# Ostomy maturation



## Praveen Ravi (Nov 18, 2014)

Hi ..Can you please help me with this.. 

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.


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