rectal instruments

OPERATION FOR STRICTURE EXCISION BY MEANS OF POSTERIOR PROCTOTOMY


By • Дек 21st, 2010 • Category: Rectum

Under inhalation or endotracheal anesthesia and with the patient lying on the right side with his legs flexed (see Fig. 128,1), an incision is made for posterior proctotomy, the coccyx is removed and the posterior aspect of the rectum is exposed as described on p. 152 (see Figs 128,2, 128,3 and 128,4). Next, a metal Hegar dilator is introduced into the rectum per anum and passed superior to the stricture. The incision should be 3 to 4 cm long. The rectal wound is drawn apart with retractors (Fig. 151,1) after which the dilator is with­drawn through the anal orifice. The incision through the rectum must then be extended upwards or downwards so that the transverse stricture is in the centre of the result­ing rectal wound. The thickened rectal wall is then exci­sed by cutting out a wedge-shaped flap from the rectal lumen side by means of a sharp scalpel (Fig. 151,2).

The resulting profuse capillary bleeding is eliminated by electric sucking or frequent application of a swab.

As soon as the stricture has been excised, the surgeon applies interrupted catgut sutures to the rectal wound edges, including the mucosa. (Fig. 151,3).

When the sutures have been laid, a thick rubber tube wrapped with fat gauze is introduced per anum into the rectum superior to the stricture (Fig. 151,4).

The wound of the posterior rectal wall is then sutured over this in two stages (see Fig. 128,7). The levatores and skin are sutured over the wound. A drainage tube or a narrow ointment swab are introduced in the wound centre. The tube is removed from the rectum on the fifth postopera­tive day.

In high-level strictures (lying more than 12 cm from the anus), the operation of low anterior resection with manual application of sutures should be employed.

Operation for dissection of the stricture in pos­terior proctotomy

Fig. 151. Operation for dissection of the stricture in pos­terior proctotomy:

1. Posterior rectal wall has been cut through the stricture. Л Hegar dilator can be seen in the wound.

2. Stricture excision from the rectal lumen side.

3. Application of sutures to the rectal wound follow­ing stricture excision.

4. A thick rubber tube is introduced into the rectum after the stricture has been sutured.



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