Ileostomy Formation and applying stoma bag

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First of all anticipate the cases where we may have to make an ileostomy like typhoid perforation. Tuberculosis peritonitis and trauma patients.

  • Pre-operative counseling of the patient
  • Site marking (pre-operative) avoiding the bony points and site for belt. Marking the site with methylene blue.
  • At the time of Surgery make the midline incision and at the level of umbilicus divert the incision to the left side. On this will help in applying the ileostomy bag.
  • On the proposed site remove a disc of skin of 2cm in diameter.
  • Do not excise the S/C fat but make a vertical incision on the S/c fat.
  • Put the left hand into the abdomen and with the guidance of the index finger of the left hand divide the fibers of the rectus abdominus muscle with artery forceps.
  • Incise the post rectus sheath and peritoneum vertically.
  • Open the hole so that the two fingers simply fit into the hole.
  • Clear the ileostomy end from the mesentery by 2-3cm.
  • Apply two babcock from outside on the end of the ileostomy and by the gently rotating movements bring the end act.
  • Evert the edges to make a spout of 4cm
  • Apply 8 stitches with vicryl at the equal distance but tie the stitches at the end.
  • First take a bite from the edge of gut then 2cm lower down from the wall of ileum including serosa and muscularis then from the rectus sheath and at the end from the skin.
  • Apply the stoma bag.

HOW TO APPLY A STOMA BAG

  1. Remove the previous appliance if present
  2. Plug the stoma with gauze
  3. Clean the area with soap and water and dry properly
  4. Take an imprint of the stoma on a piece of paper and cut the wafer accordingly with a scalpel so that it fits snugly
  5. Now apply the wafer, it can be rotated according to the situation, apply pressure with both hands so that it remains in contact with the skin for atleast 5 minutes. (the adhesive melts at body temperature). The inner circle is pressed with the back of the scalpel.
  6. Opsite is then applied
  7. The bag is clicked into position.
  8. Stomahesive paste is only used to fill out any irregular body contours so that the wafer is applied on a flat surface.