Ostomy maturation

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Ostomy maturation

INDICATIONS FOR PROCEDURE: The patient is a 46-year-old woman, who is

status post exploratory laparotomy for feculent peritonitis, status post

large bowel anastomotic leak following anastomosis for rectal prolapse

operation with resection. She had previously been diverted and ostomy

brought through the fascia, but not much ward, and left open with an

abdominal wound VAC. She was brought back to the operating room today for

washout, closure, and ostomy maturation.

DESCRIPTION OF PROCEDURE: After the patient was identified and consent was

obtained and verified, she was brought to the operating room and placed

supine on the operating room table. After general anesthesia was induced,

the patient's previous external portion of the wound VAC was removed, and

the abdomen was prepped and draped in usual sterile fashion with

chlorhexidine scrub. The inner sponge was then removed and the peritoneal

cavity was irrigated with 5 L of warm irrigation solution. Initially, a

fluid in the gutters and down in the pelvis was murky and cloudy, but

ultimately was clear after irrigation. There was some fibrinous exudate on

the bowel which was not removed. The fascia was then closed with

interrupted figure-of-eight #1 PDS sutures without any increase in the peak

ventilatory pressures. The lateral aspect of the colostomy opening in the

fascia did have to be opened a little bit more due to tension and kinking on

the ostomy where had been brought to previously. However, after this was

completed, the mucosa was pink, was light pink and viable with excellent

appearing blood supply. The ostomy itself was then matured by removing the

staple line and securing full-thickness bites to the surrounding dermis

using interrupted Vicryl sutures. The wound VAC was applied. The

subcutaneous space and the ostomy appliance was applied on the ostomy

itself. X-rays taken at the end of the case confirmed no retained sponges

or instruments. Overall, the patient tolerated the procedure well. There

were no apparent complications.

Ostomy maturation