Friday, October 10, 2014

Total Colectomy



Total Colectomy
Indications
•   Injury or lower GI bleeding where site cannot be located
•   Ulcerative colitis
•   Multiple cancers or polyps of the large bowel.
Position
Supine.
Anesthesia
General.
Procedure
1.  Mobilize right, transverse and left colon by incising lateral peritoneum. In benign conditions, retain greater omentum. In malignancies separate it from the stomach to take it with the colon.
2.  Ligate right colic, ileocolic, middle colic and inferior mesente­ric vessels at their base.
3.  Remove divided bowel taking precautions to avoid spillage
4.  Anastomose terminal ileum to rectum using interrupted non-absorbable sutures in one layer.
5.  Close abdomen without drainage.
Instruments
•   General set, 1
•   Gastrointestinal set, 1
•   Leylands Jones clamp (Fig. 9.25).

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