Atraumatic Langenbeck retractor aided eversion of ileostomy

The ileostomy is conventionally formed in the right iliac fossa and may be an end or loop stoma depending on its function be it a definative point for effluent collection or diversion prior to a distal anastomoses or obstruction [1]. A major feature of ileostomy formation originally described by Professor Bryan Brooke in 1952 is the creation of the everted spout to minimize irritation and excoriation of the skin by bowel fluid [2]. Methods described for the formation of a spout include direct traction on sutures passing via the skin, serosa of ileostomy limb and cut edge [2], application of Babcock forceps to the cut edge and internal mucosa of the ileum to be everted [3, 4] and guy rope suture technique of applying temporary traction sutures to the mucosal surface of the ileum to be everted [5]. These procedures can be traumatic to the ileostomy mucosa and may compromise the condition of the stoma and result in significant bleeding or later stoma stenosis. We describe an alternative technique of spout formation whereby a Langenbeck retractor is used as a fulcrum to evert the ileum, thus reduce handling and trauma to the ileal mucosa.