Gastrointestinal Operations and Technical Variations by Michael Korenkov Christoph-Thomas Germer & Hauke Lang

Author:Michael Korenkov, Christoph-Thomas Germer & Hauke Lang
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Fig. 27.12Position of the ileostomy, when the patient is sitting. The ileostomy is covered by a deep wrinkle. The marked position in the very low left abdominal quadrant is possible; alternatively a high up position in the right upper quadrant is also acceptable

The ileostomy should be everted. The top of the stoma is best 2–3 cm above skin level. The stitch technique is advisable in a 3-point manner. The stitch starts at the skin level from inside to outside and then catches the edge of the bowel, and the third point fixes the bowel wall at the best area to fix the intended eversion height. All nodules after tying are inside. The appliances can easily be positioned and there is no wick effect by the suturing materials.

◘ Figure 27.13a–c shows this technique of creating an end and loop ileostomy.

Fig. 27.13Sketch of an end and loop ileostomy. a The fixating stitch has three points. It comes intracutaneously from the inner to outer side, next the edge of the bowel wall and then the seromuscular bowel wall to fix the eversion. b The terminal ileostomy finished, all knots are inside and cannot be seen. c Loop ileostoma with underlying plastic tube

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