title: Multimedia article. An improved technique for end stoma creation in obese patients.
abstract: OBJECTIVE
  The formation of an end colostomy in obese patients can be technically demanding and often requires the creation of a particularly large defect in the abdominal wall. This is because of the thickness of the subcutaneous fat and mesenteric fat, and increased resistance or friction while negotiating the bowel and mesentry through the abdominal wall.
  
  
  METHODS
  The use of an Alexis Wound Protector to circumferentially retract the abdominal wall defect and, thus decrease resistance or friction during stoma formation, is described (see Video, Supplemental Digital Content 1 and 2, which demonstrates the technique, http://links.lww.com/A997 and http://links.lww.com/A998).
  
  
  RESULTS
  This technique has been used in eight obese patients who have undergone end stoma formation. In each patient, the efficacy of the wound protector was immediately obvious, resulting in a smaller than usual defect in the abdominal wall and less trauma to the bowel.
  
  
  CONCLUSIONS
  The use of a wound protector has decreased the size of the abdominal wall defect necessary for stoma creation in obese patients and hopefully will decrease the risk and rate of parastomal hernia formation.
authors.affiliation: Department of Colorectal Surgery, St. Vincents Hospital Sydney, Sydney, Australia. alanpmeagher@yahoo.com
authors.forename: Alan P
authors.initials: AP
authors.lastname: Meagher
authors.forename: Gareth
authors.initials: G
authors.lastname: Owen
authors.forename: Rohan
authors.initials: R
authors.lastname: Gett