Stoma

• When the stoma is not brought out through the abdominal inscision but through a separate hole in the abdominal wall it will be easier to handle. For transversostomy: an incision is made in the right rectus muscle and the omentum is dissected off the attachment to the relevant part of the colon. It may be difficult to obtain sufficient length of the bowel without damaging the vessel supply if the abdominal wall is thick. For an ileostomy, this is more simple.
• The least amount of skin is removed if the stoma is not brought out through the abdominal inscision.
• The bowel is pulled out as a backwards "U" and is not divided.
• The bowel is sutured to the peritoneum.
• The bowel is sutured to the anterior fascia.
• A tube or skin bridge is placed under the loop at the skin level to prevent the bowel from retracting.
• The bowel lumen is opened at the top and the bowel wall is everted and sutured to the skin.
• For a section in the right rectus chain, the stoma is placed out through a separate incision to facilitate stoma hygiene.
• Colostomy should preferably be pulled 1-2 cm out over the skin level. Ileostomy: 2-3 cm.

End sigmoid colostomy:

• A mid-line incision to the right of the navel is made.
• The bowel is divided with a closing-dividing stapler.
• The bowel is mobilized by adequate division of the vessels without damaging the vessel archade to permit the bowel to be pulled out through the skin without tightening.
• In the abdominal wall, the peritoneum and posterior fascia leaf are split.
• The musculature is split length-wise and as much as necessary transversally.
• The anterior fascia leaf is split in a cross.
• A skin cylinder with underlying fatty tissue is removed up to the fascia.
• The extracted bowel opening is sutured to the fascia and everted with sutures  in the bowel tube, mucosa  and skin.