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OPERATIVE TREATMENT OF RECTAL POLYPS


By • Дек 26th, 2010 • Category: Rectum

Single and multiple polyps of the rectum are treated either by excision per anum or by electrocoagulation through a proctoscope. Excision may be done when the polyps are spaced not more than 10 cm from the anus; otherwise electrocoagulation is indicated.

Operation for excision of polyps per anum.

Under local or combined inhalation anesthesia, and in the position as in hemorrhoidectomy, a rectal specu­lum is introduced in the anal canal, the polyp is grasped with a forceps and cut off with scissors, after which hemostasis is secured. If the polyp is large, it should be excised by making an oval incision (Fig. 121,1) and the mucosal wound sutured with catgut. If the polyp is located 6 to 10 cm from the anus, a small vaginal specu­lum 4 cm wide and 10—12 cm long is introduced into the rectum after the sphincter is stretched (Fig. 122,1). The upper rectal wall is next elevated, the lower wall retracted downwards with a 5 cm long speculum, the polyp grasped with a long forceps (Fig. 122,2) and ex­cised securing a margin of normal tissues all around the polyp.

As the excision is progressing, the mucosal wound is closed with catgut sutures (Fig. 122,3). In all three stitches are applied, after which the catgut is cut off. An ointment pack should be tucked into the rectum for 2 days.

Operation for excision of a rectal polyp

Fig. 121 Operation for excision of anal canal polyps:

1. Excision of a larger anal polyps with subsequent suture of the mucosa.

Fig. 122 Operation for excision of a rectal polyp:

1. A vaginal speculum with 13 cm long blades has been introduced into the rectal lumen. This speculum is shown separately.

2. The polyp is seized in a long Billroth forceps.

3. As the mucous membrane is dissected, catgut su­tures are applied to the wound.



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