rectal instruments

OPERATION FOR TOTAL COLECTOMY WITH ESTABLISHMENT OF ILEOSTOMY AND SIGMOIDOSTOMY


By • Дек 18th, 2010 • Category: For surgery

The patient is placed on his back and endotracheal anesthesia with ether and oxygen or with azeotropic mix­ture is used.

First a medial laparotomy is performed from the mons pubis and almost as far as the ensiform cartilage, followed by the separation of the greater omentum from the transverse colon by scissors dissection thorough the avascular base of the omentum (Fig. 188.1). This is then moved upwards in the direction of the stomach. Using scissors the peritoneum is then dissected in the right la­teral canal almost as far as the hepatic flexure and the hepatocolic ligament (Fig. 188,2) and, on the left the left lateral canal and the colicolienal ligament are dissected under forceps control (Fig. 188,3). The en­tire colon can be now easily brought out of the abdominal cavity and laid on a broad towel which covers the abdominal cavity from above (Fig. 188,4).

Next, the mesosigmoid, the internal leaf of descend­ing mesocolon (Fig. 188.5), the transverse mesocolon, and, lastly, the internal leaf of ascending mesocolon and ce-cal mesentery (Fig. 188.6) are divided step by step as they are met. If the sigmoid colon is heavily affected, the bowel mobilization is conducted in the reverse order, that is, starting, with the cecutn.

Such mobilization of the colon outside the abdominal cavity reduces the danger of its infection.

The ileum is divided between clamps at a distance of 10 cm from the Bauhin’s valve.

The sigrnoid colon is likewise dissected between clamps at the level of its lower third. The entire colon (previously towelled) is then removed.

The operation is completed by formation of two intes­tinal stomas, one on the ileum and the other on the sig­moid stump in the medial wound or, in rare instances, by performing an ileorectal anastomosis between the rectal end and the ileac side (see Fig. 183.6.7 and 8). This lat­ter variant of total colectomy is invariably used by us in onestage colectomy for multiple polyposis or multiple cancer of the colon. In contrast to this, in nonspecific ulcerative colitis this operation is resorted only in those cases when the rectal sturnp is affected with the ulcera­tive process only slightly.

In establishing the sigmoidostomy following a colo-nic resection for severe ulcerative colitis the stump should not be rendered taut so as to prevent perforation of rec­tal ulcers in the pelvis. Sometimes we wrap the stump with an ointment gauze pack which end is laid near the sigmoid stump.

Total colectomy in ulcerative colitis

Total colectomy in ulcerative colitis

Fig. 188. Total colectomy in ulcerative colitis:

1. Separation of the omentum from the transverse colon.

2. Dividing the hepatocolic ligament.

3. Dividing the colicolienal ligament.

4. The colon is laid on the towel after the ligaments have been divided.

5. Dividing the internal peritoneal leaf of the des­cending mesocolon over the towel.

6. Dividing the internal peritoneal leaf of the ascend­ing colon



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