The anesthesia, position, and abdominal incision and exposure are determined by the colon operation being performed. When markings are made preoperatively, they should be scratched gently into the skin with an “X” prior to skin preparation. If this is not done, at the end of a long and difficult case, the inked markings will likely be gone. Upon completion of the colon anastomosis and prior to closure of the abdomen, the ostomy site is revisited. The cut edge of the abdominal wall, namely, the linea alba in the midline incision, is grasped with Kocher clamps and retracted to the central position it will occupy after closure. In patients with a thick abdominal wall, an additional clamp may be placed on the dermis to hold the abdominal wall in its usual alignment. A 3-cm circle of skin is excised and the dissection is carried down through the subcutaneous fat to the anterior fascia of the rectus muscle. A two finger–sized opening is made through the fascia. Some prefer a single slit, while others make a cruciate incision. The rectus muscle is spread or retracted medially. Care should be taken not to injure the epigastric vessels that run deeply in the center of this muscle. Another two finger–sized opening is made through the posterior sheath and peritoneum.