rectal instruments


By • Дек 26th, 2010 • Category: Rectum

This operation for total rectal prolapse consists of peeling off the posterior semicircumference of the rec­tum from the anterior surface of coccyx and sacrum followed by the application of gauze packs to the retro-rectal cavity thus formed. We make use of packs im­pregnated with a liquid ointment having the formula: Pics liquidi 3 ml, (seu Balsami Peru—15,0) Xerophormu 3 g, Anestesini 1 g, Acidi carbolici liquidum 1 g, and Olei ricini 100 g.

The operation is performed under inhalation anesthe­sia with azeotropic mixture plus a presacral block to facilitate rectal mobilization (see p. 27, Fig. 25). The posterior rectal wall is dissected off bluntly from the sacrum and coccyx with scalpel (Fig. 1>7,1), the ano-coccygeal ligament is cut across, and the rectum is dis­sected free posteriorly 12—13 cm deep with a swab holder (Fig. 117,2), keeping it close to the sacrum (Fig. 117,3). The retrorectal cavity is temporarily filled with dry gauze. The surgeon, helped by the assistant, then dissects away the posterior semicircumference of the rec­tum on either side (Fig. 117,4), which is then widely sutured, together with the sphincter, with 4—7—10 Lembert-type sutures (Fig- 117,5). The gauze is now with­drawn from the cavity and the rectum is sutured taking a bite of the coccyx apex (Fig. 117,6). Two large packs soaked in ointment having the above indicated formula but with added carbolic acid are introduced into the right and left parts of the retrorectal space respectively, and the skin edges of the wound between the packs are united with catgut so as to include subcutaneous fat (Fig. 117,7).

The patient is given opium tincture for 5 or 6 days.

Beginning with the 10th postoperative day the oint­ment packs shoud be drawn out step by step until re­moved altogether on the 14th day. If after that the wound dehisces, the residual rectrorectal cavity should be washed with antibiotics through a catheter.

The residual prolapse of the anterior wall of the rec­tum should be excised in three weeks in the same way as in the ligature operation for hemorrhoids Figs 118,1 and 118,2. See also p. 118).

Lockhart-Mummery operation for rectal prolapse in Rygick's modification

Tying off and excision of prolapsing anterior rectal wall

Fig. 117 Lockhart-Mummery operation for rectal prolapse in Rygick’s modification:

1. The upper half of the wound has been elevated with a broad retractor and the surgeon identifies the coccyx apex with finger.

2. The rectum is peeled off from the sacral concavity by means of a swab fitted to a long swab holder. (Sche­matic).

3. The posterior rectal wall is raised with a blunt va­ginal speculum. (A speculum with 12 cm long blade is shown separately).

4. With the surgeon’s left-hand finger in the rectal lumen, the wound is enlarged to the left by means of Allis clamps and a hemorrhoidal retractor.

5. Lembert sutures have been placed, and should be tied in order to reinforce the sphincter and to narrow the rectal lumen.

6. Л catgut suture is applied between the posterior rectal wall and the coccyx apex,

7. Appearance of the wound and protruding packs af­ter suture,

Fig. 118 Tying off and excision of prolapsing anterior rectal wall:

1. The excessive anterior rectal wall is grasped with Luer clamps in two stages.

2. The proximal part of the rectal wall is tied and cut off (its distal portion has already been removed).

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