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An end colostomy follows a Hartmann's procedure or an abdominoperineal excision of the rectum. The site of the stoma is marked beforehand in the left iliac fossa. An incision is made into the abdominal wall, through the muscle layers and into the peritoneum. The mobilised and clamped colon is drawn through; if the stoma is to be long-term, a peritoneal tunnel can be formed to prevent internal herniation and prolapse.
The abdominal wall is closed around the colon and the clamp is removed by excision. The edges of the colon are sutured to the skin using interrupted Vicryl so that there are no gaps in the mucocutaneous junction. A colostomy bag is applied.
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