Anterior Resection

17. Anterior Resection

Objective

In case of:

•   Rectal cancer more than 6 cm from anal verge

•   Trauma to the rectum

•   Polyps of the rectum

•   To remove the rectum with anastomosis of sigmoid to anal canal.

Position

Supine with Trendelenburg.

Anesthesia

General.

Incision

Lower midline or transverse.

Procedure

1.  The rectum is mobilized after incising the peritoneal reflections on both sides of the rectal tube.

2.  The branches of the inferior mesenteric artery are divided between ligatures and the rectum is mobilized off the presacral space till the desired level is reached.

3.  The lateral ligaments are divided after protecting the ureters.

4.  At the deserved levels of resection the mesorectum is divided between ligatures and the rectum is divided.

5.  The colon is then anastomosed to the rectal stump using a single layer interrupted anastomosis.

6.  A stapled anastomosis is a good alternative. The presacral space is drained and the wound closed in layers.

Instruments

•   Harrington’s retractor (Fig. 9.26)

•   General set, 1

•   Gastrointestinal set, 1

•   Deep set, 1.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.surgseminar.blogspot.com    www.drmmkapur.blogspot.com

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).

Any questions be sent to drmmkapur@gmail.com

All plder posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surginstruatlas.blogspot.com

www.surgseminar.blogspot.com   www.drmmkapur.blogspot.com

Left Hemicolectomy

Left Hemicolectomy

Indications

•   Tumors of the splenic flexure and descending colon

•   Diverticular disease with perforation or bleeding.

Position

Supine.

Anesthesia

General.

Procedure

1.  Midline incision.

2.  Mobilize descending colon and splenic flexure.

3.  Divide the inferior mesenteric vessels between ligatures at its take off.

4.  Separate greater omentum from the stomach to take it with the left half of the transverse colon.

5.  Divide colon between clamps removing left lateral third of transverse colon.

6.  Descending and simoid colon.

7.  Anastomose transverse colon to the rectum using single layer of interrupted non-absorbable suture.

8.  To avoid tension, it may be necessary to mobilize the right transverse colon.

9.  Close abdomen without drainage.

Instruments

•   General set, 1

•   Gastrointestinal set, 1.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surginstruatlas.bogspot.com

www.surgseminar.blogspot.com   www.drmmkapur.blogspot.com

SPLENECTOMY

Splenectomy

Indications

In cases of:

•   Traumatic splenic rupture

•   Hematologic splenic disorders (ITP, Hereditary spherocytosis)

•   Removal of deceased spleen.

Position

Supine.

Anesthesia

General.

Procedure

Incision of midline for trauma and left subcostal for elective splenectomy:

1.  Incise posterior layer of spleno-renal ligament and deliver spleen to wound.

2.  Divide splenic artery and vein between double ligatures protecting the tail of the pancreas.

3.  Divide short gastric arteries between ligatures taking care not to injure the stomach wall.

4.  Remove spleen.

5.  In hematological diseases, look for accessory spleens.

6.  Close abdomen in layers without drainage.

Instruments

•   General set, 1

•   Gastrointestinal set, 1

•   Deep set, 1.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.surgunstruatlas.blogspot.com

www.surgseminar.blogspot.com   www.drmmkapr.blogspot.com

Cholecystostomy

Cholecystostomy

Objective

In case of inflammation of gallbladder:

•   Remove the gallstones

•   To remove pus from gallbladder.

Position

Supine.

Anesthesia

General.

Procedure

1.  Vertical or right subcostal incision.

2.  Surround gallbladder with packs.

3.  Aspirate bile.

4.  Incise into gallbladder fundus - aspirate bile and remove all stones.

5.  Do not miss stone impacted in cystic duct.

6.  Insert a 24 F Foley’s catheter and close opening around the catheter using a purse string suture.

7.  Fix gallbladder to parietal peritoneum.

8.  Wash subhepatic area and close abdomen with subhepatic suction drainage.

Instruments

•   General set, 1

•   Biliary tract set, 1

•           Foley’s catheter (drain GB)

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review.
Visitors that follow may post contributions to th site,please write to address above.
To create cnsumer/provider engagement visit www.surginstruatlas.blogspot.com
www.surgseminar.blogspot.com   www.drmmkapur.blogspot.com