Colonostomy Procedure: Preparation, Surgery & Recovery

Colostomy (not "colonostomy") = surgical creation of a stoma from the colon to the abdominal wall for fecal diversion.

Preoperative

• Medical optimization (cardiopulmonary, nutrition, anemia).
• Bowel prep (mechanical + oral antibiotics) per protocol.
• Stoma site marking (by WOC nurse) – visible, within rectus, away from scars/creases.
• Informed consent: permanent vs. temporary, lifestyle impact.

Surgical Steps (Open or Laparoscopic)

1. General anesthesia.
2. Incision / port placement.
3. Mobilize healthy colon segment (usually sigmoid or transverse).
4. Bring through abdominal wall (trephine or laparotomy incision).
5. Evert to form stoma (brooke or turn-back technique).
6. Secure to fascia/skin (absorbable sutures).
7. Mature stoma: beefy red, moist, protruding 1.5–2.5 cm.
8. Close abdomen; apply pouching system.

Recovery

• Hospital: 3–7 days (open), 2–4 days (lap).
• Stoma education: pouching, skin care, diet, hydration, gas/odor control.
• Diet advancement: clear → low residue → regular (6–8 wks).
• Follow-up: WOC nurse, surgeon; reversal planning if temporary.

Complications

• Early: retraction, necrosis, parastomal hernia, obstruction, high output.
• Late: stenosis, prolapse, hernia, skin dermatitis.