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).
Any questions be sent to drmmkapur@gmail.com
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