A 43-year-old male undergoes a total proctocolectomy for ulcerative colitis. The terminal ileum is brought out on the anterior abdominal wall as an end (Brooks) ileostomy. What is necessary to obtain optimal healing?

The ileostomy should be circular rather than square to avoid excessive stenosis of the stoma. Wound healing by a square incision results in a greater degree of stenosis than by an equivalent circular stoma. Failure to close the gap between the ileal loop on the abdominal wall may lead to subsequent internal herniation. It is critical to ensure that the ileal stump is not devascularized.