.

l54

o Surgicol Procedures including Minimol Access Procedures

Gostrointestinol Surgery

r l$$

Equipment Electrosurgical unit

Suction

rhom an abdominal procedure entails a significantiy hnger terrn result than the encirclement procedure
{see Thiersch,

p.

151).

Procedure lnstrumentotion Major procedures tray Long instruments traY Gasirointestinal procedures tray (available) Harrington retractor Self-retaining retractor (e.g., Balfour) Hemoclip appliers (assorted sizes and lengths) Stapler (fascia)
Supplies Basin set The lithotomy position is preferred as the prolapse is amentuated. Tlre prone position can be employed. The patient has been prepared as for formal colon resection; a Foley catheter is placed. A circumferential incision is
nnade proximal

to the dentate line through the full

thickness ofthe rectum. The prolapse is distracted and arnputated at an appropriate level, taking care to obtain hemostasis of the messenteric vessels. A peritoneal defect, ifcreated, is repaired. As indicated, a leTatorplasty is preferred. The rectal continuity is then restored by primary anastomosis

Electrosurgical pencil Blades (3) No. 10

Suction tubing Needle magnet or counter Hemoclips (varietY) Mesh or banding materials. Staples (optional)

Freporotion of the Potient, Skin Preporotion, Droping, Equipment, ond

ffirumentotion $eciotNotes

See Hemorrhoid Sungery, p. 148.

SpeciolNotes Check with the surgeon regarding prosthetic material

to be used. PERINEAI RESECTION OF THE RECTUM FOR COMPTETE RECTAT PROHPSE

In addition to the hemorrhoid instruments, a pediatric

Ileaver and malleable retractors may be required.

(PROCIDENTIA)
Definition

Excision of the prolapsed segment of the rectum.

Discussion be accomplished by a perineal approach. This is partie-

Complete excision of the prolapsed rectal segment may

ularly applicable in medically compromised patients in