134

Procedures Surgicol Procedures lncludirrg Minimol Access

Goslrointestinol Surgery

r l$$

ANIERIOR RESECTION OF THE SIGMOID COTON AND RECIUM

IBI'OMINOPERINEAL RESECTION OF THE IECTUM Definition Bxcision of the rectum, usually including a portion of

Definition
when.apInvolves the excision of the sigmoid colo.n and

"fit.Uf" " ;f;h;;;il

"egmett[

ti

rectosigmoid

;;";iil;;;;to*imal
Discusion

*iirt"trt"

sigmoi<l colon to the remaining

anastornosis of the distal de-

.ttd'th" proximal two-thirds

&e sigmoid colon, through an abdominal (anterior) and

rperineal approach.
llccussion

of the rectosigmoid or rectum'

This procedure is performed for benign (e'g'' diverticuhtis) or malignant conditions' Procedure
The lower A verticaL or transverse incision can be used' rectosigmoid colon (and proxil;;;iG;Gmoid, and mesenteric i*ut "".ti*)"are mobilized by- dividingmalignancy' procedures for ;;;lt" attachments. In *".1"" o"ttions of the mesentery are excised to include laaiii.ti"t lymph-node-bearing tissue' The ureters are of ia""iin"a and protected. The"appropriate segmentsu' bowel is anastomosed with &.i.ed, and the ""i""1" staples. Tension is avoided on the anastomos$ i"r"t o" Th by mobilizing more p-roximal colon as necessary' is closed in laYers.

ftis procedure is performed most often for the treatnent of rectal malignancy but also for inflammatory twel disease, ineversible sphincter injuries, and so o Abdominoperineal resection of the rectum may be
mbined with
resection of the proximal colon as well.

ftocedure A vertical or transverse abdominal incision is made. ffie extent and level of the pathology is determined. frviding the mesenteric vascular attachments to the rllorel, carrying the dissection to the rectum. The and other adjacent organs are identified and
rvise avoided unless they are to be removed. The

lte

portion of the colon to be removed is mobilized by

"tdo^"tt

is transsected proximally. The distal portion (the end of which is protected from spillage by oflap pads, clamps, and/or a rubber glove secured

Preporotion of the Potibnt on armThe patient is supine; arms may be extended ;;il. Ch"ck with surgeon regarding insertion of a uuro". b"eginning preparation' Applv

'rmbilical tapes) is dissected into the depths of the ris transsecting the lateral rectal stalks (middle
connective and adipose tissue are removed malignancies. In benign disease the dissection close to the bowel waII. A stoma site is fashioned cxcising a disc of skin and tunneling into the peri-

vessels)

to the level of the

coccyx.

F;i;;";.th;i""

electrosurgical disPersive Pad'

Skin PrePorotion

extending Begin at the incision (vertical or transverse)f";il;;;i; to upper thighs, and down to the table at

the sides. Droping, Equipment, lnstrurnentotion' ond

SuB'priei
See Right HemicolectomY, P' 131'

um through the rectus muscle. The end of the imal portion of the colon (or ilerrm) is passed the tunnel without tension and assuring good is sutured to the peristomal skin. The abmay then be closed, or if simultaneous perineal ion is performed, the "abdominal" surgeon reins to assist from above. As the perineal portion is
,

the surgeon above closes the abdomen. The surgeon closes the anus with a heavy-gauge