Divided loop colostomy that does not prolapse.

A loop colostomy in infants and children is usually temporary, made through a small abdominal incision, and frequently prolapses its distal limb within months of its construction. Once this prolapse occurs, its permanent reduction is hardly ever achieved. On the other hand, the colostomy that is made at the time of a major laparotomy and the colostomy whose limbs are brought out through separate abdominal wall openings, rarely prolapse. The advantage of the loop colostomy over the latter two types is that it is easier to make and easier to close. Within the last 3 years, 13 infants and children received a form of loop colostomy that way easy to construct, easy to close, and did not prolapse between these two procedures. The loop colostomy (right transverse in all instances) was brought out through a small right upper quadrant transverse rectus cutting incision, and after the fascia was closed on either side of the colon loop, the latter was divided with the distal stoma tunnelled under the skin about 2.5 cm to the left and sutured to a second skin opening with interrupted 4-0 Dexon sutures. The proximal stoma was sutured to the original skin incision in a similar fashion. Function of this modified loop colostomy was no different, and neither the stomal therapist nor the parents had any trouble caring for this double type of colostomy opening. The closure was not any more difficult. Both stomas were mobilized through one longer than usual transverse incision, trimmed off, and the usual end-to-end colostomy anastomosis was made either extraperitoneal or intraperitoneal.