rectal instruments


By • Дек 19th, 2010 • Category: Rectum

In the descriptions of operations that follow, some of the figures aie repeated so as not to distract the atten­tion of the surgeon.

The experience gained in the proctological clinics hea­ded by the author (some 1 000 operations for rectal can­cer) has shown the following three radical procedures to be especially useful: (1) abdominoperineal excision of the rectum with establishment of a terminal iliac colos-tomy (Quenu-Miles operation); (2) abdomino-anal resec­tion of the rectum with pull-through of the sigmoid and preservation of the sphincter (pull-through operation); and (3) low anterior resection of the rectum.

In addition to these, two more operations are used: (a) perineal amputation of the rectum and (b) intraab-dominal resection of the rectum with establishment of a terminal colostomy.

In cancer of the rectum, the choice of operation de­pends on the tumour site and its histological structure.

If the tumour is located up to G cm (inclusive) from the anal verge, the Quenu-Miles operation is indicated (Fig. 152.1); if it is sited 6 to 9 cm from the anal verge in females and 6 to 12 cm in males, the pull-through ‘operation Is’the :method of choice (Fig. 152.11); lastly, if the tumour is situated 9 to 22 cm from the anal verge in females and 12 to -22 cm in males low anterior re­section is indicated (Fig. 152.HI);

In very obese patients, no .sphincter-saying operations should he attempted arid ‘only the Quenu-Miles operations is indicated.

Schincter saving operations are likewise con-traindicated in cases with colloidal or solid cancer, and the Qu’enu-Miles ‘operation’ should be carried out instead.

Localization of rectal cancer. (Schematic)

Fig. 152. Localization of rectal cancer. (Schematic).

I. The tumour is located 6 cm from the anal verge, Quenu-Miles operation II. The tumour is located 7 to 9 cm (females) or 7—12 cm (males) from the anus. Pull-through operation. III. The tumour is located 9 to 22 cm (females) or 12 to 22 cm (males) from the anus. Low anterior resection

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