How to Repair an Enlarged Stoma
For those with inflammatory disease, cancer or trauma, the resulting treatment may include a stoma. A stoma is a surgically created opening that creates a communication between the environment and the inside of the body. The purpose of the stoma is to discharge body wastes. However, if stomas are present for long periods of time, weakening of the stomal walls are eminent. Therefore, repair is necessary for the well-being of the stoma. This procedure, for colostomy repair, requires hospitalization and bowel preparation before surgery.
Things You'll Need
- Surgical gown
- Sterile dressings
- Gloves
- Liquid soap
- Nail brush
- Sterile paper towels
- Disinfectant (chlorhexidine or iodine)
- Cotton wool balls
- Sterile garbage can
- Surgical towels
- Surgical cap and shoe covers
- Surgical mask
- Surgical tongs
- Towel clips (4)
- Dissecting forceps
- Tissue forceps
- Curved forceps
- Scalpel
- Electrocautery pencil with holder
- Maxon 4-0 Suture
- Needle holder
- Surgical scissors
- Colostomy bag
- Bandages
Instructions
-
Stoma Repair
-
1
Wear surgical cap, shoe covers and facial mask before entering operating room.
-
2
Scrub hands and forearms with liquid soap for 3 minutes, as well as nails with nail brush. Discard nail brush in sink. Rinse fully.
-
-
3
Dry hands with sterile paper towels and promptly throw away. Put on surgical gown and gloves.
-
4
Clean stoma area with iodine soaked cotton balls--grab with surgical tongs. Clean area within 3 inches of stoma and at the stomal opening. Throw away cotton balls after use.
-
5
Drape patient with sterile drapes from head to toe. Only the surgical area should not be draped. Hold drapes around surgical area with towel clips, one for each corner of the square window formed for the surgical area.
-
6
Dissect stoma edges with dissecting forceps until stoma is free of its edges. Gently touch stoma tissue with tissue forceps.
-
7
Locate new stoma area on internal abdominal wall. Locate area with curved forceps and dissect abdominal wall layers until new stoma complete.
-
8
Relocate colon opening to new stoma area. Suture colon mucosa to abdominal wall with Maxon 4-0 and needle holder. Cut excess suture material with surgical scissors.
-
9
Close the old stoma area with Maxon 4-0. Cover area with bandage.
-
10
Clean colostomy edges and abdomen with alcohol. Place bandages on colostomy edges. Place colostomy bag on area.
-
1
Tips & Warnings
If iodine allergy exists use chlorhexidine.
If whilst dissecting adhesions or bleeding is present, use electrocautery to cut or coagulate.
Wipe any bleeding with surgical towels and compress area to stop bleeding.
If you do not feel competent ask for help--better to be humble and ask for help than to allow the patient to bleed to death.
If colon stoma is gangrenous or not 'pink', cut off stoma ends and suture new stoma to ensure the formation of a 'lip'.
This is a major procedure that is only to be performed by at least two medical doctors and at a hospital with access to blood transfusion products.
Bowel preparation is highly important or else fulminant infection and septic shock may occur.
Give antibiotics before operating to prevent infection.
Look out for bleeding as neovascularization around the stoma may have occurred.
Know your anatomy because proper stoma placement essential.
