To the Editor.—The article, "Antimesenteric Slit: An Aid in the Primary Maturation of the End Colostomy" (Arch Surg 109:580, 1974), violates the primary concepts and advantages of end colostomy. The principal advantage of an end colostomy, as contrasted with a side colostomy, is the sphincteric effect of the circular muscles which remain intact. The longitudinal muscle eliminates the effectiveness of the cut circular muscles in side colostomy, preventing any sphincteric effects. In an end colostomy, the circular muscles remain intact, unimpeded by the cut longitudinal muscles.
Eversion is not necessary in an end colostomy as it is in ileostomy. The fecal stream is not irritating to the skin as is ileal content. Simple tacking of the bowel to the skin produces primary maturation without serositis and minimizes stricture formation. Discrepancy in size between end colostomy and skin is usually evened out by a few extra sutures.