Outpatient Management: Colostomy

1. First postoperative visit 7-14 days postoperatively OR two weeks after discharge if hospitalized on postoperative day #14
2. Second postoperative visit 2 months postoperatively (telehealth if eligible)
3. Pre-Reversal Workup
4. If age > 44 and no recent colonoscopy
   • Order colonoscopy
   • Barium enema if indicated on checklist
5. If age < 44 or recent colonoscopy:
   • Barium enema if indicated on discharge checklist
6. If family history of colon cancer, consider screening colonoscopy prior to reversal
7. If known or possible sphincter injury, will need in person appointment with rectal examination
   • Anal manometry ordered at faculty discretion
   • If manometry abnormal, refer to colorectal surgery
8. Schedule date of surgery
9. Preoperative Orders
10. Antibiotic Bowel Preparation
    • Neomycin 1g TID day prior to surgery (2:00 PM, 4:00 PM, 10:00 PM)
      • Erythromycin 1g TID is reasonable substitute if neomycin unavailable
    • Metronidazole 500 mg TID day prior to surgery (2:00 PM, 4:00 PM, 10:00 PM)
11. Mechanical Bowel Preparation
    • Magnesium citrate 1-2 bottles OR
    • Miralax (polyethylene glycol) 256 g
12. Chlorhexidine Wipes to be used the day before surgery
13. NPO 6 hours prior to procedure with electrolyte/sports drink immediately prior to NPO
14. Anesthesia: Perioperative Consultation Service consultation for adjunctive analgesia

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Last update: March 27, 2025
Created: March 27, 2025