Colon Rescection

Question 1

Colon Resection

Answer 1

. Running of Colon
. Colon freed
. Intestinal clamps
. End-to-end anastomosis
. Laparotomy closure performed

Question 2

Surgical Anatomy & Pathology

Answer 2

. Colon divided into 7 sections: cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anal canal
. Cecum held in position by peritoneum
. Ascending colon begins at ileocecal valve and ends at hepatic flexure; held in place by peritoneum and hepato-renal ligament at the hepatic flexure
. Transverse colon begins at the hepatic flexure, travels across top of abdominal cavity, and ends at splenic flexure; most mobile section of the colon attached to the posterior surface of the diaphragm by the phrenocolic ligament
. Descending colon begins as splenic flexure and is supported by peritoneum and attached to the posterior abdominal wall
. The sigmoid colon is held in place by fold of peritoneum called the iliac mesocolon and it ends at the rectum; it is the most frequent site of colon cancer and volvulus.
. Colon has four layers: serosa, muscular, submucosa, mucosa
. Arterial vessels encountered during a colon resection can include the right, middle, and left colic arteries; inferior & superior mesenteric arteries; intercolic & sigmoid arteries; superior rectal artery

Question 3

Preoperative Diagnostic Test & Procedures?

Answer 3

?

Question 4

Equipment & Instruments Unique to Procedure

Answer 4

. Major instrument set; include extra Crile hemostats and large hemostats such as curved Kelly & Pean due to large vessels
. Long & deep instrument set
. GI instrument set with bowel clamps
. GI staplers (type of staplers needed according to resection & anatomies to be performed)
. Large self-retaining retractor
. Extra needle holders, scissors, and thumb forceps (Bowel technique will be used and these items will be handed off the field.)

Question 5

Supplies Unique to Procedure

Answer 5

. Large-diameter ties due to size of vessels that will be encountered; will need a large number of ties opened and ready to use
. Foley catheter
. Active drain (e.g Hemovac or Jackson-Pratt)
. Extra laparotomy sponges & towels

Question 6

Preoperative Preparation

Answer 6

. Colon has the largest population of intestinal flora; therefore, the chances of a postoperative SSI are higher than normal
. Bowel prep is performed on the ward to cleanse the colon of fecal matter & bacteria
. Prophylactic antibiotics are given by anesthesia preoperatively, possibly intraoperatively and postoperatively by IV.
. Position: Supine
. Anesthesia: General
. Skin Prep: Mid-Chest to symphysis pubis and laterally as far as possible. Care myst be taken to avoid removing the markings made by the surgeon for the site of potential colostomy
. Draping: Square off the four towels - edge of upper towel placed mid-chest; lateral towels placed using anterior superior iliac spines as guide; edge of lower towel placed just above line of symphysis pubis
. Laparotomy drape: Surgeon may want to place an incise drape that is impregnated with an antimicrobial iodine agent. The incise drape is placed prior to the placement of the laparotomy drape

Question 7

Practical Consideration

Answer 7

. The ST, along with the other members of the. sterile team, must use bowel tech. once the bowel is opened.
. Instruments, sponges, & gloved hands that come into contact with the open bowel are considered contaminated
. It is recommended the ST create 2 mayo stand setups, 1 for surgical wound & colon resection, and the other for wound closure. The instruments & supplies set aside for closure should not be handled until the colon is closed and the sterile team members have changed gown and gloves
. A stoma may be created as part of the surgical procedure

Question 8

Surgical Procedure #1

Question 9

Surgical Procedure #2

Question 10

Surgical Procedure #3

Question 11

Surgical Procedure #4

Question 12

Surgical Procedure #5

Question 12

Surgical Procedure #5a

Question 13

Surgical Procedure #5b

Question 14

Surgical Procedure #5c

Question 15

Surgical Procedure #7

Question 15

Surgical Procedure #9

Question 15

Surgical Procedure #6

Question 15

Surgical Procedure #10

Question 16

Postoperative Considerations: Prognosis

Answer 16

. No complications: Return to most. normal activities in 6-8 weeks. Long-term prognosis will depend on the reason for the resection being performed. Patients may require additional medical treatment such as chemotherapy & radiation therapy
. Depending on location of resection, bowel habits may be altered. Lifestyle and diet will be somewhat altered if colostomy is performed
. Complications: Hemorrhage; SSI; intestinal obstruction due to formation of postoperative adhesions; stump rupture if colostomy performed; sepsis; ureteral injury; thromboembolism; stoma complications

Question 16

Surgical Procedure #8

Question 17

Postoperative Considerations: Immediate Postoperative Care

Answer 17

. Transport to PACU
. Instruct patient not to strain & to bolster wound with a pillow if he or she must cough or sneeze

Question 18

Postoperative Considerations: Wound Classification

Answer 18

. Class 2: Clean Contaminated
. Class 3: Contaminated (if spillage from the GI tract occurred)