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The colon is brought through the abdominal wall and stitched to the skin in a convenient site to allow the comfortable application of a stoma bag (or pouch) which is stuck around the open end of the bowel. Faecal material is passed into the bag by peristalsis and the bag changed when full or uncomfortable.
The operation may involve the removal of a portion of the bowel, usually on the left side, or be performed to divert the faecal stream away from the bowel beyond without the need for bowel resection. Where bowel is removed and a stoma made with the bowel beyond closed off a Hartmann’s procedure has been performed.
When bowel is removed and the remaining colon and rectum rejoined (anterior resection) the colon may be brought out upstream of the join to protect it. This is known as a de-functioning loop stoma and may also be performed (as a loop) without removing any bowel. The operation is carried out for a variety of disorders but most commonly for bowel cancer and diverticular disease. The operation is usually performed laparoscopically but an open procedure may be necessary.
The bowel is freed from its attachments within the abdominal cavity and where appropriate its blood supply is divided. The bowel is then cut and any diseased segment is removed if necessary. The upper end or loop of colon is brought through a pre-marked site in the abdominal wall after splitting the muscles and removing a small amount of skin and fat. The bowel wall is stitched to the skin with absorbable stitches.