The omentum is returned to the region of the new pelvic floor and the table is leveled. The colostomy is created through a separate 3-cm (1¼ in.) opening selected and marked prior to surgery. In general, it is midway between the umbilicus and the left anterior superior spine (Figure 18). As this colostomy will be a permanent one, it is wise to choose the site in consultation with the enterostomal therapist. The adhesive ring of the colostomy bag must conform to the contour of the abdomen and must be secure when the patient is standing, bending, or sitting. After excision of the circle of skin, a two-finger-sized opening is made through the abdominal wall. The colon is grasped with Babcock forceps and brought out through the opening without undue rotation of the mesenteric blood supply. Late herniation about the colostomy can be minimized by tailoring the opening in the abdominal wall such that the colon plus one finger is a snug fit.