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End colostomy, Step by step
- Prepare colon for colostomy (temporarily closed with suture or staples)
- Place traction clamps on dermis and fascia and align them
- Excise disk of skin of about 3 cm
- Incise subcutaneous fat (or excise just a very narrow portion)
- Incise anterior rectus sheath (fascia)
- Divide muscle fibers and beware of the crossing superficial epigastric vessels
- Open peritoneum
- Pull colon through the opening
- Check if torsion is avoided
- Close abdominal wound and protect it
- Excise staple (or suture) line from colon
- Place sutures between full thickness of colon and skin
- Apply stoma appliance
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