Saturday, October 25, 2014

Abdomino-pereneal Resection


Abdominoperineal Resection
Objective
In case of rectal cancer to remove the rectum anal canal.
Position
Lithotomy Trendelenburg. Urethral catheter in site.
Anesthesia
General.
Procedure
1.  The operation is done synchromously by two teams.
2.  The rectum is mobilized as for an anterior resection down to the levator one.
3.  The anus is closed with subcutaneous purse string.
4.  A circumferential incision is made and deepened through the ischis-rectal fossa.
5.  Posteriorly the Waldeyer’s fascia is divided to enter the presacral space and the levator ani is divided.
6.  Anteriorly the incision is deepened.
7.  Using the catheter as a guide to expose the retroprostatic space where the encircling fibers of the puborectalis are divided.
8.  The abdomen and perineum are closed after reconstituting the peritoneum and colon brought out through the rectus sheath. It is now sutured as a colostomy with interrupted mucocutaneous catgut sutures.
Instruments
•   General sets, 2 (one for perineal approach)
•   Deep sets, 1
•   Gastrointestinal set, 1
•   Cope crushing clamps (Fig. 8.72).

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