Options for surgical stoma construction

Various options are available for surgical construction. Among them are the following:


Constructed by dividing a portion of the small or large intestine, bringing out the proximal end, then turning it back on itself like a cuff, as a single stoma pulled through and sutured to the abdominal surface. A distal segment may be removed, based on the disease entity, with the remaining bowel over-sewn and left in the abdominal cavity with its mesentery intact.


When the distal (or defunctionalised) intestine is over-sewn and left in the abdominal cavity rather than removed, it is called a Hartmann's Pouch.


A section of distal intestine whose proximal end is sutured, closed, and left within the peritoneal cavity is contiguous with the rectum and anus. If the distal bowel remains left in place, intact, and over-sewn, the bowel may be reconnected to the stoma at a later date. This procedure is known as a "takedown."



If the distal bowel segment is brought through the abdominal surface as a separate stoma, it is called a "mucous fistula."



This is a loop of bowel brought out through the abdominal wall providing faecal diversion. This is commonly constructed when a temporary diversion is needed and a minimally invasive procedure is indicated. The loop of bowel may be opened transversely or longitudinally. This is temporarily held in place with a support device such as a loop of a red argyle catheter.


There is one stoma with two openings: a proximal (functional) end that effluent empties from and a distal (nonfunctional) end that empties mucus. Keep in mind that there is some continuity of proximal bowel to distal bowel and some stool will enter the distal stoma, thus there may occasionally be passage of stool and/or mucus via the anus.


This stoma is constructed when complete diversion of the faecal stream is indicated. A loop of bowel is completely divided and both ends are sutured to the abdominal surface as two separate end stomas. There is usually a bridge of skin between the two or they may be located on different abdominal quadrants based upon surgeon preference. Some may refer to the distal stoma as a "mucous fistula."


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