Colorectal surgery

I- Colic surgery:

A- colectomy right:

The goal is to resect the right colon, appendix and terminal ileum. The dangers are the right ureter and duodenum.Vascularisation ensured by the branches of the superior mesenteric artery

1- supine, above-median incision and infraumbilical

2- Ligatures meso: vascular arcade section of the last cove section ileo- caeco-appendiceal vessels, right colic and arcade Riolan

3- colorectal épiplooïque detachment right of the transverse colon. Detachment of the right angle colic, colo-parietal separation law (incision of the fascia Toldt law).

Section 4 of the transverse colon by 1 shot of 55 blue GIA staples and ileum on a clamp

5- anastomosis termino-lateral transverse ileocecal 2 running sutures

6. Closing the mesenteric defect

Colorectal surgery

B- colectomy left:

The goal is to resect the left colon from the left transverse colon to the upper rectum. The dangers are left ureter and spleen.Vascularisation ensured by the branches of the inferior mesenteric artery.

1- supine, rectum position (apart leg, slightly bending the legs) and above-median incision infraumbilical

2- Ligature and section of the artery and inferior mesenteric vein and arcade Riolan

3- detachment colo-left parietal (incision of the fascia Toldt left)

4- colo-épiplooïque detachment left on the transverse colon, continued until the splenic flexure.

5- detachment continued to the upper meso-rectum

Section 6 of the rectum by a gust of 55 TA green staples

Section 7 of the left transverse colon after application of a purse clip

8. Establishment of a circular mechanical gripper head 29 or 31 hp

9- colorectal anastomosis with transanal approach (the Knight)

10- Verifying the anastomosis by injection of methylene blue into the rectum and the flanges on the clamp

11. Drainage in contact with a multi-blade tubulated

C- anterior resection:

Operation performed to treat a tumor of the upper rectal means or rectum, see the lower rectum with a distance between the lower pole of the tumor and the anal margin of the order of 3 cm. In the latter case, the mechanical anastomosis is very difficult and it offers a manual colo-anal anastomosis that we will detail.

Rectal cancer is accessible to pre-operative radiotherapy and may be necessary in this case to achieve a temporary loop ileostomy FID

1- supine, position rectum, urinary catheterization

2- under umbilical median incision

3- detachment of the sigmoid loop (colo-parietal detachment).

Section 4 of the inferior mesenteric artery and vein, and the mesosigmoid.

5- detachment of the upper meso-rectum, middle and lower

6- Incision of the peritoneum right and left latero rectal and peritoneum of the cul-de-sac of Douglas forward

Ligature and section 7 of peri-rectal vessels by performing the cleaning, maintaining the branches of the lateral pelvic plexus nerves and respecting the ureters

Section 8 of the sigmoid by a gust of 55 GIA Blue

Section 9 of the rectum above the anal canal and the room ablation

10- For transanal approach the summit of the sigmoid is drawn down and the line of staples is resected

11- anastomosis end to end coloanal performed by separate points between the colonic wall and the lining of the anal canal (often necessary separation of the splenic flexure)

12. Establishment of a trans-anal drain

13. Establishment of a multi-cannulated blade in the pelvis, in contact with the anastomosis

14- side Ileostomy FID or lateral colostomy right transverse

D- The abdominoperineal resection:

Very mutilating intervention that aims a wide oncologic resection of a tumor of the lower rectum, extended locally or very close to the anal margin.

It removes the anus, the anal canal and rectum. The muscle layers are closed with the pelvis a certain tension, and the skin surface. This often causes disunity, abscesses, delayed wound healing, aggravated by a state of malnutrition or radiotherapy.

The terminal colostomy and definitive in FIG.

E- sigmoidectomy laparoscopic:

Increasingly achieved, the goal is to resect the sigmoid loop (for diverticulosis, polyps or small cancer) with minimal parietal incision.

The steps are those of the left colectomy, while the level of colonic resection will determine the colorectal épiplooïque detachment left and the splenic flexure.

The rectal section is made by “endo-GIA”. The anastomosis is performed on the circular clamp.

F- Intervention Hartmann:

The principle is to perform emergency surgery, at a fragile patient (general condition or shock) for treating occlusive cancer or colon or rectal perforation. There is provided a colonic resection (often sigmoid) with a closing of the rectum by a TA or an overedge or 2, and a terminal colostomy in FIG.

G- Ileostomy and Colostomy:

Can be the side (lateral incision of the intestinal loop output by a port through the wall) or terminal (opening bowel full channel to the skin)

May be permanent (such as a colostomy after abdominoperineal resection) or temporary (like a loop ileostomy after anterior resection).

II- Proctology surgery:

A- Hemorrhoids:

The dilation of the veins of the anal canal causing them prolapse and complication: pain, thrombosis, hemorrhage, inflammation.

Haemorrhages are treated urgently by binding (with an elastic, performed by a gastroenterologist), or absorbable sutures (a surgeon)

Seizures should be treated medically at first.

Thrombosis must be surgically incised.

Hemorrhoid treatment has in the conventional technique aims to remove dilated veins and mucosa of the corresponding anal canal.

Scarring is often long (4 to 6 weeks). In severe forms, it can lead to anal stricture.

B- The abscess of the anal margin:

Very painful, it is often linked to inflammation of microscopic glands in the lining of the anus.

This inflammation is a small abscess that can either be solved by discharging into the light of the anal canal or rectum, or spread to the perianal area see Perirectal.

Emergency treatment is surgical flattening after examination performed under GA (anoscopy). The flattening is done by direct incision, wash the abscess and possibly wicking.

Anal fistula results from the spontaneous development or post-surgical abscess of the anal margin. Treatment can be excision of fistula tract if it is extra-sphincter. It may be the “elastic strain” in case of excess or trans-sphincter fistula.

C- anal fissure:

Is a chronic wound of the anal mucosa, due to hypertonicity of the internal anal sphincter. Treatment consists of excision of the anal mucosa cracked in a partial internal sphincter sphincterotomy and a mucoplastie progress.

The laxative and antibiotic treatment is often necessary in the anal surgery.