Turnbull Stoma

Today we present a video showing the technique of a Turnbull loop stoma. Here you see a picture of a baby born with an anorectal malformation, and we have opened the traditional left lower quadrant incision with the intention of doing a double barrel stoma. Nowadays, I would do laparoscopy, identify the segment of bowel I want to open, and then mature a stoma. And recently, we have changed this technique to do a loop stoma. On the right panel, you see the baby's abdomen where the ribs, the anterior superior iliac crest and the pubic bone are marked. You want to mature that stoma on the flat portion of that baby's left lower quadrant. Remember that the sigmoid loop has some variation to it. You want to choose the proximal sigmoid to mature that stoma, so you have the distal sigmoid and, of course, the rectum to mobilize for your ultimate pull through. In this photo, you see the Turnbull loop stoma. The stoma is in the left lower quadrant and looks to the world like an end stoma. However, there is a mucous fistula that's tiny and flat. And here in this video, we will show you how to do it. I wanted to show you this panel, which shows the colostomy closure of a patient who had a double barrel stoma. And I've marked out the mesentery. In this particular case, the mesentery to the distal segment was successfully preserved, and you can see how easily it would be that you could ligate the key collateral vessels to the distal segment when you do a double barrel stoma. The beauty of the Turnbull stoma is that that cannot happen. You will not take any mesentery. All right, so in this case, we show you the creation of a Turnbull stoma. It's a loop that essentially functions like an end. The key is to create a loop with the proximal side brooked and the distal side flat. In this particular case, we did the Turnbull stoma for an ileostomy in a case of Hirschprung's disease, but it was ideal to show you the Turnbull technique. This patient underwent a laparotomy via prior transverse incision for a redo of their pull through. And we decided to divert the patient to allow for healing. We have drawn a circle for the intended stoma on a nice flat part of the left lower quadrant some distance away from the incision. The circle is carved and the fat below removed. We incise the fascia and then pull this loop into the hole. We then close the incision. We have made sure to mark the correct orientation for proximal and distal. And we note the anti-mesenteric side where we will open the bowel. Recognize that this is going to be a 90 to 10 separation from proximal to distal. We tack the serumuscular layer to the fascia, and then we tack the two corners to the dermis. This is really important because the main complication related to a loop stoma is prolapse. Using a retractor, we then turn the proximal limb inside out, which creates the appearance of an end stoma. I now tack the distal limb, which is flat to the skin, and complete the maturing of the proximal stoma.