Turnbull Stoma

The speaker currently uses laparoscopy to identify the bowel segment and mature a stoma, rather than the traditional left lower quadrant incision for double barrel stoma.

The technique has recently changed to doing a loop stoma instead of double barrel.

The stoma should be matured on the flat portion of the baby's left lower quadrant.

The sigmoid loop has some variation to it.

The proximal sigmoid should be chosen to mature the stoma, preserving the distal sigmoid and rectum for the ultimate pull through.

The Turnbull loop stoma looks to the world like an end stoma but has a tiny, flat mucous fistula.

In double barrel stomas, key collateral vessels to the distal segment can be easily ligated when taking mesentery.

The Turnbull stoma prevents mesenteric vessel injury because no mesentery is taken.

The Turnbull stoma is a loop that essentially functions like an end.

The key to the Turnbull stoma is creating a loop with the proximal side brooked and the distal side flat.

The Turnbull technique can be used for ileostomy in Hirschsprung's disease cases.

Diversion was chosen to allow for healing after a redo pull-through procedure.

The stoma site should be drawn on a flat part of the left lower quadrant at some distance from the incision.

The correct orientation for proximal and distal must be marked.

The bowel is opened on the anti-mesenteric side.

The separation from proximal to distal is 90 to 10 (90% proximal, 10% distal opening).

The seromuscular layer is tacked to the fascia, and the two corners are tacked to the dermis.

Tacking to fascia and dermis is really important because the main complication related to a loop stoma is prolapse.

The proximal limb is turned inside out using a retractor, creating the appearance of an end stoma.

The distal limb is matured flat to the skin.