Ileostomy placement

Ideally, the marking and subsequent instruction for stoma care should be performed by specially trained stoma therapists or an experienced surgeon.

1. Trial marking on the patient who is lying down or already seated in the area of the right rectus abdominis muscle (navel height) in a 10 × 10 cm skin area, preferably without folds, scars, or bony protrusions.
2. Verification of the intended position in motion (standing, bending).
3. The chosen site should be easily visible and accessible to the patient and should be compatible with the position of the pants or belt.
4. Determining an alternative marking is recommended in case of intraoperative complications.
5. Covering the marking with a skin-friendly adhesive tape.

The position of the stoma significantly influences handling and care, and thus the patient's quality of life!

After opening the abdominal cavity or upon completion of the primary operation, the terminal ileal loop is located for the creation of a loop ileostomy. The loop selected for stoma creation should be at least 20 cm away from the ileocecal valve.

In the selected loop, an incision of the mesentery is made near the intestine, preferably in a vessel-free area, and a silicone tube is passed through.

In the area of the preoperatively marked region, the circular skin incision is made after grasping the skin with, for example, a Backhaus clamp. The skin incision should not be larger than 2-2.5 cm. Subsequently, preparation to the fascia is performed.

Note: In laparoscopic stoma creation, it is advisable to maintain the pneumoperitoneum during the formation of the stoma channel. This makes the abdominal wall thinner and facilitates the identification of each subsequent layer. Additionally, the risk of accidental injury is reduced.

After excision of the skin and subcutaneous tissue, the anterior layer of the rectus sheath is split in a cruciform manner. The fascia is tensioned to avoid a curtain phenomenon.

Note: The removal of subcutaneous tissue is not generally recommended in the literature. There is concern about a higher rate of stoma retractions due to increased subcutaneous scarring and an aesthetically unfavorable indentation of the scar after stoma relocation. Alternatively, the subcutaneous fat tissue is incised only in the longitudinal direction and retracted with hooks.