Noncrushing vascular-type forceps are inserted through the ileostomy site and applied just proximal to the similar forceps on the terminal ileum (Figure 19). The original forceps are removed, and the ileum is withdrawn through the abdominal wall with the mesentery cephalad. At least 5 to 6 cm of mesentery-free ileum should be above the skin level so that an ileostomy of adequate length can be constructed. It may be necessary, especially in the obese patient, to undercut the terminal ileum under the mesenteric blood supply to attain this essential length. The viability is then reevaluated after the ileum is pulled up through the abdominal wall. The mesentery can be anchored to the abdominal wall or brought up into the subcutaneous tissue (Figure 20). It may be advisable to anchor the mesentery of the ileum to the parietes laterally before constructing the ileostomy, because of the possibility of interfering with the blood supply to the terminal ileum. The right lumbar gutter should be closed off to avoid the potential of a postoperative internal hernia. At times it may be difficult to approximate the mesentery of the right colon and ileum to the right lumbar gutter and effect a closure (Figures 20 and 21). The surgeon should palpate the right gutter repeatedly and place whatever sutures are necessary to close it completely or else leave it completely open. The completed ileostomy should extend upward from the skin level at least 2.5 to 3 cm. The mucosa is anchored with interrupted fine synthetic absorbable sutures to the serosal edge of the bowel at the level of the skin and then to skin (Figure 21). Likewise, the mesentery may be anchored to the peritoneum, but no sutures should be taken between the seromuscular coat of the terminal ileum and the peritoneum. When the terminal ileum is divided with a cutting linear stapler (GIA), the maturation of the stoma is delayed until after closure of the abdominal wounds, the staple line is excised, and the stoma matured as described.