The routine steps of colostomy reduction include disinfection of the operative area, opening the abdomen, separating the intestinal tube from the abdominal wall, removing the subcutaneous muscle attached to the intestinal tube as well as the fascial tissue, anastomosing the intestinal tube, and closing the abdomen.
Preoperative disinfection of the surgical area is required. In colostomy reduction, since the presence of the fistula can cause contamination of the wound, disinfection needs to be done from the periphery of the wound to the center of the wound, and the fistula should be covered with iodine-vapor gauze to avoid contamination of the wound.
The abdomen is opened mainly through the mid-abdominal incision into the abdominal cavity, and then the stoma edge shuttle incision to return the stoma to the abdominal cavity, usually choose to the fistula as the center of the shuttle incision, in turn, incision of the skin, subcutaneous, soft tissue.
After incision of the peritoneum, it is necessary to free the intestinal tube, so that the stoma intestinal tube and the abdominal wall are separated, and the adhesion between the intestinal tube and the abdominal wall should be separated very carefully, to prevent the intestinal tube from rupturing, causing the intestinal contents to enter into the abdominal cavity and cause intra-abdominal infections. The intestinal tube is raised and the skin and subcutaneous tissues attached to the intestinal tube are carefully excised.
After freeing, the distal and proximal intestinal tubes should be anastomosed, which can be done by closure anastomosis, anastomotic anastomosis, or hand-operated suture with absorbable suture, and the colonic anastomosis is usually done by anastomosis, to avoid the leakage of intestinal contents after hand-operated suture.
Finally, irrigation is performed, necessary drains are placed and the abdomen is closed.