and satisfying. When creating temporary stomas, thoughtful considerations of future stomal takedown will make the ensuing surgery safer and less difficult. This article offers insight into creating temporary stomas, which do not require subsequent laparotomy for takedown. In addition, it offers several methods to make the challenging ``Hartmann takedown'' less difficult. Even in the best of circumstances some stomas will develop postoperative ischemia. This article includes assessment methods for evaluating the degree of the ischemia in the early postoperative period. Treatment algorithms are also included that help determine the appropriate treatment for various degrees of stoma ischemia. In conclusion, we offer relatively simple, straightforward technical advice that will lead to the creation of the well-perfused, properly placed intestinal stomas, which if necessary, will last a lifetime.
KEYWORDS
Difficult stomas - technical considerations - stoma marking - intestinal segment - Hartmann takedown - well-perfused stoma
