the Linear Dissecting
Sigmoid Colostomy With Hartmann's Pouch
of a Loop
of the Colon With Low
the Gambee Suture
of Colon to Rectum
Using the End-to-End
of the Colon With
Low Anastomosis via
Transverse Loop Colostomy
Transverse loop colostomy is a simple, fast, and relatively easy procedure
used for those patients with pelvic disease in whom a temporary fecal
diversion is needed and who are not candidates for an end sigmoid colostomy
because of medical or technical reasons.
In general, transverse colostomies
related to gynecologic malignancies should be performed on the left
rather than the right transverse colon. A left transverse colostomy
has the advantage of additional length of colon for fecal fluid absorption
and allows the right transverse colon to remain available for small
bowel bypass if needed in the future.
The purpose of the transverse
loop colostomy is to divert the fecal stream.
Physiologic Changes. The fecal stream is diverted.
Stool from the transverse colostomy will contain a larger volume of
water than stool from a sigmoid colostomy. Therefore, a transverse
colostomy may be more difficult to regulate.
Points of Caution. The incision for the colostomy
should be well designed. The site for the stoma should be marked the
night before surgery while the patient is in the standing position
so that the stoma for the colostomy is not on the underside of the
abdominal panniculus. The stoma site should be selected so as not to
interfere with the waistline of clothing. The incision should be long
enough to ensure adequate exposure of the bowel.
The three anatomic
characteristics of the colon should be identified prior to performing
the operation: the teniae coli, haustral markings, and the colonic
relationship to the omentum. Closure of the abdominal wall around the
colostomy should be tight enough to prevent hernia but should allow
enough space to prevent strangulation and ischemia of the colonic loop.
The patient is placed in the dorsal position.
A transverse incision is made left of the midline and approximately
6 cm above the umbilicus.
The colon is identified by the three anatomic
characteristics: haustral markings, teniae coli, and omentum.
A Metzenbaum scissors is used to lyse the fine filmy adhesions
of the omentum for a distance of 8-10 cm.
The colon is rotated, and the posterior leaf
of the omentum is likewise dissected from the surface of the
bowel. This leaves a defect in the omentum.
The defect in the omentum
is seen with the colon lying underneath. The mesocolon with its
vessels is identified.
An avascular portion of the mesocolon is
opened for a distance of approximately 3 cm. This is performed
by placing the index finger of one hand under the colon and tenting
up the avascular portion of the mesocolon.
The index finger of one hand
is inserted through the opening in the mesocolon. The colon is
elevated through the defect in the omentum. A rod is passed through
the mesocolon. The omentum acts as a seal around the colon to
reduce spillage into the peritoneal cavity when the colon is
The colon is brought through
the incision in the abdominal wall. If a large incision was needed
to perform the procedure, a portion of the abdominal wall including
the skin is closed with interrupted sutures. The wound is left
open 1 finger width to ensure against strangulation. A rubber
hose is connected to each end of the glass rod, or the rod is
attached to the ring of a contemporary colostomy bag. The colon
is ventilated by opening the anterior colonic wall in the longitudinal
plane if the bowel has been prepared before surgery. The colostomy
should be sutured with a 3-0 synthetic absorbable "rosebud" stitch.