I52 .

surglcol Procedures lncluding Minimol Access Procedures

'

Gostrointeslinol Surgery

153

Skin Preporotion

Preparation is minimal. Begin inside tape margins,

discarding each sponge after wiping the anus: Droping

nrPsTEtN PROCEDURE (PRESACRAT RECTOPEXY)

Definition

An anterior (abdominal) approach to correct complete

Jackknife. Folded towels and a laparotomy sheet Lithotomy. Drape sheet under buttocks, leggings,
toyels, drape sheet over abdomen

Modified Lateral. Folded towels and a laparotomy

sheet

rectal prolapse (procidentia) by mobilizing the rectum within the abdomen (andpelvis) and fixingitto thepresacral fascia and periosteum by an encircling band of material such as a Teflon, Marlex, or Mersilene mesh.
Dhcussion

Equipment Electrosurgical unit

Suction Pillow and roll or stirrups (for positioning)

lnstrumentotion
Rectal procedures tray Sawyer

may be resected. Accordingly, low anterior resection (see p. 13a) with extensive mobilization of the distal rectum may be performed without requiring placenent of a prosthetic mesh altogether and is currently onsidered by some to be the procedure of choice for omplete rectal prolapse.

dit

If the sigmoid colon is extremely redundant, a portion

Rectal retractors, including Sims, Hill-Ferguson, antl Ligature carrier (optional)

Supplies Blades (1) No. 10, (2) No. 15 Needle magnet or counter

Ptocedure

Small basin
Suction tubing

Avertical or transverse incision is used. The rectum is ffssected from its supporting tissue attachments. A reh of Marlex (or Mersilene, Teflon, etc.) is sutured k stapled) to the presacral periosteum, taking care to rreid the local venous plexus. The mesh is placed about [ebowel to anchor it to the sacrum without restricting " -,rectum too tightly. A resection proximally may be puformed. The abdomen is closed in layers.
of the Potient

Electrosurgical pencil

Lubricant

Antibiotic irrigation and bulb syringe (optronal) SpeciolNotes

Protect skin under tape with tincture ofbenzoin. Be prepared for sigmoidoscopy prior to the proce dure.

F;.th;;i;

patient is supine; arms may be exterided on armnrds. Check with the surgeon regarding insertion of
Foley catheter. Apply electrosurgical dispersive pad.

Preporotion
at the incision (vertical or transverse) extending nipples to upper thighs, and down to the table at
r

sides.

Lubricaie retractors. -r""g*"

terial.

ch;;t;tilirt"

regarding prosthesis matowels and a laparotomy or transverse sheet