Gostrointestinol Surgery

120

r lll

surgicol Procedures lncluding Minimol Access Procedures

PreporotiQn of the Potient

The patient is supine; arms m,ay be extended on armboards. Apply electrosurgical dispersive pad'
Skin Preporotion

nent end ileostomy); to protect a distal anastomosis, for example, ileo-anal (temporary loop ileostomy); or to relieve inftammatory bowel disease of the colon with or without distal resection. A continent ileostomy (Koch
pouch) consists of a stoma in continuity with a pouch offolded and sutured ileum that serves as a reservoir.
pouch.

Begin at the incision (usually right parame{iq) frgm ;ipJ;r-1" upper thighs, and down to the table at the
sides.

The patient catheterizes the stoma to empty the

Procedure
The abdomen is entered, usually through a riglit paramedian or midline incision. A disc of skin and subcutaneous fat is excised at the ileostomy site; the anterior recfirs sheath is incised and a small fragment removed. The incision i's deepened into the peritoneum. The ileum is deared oT its mesentery for several centimeters and divided, and the proximal end is passed through the stoma site onto the abdominal wall. The distal end of the ileum, unless resected, is sutured or stapled closed. The proximal end is everted on itself and sutured circumferentially. The mesentery of the terminal ileum is sutured to the parietal peritoneum to prevent internal hernia. Alternatively, a loop ileostomy may be performed. The abdomen is closed. An ileostomy appliance is placed over the stoma.

Droping
Folded towels and a laparotomy sheet

Equipment
Suction

Electrosurgical unit lnstrumentotion Major procedures traY Long instruments traY Gastrointestinal procedures tray Hemoclip appliers (varietY) Self-retaining retractor (e.g., Balfour) Automatic stapling devices (optional)
Supplies

Preporotion of the Potieni

Basin set

lte

Blades (2) No. 10, (1) No' 15 Hemoclips (assorted sizes) Electrosurgical Pencil Needle magnet or counter Staples (optional)
GUTANEOUS ILEOSTOMY

patient is supine; arms may be extended on arm' boards. Apply electrosurgical dispersive pad.
Skin Preporotion

Begin at midline extending from above nipples to the qlper thighs, and down to the table on the sides.

Definition Formation of temporary or permanent opening of tbe ileum, whichisbroughtoutonto the abdomen as a stomaDiscussion

Ilroping
Folded towels and a laparotomy sheet

Cutaneous ileostomy is performed to divert the fecal stream in resection of the colon and rectum (pernia-