# Descending Colostomy for Anorectal Malformations Dr. Tamer Ashraf Wafa — GCMD Library

In this video, a creation of a descending colostomy is demonstrated in a newborn with ano-rectal malformation.The video shows the surgeon's point of view (POV). And the surgeon is standing on the patient’s left side.

This video is intended as an education material ans should not replace formal surgical training.

In this procedure, the operative steps are played in normal speed while some of the steps is played in faster speed for illustration purpose.The original video is one hour and 55 minutes.
Surgical steps a described in the subtitles during the video. This is an educational video designed for junior pediatric surgeons in training.

Tamer Ashraf Wafa PhD, MRCS
Assists Professor, Pediatric Surgery Department

Type: video · 5 min · posted 2021-05-07 Canonical: https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002 ## Chapters - [0:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=0) Anatomical Planning and Incision - [1:30](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=90) Bowel Exteriorization and Meconium Evacuation - [3:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=180) Mesenteric Division and Colon Transection - [4:30](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=270) Stoma Fixation and Closure ## Statements - "The target part of the colon to create the stoma is in the most proximal part of the sigmoid colon, as high as possible close to the descending colon" — Tamer Ashraf Wafa (clinical) [0:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=0) - "Targeting the proximal sigmoid colon as high as possible is done to avoid future stoma prolapse" — Tamer Ashraf Wafa (clinical) [0:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=0) - "The site of the proximal stoma is in the center of a triangle between the anterior superior iliac spine, costal margin, and the umbilicus" — Tamer Ashraf Wafa (clinical) [0:40](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=40) - "The distal colon is brought out at the medial end of the incision as a mucous fistula that is made as narrow as possible" — Tamer Ashraf Wafa (clinical) [1:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=60) - "The incision is oblique and about 5 to 6 centimeters in length" — Tamer Ashraf Wafa (clinical) [1:15](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=75) - "The layers are carefully opened to avoid bowel injury due to the colonic distension" — Tamer Ashraf Wafa (clinical) [1:25](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=85) - "The distal and proximal limbs must be carefully identified to avoid stoma reversal" — Tamer Ashraf Wafa (clinical) [1:40](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=100) - "A purse-string suture is applied around the stoma site using a 4-0 suture" — Tamer Ashraf Wafa (clinical) [1:55](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=115) - "A small puncture is made to allow the introduction of a 12-French catheter" — Tamer Ashraf Wafa (clinical) [2:10](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=130) - "The catheter is used for suction of meconium and emptying the distal colon" — Tamer Ashraf Wafa (clinical) [2:25](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=145) - "Saline is used to help liquefy the thick meconium" — Tamer Ashraf Wafa (clinical) [2:40](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=160) - "Washing and suction continues until the colon is completely cleaned out" — Tamer Ashraf Wafa (clinical) [2:50](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=170) - "A window in the mesentery is created with preservation of the marginal vessels" — Tamer Ashraf Wafa (clinical) [3:00](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=180) - "Bipolar diathermy is applied to the vessels distal to the marginal vessels" — Tamer Ashraf Wafa (clinical) [3:15](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=195) - "Coagulation is kept close to the colonic wall and a 2 cm window is created" — Tamer Ashraf Wafa (clinical) [3:25](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=205) - "Two fine bulldogs are applied to occlude the colonic lumen before the colon is divided" — Tamer Ashraf Wafa (clinical) [3:40](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=220) - "Another division of the mesenteric vessels is done to ensure adequate placement of the two stomas at the two ends of the wound" — Tamer Ashraf Wafa (clinical) [3:55](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=235) - "The colon is fixed to the peritoneum using 4-0 absorbable sutures starting on both ends" — Tamer Ashraf Wafa (clinical) [4:10](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=250) - "The peritoneum in between is then approximated with interrupted sutures" — Tamer Ashraf Wafa (clinical) [4:25](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=265) - "The distal stoma is made as narrow as possible" — Tamer Ashraf Wafa (clinical) [4:35](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=275) - "The muscles are approximated using interrupted sutures, followed by closure of the skin with interrupted subcuticular sutures" — Tamer Ashraf Wafa (clinical) [4:42](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=282) - "The stoma edges are fixed to the skin with few simple sutures using 5-0 sutures" — Tamer Ashraf Wafa (clinical) [4:55](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=295) - "The stoma bag shall be applied to the proximal stoma only" — Tamer Ashraf Wafa (clinical) [5:05](https://library.globalcastmd.com/watch/descending-colostomy-for-anorectal-malformations-dr-tamer-ashraf-wafa-4002?t=305) ## Transcript Hello and welcome, this video showed the creation of a descending colostomy in a newborn boy having an indirect malformation. The target part of the colon to create the stoma is in the most proximal part of the sigmoid colon, as high as possible close to the descending colon, and that is to avoid future stoma prolapse. The site of the proximal stoma is in the center of a triangle between the anterior superior iliac spine, costum margin, and the umbilicus. The distal colon is brought out at the medial end of the incision at the mucous fistula that is made as narrow as possible. The incision is oblique and about 5 to 6 centimeters in length. The layers are carefully opened to avoid bowel injury due to the colonic distension. The sigmoid colon is exteriorized and the anatomy is verified. The distal and proximal limbs are carefully identified to avoid stoma reversal. The site of the stoma is marked and a per-string suture is applied around it using a 4-row suture. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. A small puncture is made to allow the introduction of a 12-French catheter. bar, the catheter. of a 12 French catheter. The catheter is used for suction of meconium and emptying the desto cone. Saline is used to help liquefy the thick meconium. Washing and suction continues until the cone is completely cleaned out. Now, a window in the mesentery is created with preservation of the marginal vessels. A bipolar diathermy is applied to the vessels distilled to the marginal vessels. Coagulation is kept close to the colonical and a 2 cm window is created. Coagulation is also applied to the colonic lumen. Coagulation is applied to the colonic lumen. Two fine bulldogs are applied to occlude the colonic lumen and then the colon is divided. Coagulation is applied to the colonic lumen. Another division of the mesenteric vessels is done to ensure adequate placement of the two stomas at the two ends of the wound. Now, the cone is fixed to the peritoneum using 4-0 absorber sutures starting on both ends. Coagulation is fixed to the colonic lumen. The peritoneum in between is then approximated with interrupted sutures. The distal stoma is made as narrow as possible. Then the muscles are approximated using interrupted sutures, followed by closure of the skin with interrupted subcuticular sutures. Finally, the stoma edges are fixed to the skin with few simple sutures. Here, 5-0 sutures are used. The stoma bag shall be applied to the proximal stoma only. The stoma bag shall be applied to the proximal stoma only. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai