This episode offers a practical, case-based approach to one of the most common intraoperative challenges in GI surgery: constructing a stoma that just won't cooperate. The discussion covers preoperative marking and stoma siting in the obese and non-elective patient, technical maneuvers to gain length and reduce tension on the stoma, strategies for the foreshortened small bowel mesentery, and considerations for maturing a stoma in a massively dilated, thick-walled colon. Join Drs. Elissa Dabaghi, Jared Hendren, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss this clinical challenge in colorectal surgery.

Hosts: 
·      Elissa Dabaghi, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio

·      Jared Hendren, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio

·      Joseph Trunzo, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter @joseph_trunzo

·      Ajaratu Keshinro, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @AJKesh

·      David Rosen, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @davidrrosenmd

Learning Objectives: By the end of this episode, listeners will be able to:

1.     Describe preoperative marking strategies and intraoperative technical adaptations for stoma siting and construction in obese and non-elective patients.
2.     Apply strategies for managing a foreshortened small bowel mesentery when constructing an end or loop ileostomy.
3.     Recognize technical considerations for maturing a stoma in a massively dilated, thick-walled colon and identify associated long-term risks

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