Lecture on steps on ostomy surgery for medical students. Provides a step-by-step instruction on ostomy creation which might be beneficial for junior surgical doctors learning to perform this relatively common procedure.

1. Ostomy surgeries
Chea Chan Hooi
General Surgeon
Sibu Hospital

2. Content
• Anatomy
• Definition
• Types
• Technique
– Colostomy
– Ileostomy

3. Anatomy

4. Stoma
• Surgically created opening of a hollow viscus out to
skin surface
• Types
– Anatomy
• GI tract
– Colostomy
– Ileostomy
• Urinary tract
• Tracheostomy
– Configuration
• Loop stoma
• End stoma
• Double-barrel stoma

5. GI stomas
Ileostomy Colostomy

6. Configurations
Double-barrel stomaEnd stoma Loop stoma

7. Techniques in creating loop
colostomy

8. Skin incision

9. Dissect down till anterior rectus sheath

10. Opening the anterior rectus sheath

12. Dissect thru rectus abdominus muscle

13. Opening the parietal peritoneum

14. Trephine two fingers breadth

15. Deliver out the bowel

16. Bridge inserted thru mesocolon using
Ryle’s tube

17. Various other types of bridges

18. Bowel lumen opened

19. Bowel wall anchored to skin ± rectus

20. Initial anchoring sutures

21. Almost completed…

22. Check patency of afferent & efferent
loops

23. Bridge in situ

24. Techniques in loop ileostomy

25. Ileal lumen entered

26. Everting the proximal loop

27. Anchoring

28. Principles of stoma siting
• Away from bony prominence
• Away from umbilicus
• Away from previous incision site
• Away from belt line
• At the apex of fat fold
• Within rectus muscle bulk
• Visible to patient when he stands/sits
• If two separate stomas are created, avoid the
same horizontal plane

29. Principles of stoma formation
Ileostomy
• Spouted at least 2cm from
skin level
Colostomy
• Mucosa level with skin

31. Thank you
Q&A?