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
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