Colorectal Surgery

Question 1

What is a Hartmann’s procedure?

Answer 1

It is a:

• Emergency procedure
• Sigmoidectomy +/- resection of some of the rectum or descending colon
• Leaves a end colostomy
• Leaves a rectal stump

Question 2

What are the indications for a Hartmann’s procedure?

Answer 2

Peritonitis following a perforation: crohn’s, diverticulitis, malignancy.

Complicated malignancy needing an emergency operation aka an obstructing sigmoid malignancy.

Question 3

What is a anterior resection?

Answer 3

Primarily a rectal resection +/- sigmoid/descending colon resection.

• High: rectal stump must be greater than 6cm in length.
• Low: rectal stump is between 2-6cm in length.

A primary anastamosis is formed and it is usually protected by a loop ileostomy being formed (always in low, not necesarrily in high)

Question 4

What are the indications for an anterior resection?

Answer 4

Rectal Ca primarily but also for higher up malignancies.

Essentially a high anterior resection is the same as a left hemicolectomy.

Question 5

What are the specific complications of anterior resection surgery?

Answer 5

May damage the sacral plexus leading to bladder and sexual dysfunction.

Question 6

What is an abdominoperineal resection?

Answer 6

Sigmoid to anus resected with an end colostomy.

If a patient doesn’t have an anus then it is either this surgery or a panproctocolectomy that has been done.

Question 7

What is the indication for abdominoperineal resection and the main complication?

Answer 7

Recto-anal cancer.

Low rectal cancer in which the rectal stump would be less than 2cm.

Very high risk of sacral plexus damage at least temporary bladder and sexual dysfunction.

Question 8

What is a right hemicolectomy and what is the indication?

Answer 8

Distal terminal ileum to the transverse colon resected.

Primary anastamosis with a covering loop ileostomy.

Inidcated in caecal Ca.

Question 9

What are the differences between pancolectomy, sub-total colectomy and panproctocolectomy?

Answer 9

Pancolectomy:

• Terminal ileum to rectum resected.
• Small rectal stump.
• End ileostomy.

Subtotal colectomy: almost interchangeable only difference is that rectal stump is slightly bigger allowing the potential for stoma reversal with a ileorectal pouch (J pouch)

Panproctocolectomy:

• Terminal ileum to anus resected
• End ileostomy

Question 10

What are the inidications for pancolectomy and panproctocolectomy?

Answer 10

Severe UC

Crohn’s colitis

Familial polyposis conditions

Question 11

Which surgery is ideally indicated in severe UC and why?

Answer 11

Panproctocolectomy.

Although UC affects the rectum and tracks proximally it still carries an increase risk of anal cancer and therefore a panproctocolecteomy is reccommended.