Procedure:

Patient supine in lithotomy position under epidural anesthesia

Markings of a stoma location at Left side of the abdomen at the level of the
umbilicus
Asepsis and antisepsis done, sterile drapes placed
Closure of anus with purse-string silk suture
Reprepping with Betadine antiseptic
Abdomen opened through a midline incision from about 2 cm. above the
umbilicus to
the pubis carried down to the peritoneum
Incision at the mesentery lateral to the recto-sigmoid area along the White line
of Toldt
Ureters identified and preserved
Blunt dissection continued posteriorly and anteriorly to the level of the
coccyx.
Washing and Hemostasis
Perineal phase started.
An elliptical incision made down to subcutaneous tissues, sphincter muscles
transected starting laterally followed by posterior and anterior blunt dissection
until it is fully mobilized.
Rectosigmoid area clamped and transected with about 10 cm. margin
Specimen brought out perianally
Abdomino-Perineal Resection done
Anal defect partially approximated; drains placed
Proximal component of the resected bowel was brought-out as an endcolostomy
Construction of an end-colostomy:
Circular incision about 2 cm from the previously marked location of the stoma
at left side of the abdomen at the level of the umbilicus carried down to the
posterior rectus sheath
Washing and hemostasis
Peritonealization done
Sponges and instruments count complete, correct and verified
Closure of peritoneum, fasciae and skin
Dressing done
End-colostomy mucosa sutured to skin
Application of appliance and colostomy bag
Patient tolerated the procedure well