rectal instruments

Formation of temporary loop sigmoidostomy without sigmoid resection

By • Дек 19th, 2010 • Category: Colon

This operations is occasionally resorted to in order to provide a passage for faeces during the operative treatment of some benign lesions of the rec­tum and perineum, such as perineal deformity, inconti­nence or trauma of the sphincter, extensive rectovaginal fistula, etc.

With the patient lying supine and under ether-oxygen anesthesia or local anesthesia according to A. V. Vishnevsky, an 8 cm long oblique incision is made in the left iliac region (see Fig. 173.1), and the abdominal ca­vity is opened in layers. The peritoneum is grasped with Mikulicz clamps, a small sigmoid loop is brought out from the abdominal cavity, and a window 3 cm high is made in the mesosigmoid (Fig. 174.1). The loop is now-lifted by the assistant about 8 cm above the skin level, and the surgeon unites both its limbs with 3 fine su­tures (Fig. 174.2), along the free taenia. This step is followed by suturing the peritoneal edges of the iliac wound to the skin edges around the circumference of externalized loop, without cutting the suture ends (Fig. 174.3). The loop is then lowered to the wound below the skin level so that half of the mesenteric window remains above the skin and the bowel is sutured to the ab­dominal wound around its full circumference by the re­maining threads. Л rubber tube 1 —1.5 cm in diameter with rod is then laid on the skin through the mesente­ric window (Fig. 174.4).

Establishment of temporary loop sigmoidostomy without sigmoid resection

Fig. 173. Resection of the exteriorized sigmoid with establishment of temporary loop sigmoidostomy:

5. The externalized intestinal loop has been cut off over the clamps by diathermy knife; the clamps are left on the bowel for 24 hours.

Fig. 174. Establishment of temporary loop sigmoidostomy without sigmoid resection:

1. The sigmoid loop has been brought out from the iliac wound, and a window made in its mesentery.

2. Both limbs of the exteriorized sigmoid are sutured with 3 stitches near the free taenia.

3. The peritoneal edges are sutured to the skin edges around the exteriorized sigmoid loop.

4. Both exteriorized sigmoid limbs are sutured circum-ferentially to the iliac wound edges. A rubber tube with rod has been passed through the mesenteric window.

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