rectal instruments


By • Дек 26th, 2010 • Category: Rectum

Proctototny is carried out in those cases when the tu­mour has a wide base and is located 4 to 14 cm supe­rior to the anus.

The operation is performed with the patient lying on his right side with his legs flexed and somewhat drawn up to the abdomen (Fig. 128,1). Under combined inhala­tion or intubation anesthesia (local anesthesia by the Vishnevsky method is also possible), an incision is made along the middle sacrococcygeal line 1 cm below the coccygeal apex, and the posterior coccygeal surface and that of two sacral vertebra are exposed, so as to visualize the anococcygeal ligament (Fig. 128,2). The coccyx is then resected under the protection of a metal spatula (see Fig. 110,2). After resection, hemostasis is instituted by ligating the middle sacral artery. Next, the anococcygeal ligament is dissected longitudinally, the levator ani musc­les and retrorectal fat are bluntly drawn apart, and the posterior rectal wall is exposed (Fig. 128,3) and opened by a longitudinal incision 4 or 5 cm long (Fig. 128,4). If the tumour is situated on the posterior rectal wall, it is to be removed with scissors together with the mar­gin of the rectal wall. If located on the lateral or an­terior rectal wall (Fig. 128,5), the tumour should be gras­ped with a Luer clamp, brought to the exterior and excised securing a margin of normal tissues around the tu­mour. A careful hemostasis with suture of the involved vessels is necessary.

The mucosal margins are then dissected upwards and downwards and sutured with catgut over the tumour base (Fig. 128,6).

The rectal wound is closed with two longitudinal rows of catgut (Fig. 128,7) in such a way that the first row does not include the mucosa (as in the suture of the bladder).

The margins of the levator ani muscles are sutured separately over the rectum. The skin is sutured with silk, except for the central portion of the wound where an ointment pack and a thin vinyl chloride tube should be introduced for 7 or 8 days. The sutures are removed on the 9th day, after which time daily baths are taken and dressings applied as usual.

If a fistula develops in the wound centre, as a rule it would heals spontaneously with conservative treatment (daily baths, dressings, etc.).

Posterior proctotomy operation

Posterior proctotomy operation

Fig. 128. Posterior proctotomy operation:

1. Position of patient in posterior proctotomy opera­tion.

2. The anococcygeal ligament is visualized following dissection and retraction of the skin and subcutaneous fat.

3. The posterior surface of the rectum following resec­tion of the coccyx and retraction of the levatores. (Sche­matic).

4. The posterior rectal wall has been divided. A villous tumour is visualized.

5. A villous tumour on the anterior rectal wall.

6. The villous tumour removed and mucosa closed.

7. Two series of interrupted sutures placed on the pos­terior rectal wall.

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