Loop Colostomy Periprocedural Care

Updated: Jul 12, 2021
  • Author: Aparna Vijayasekaran, MD; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Preprocedural Planning

Imprecise location of the stoma site can be a source of extensive morbidity and patient dissatisfaction in the postoperative period. The goal of preoperative marking of the stoma site is to provide an opening that allows easy placement of an ostomy appliance that can be maintained with an adequate seal for up to 5-7 days. An enterostomal nurse aims for marking a stoma that is preferably away from the umbilicus, skin creases, and bony prominences.

Key points in the marking of the location are as follows:

  • The patient should be awake
  • The site is evaluated with the patient supine, sitting, and bending; this will allow choice of the optimal location for facilitating subsequent care
  • The site is marked with permanent ink before the surgical preparation to ensure that the marking is not displaced and to avoid anatomic distortion when the abdomen is opened
  • In patients who have undergone multiple previous abdominal surgical procedures, computed tomography (CT) of the abdomen may be useful for helping determine the best location for the colostomy
  • As a rule, in an individual with an average body mass index (BMI), the most common location is through the infraumbilical fat roll; in an obese individual with a pannus, the stoma is located in the upper abdomen, away from skin creases, where the skin is flat