GI - Summary Of Surgical Procedures and types of stoma

Question 1

What type of resection and anastomosis would you perform for caecal cancer, ascending or proximal transverse colon?

Answer 1

• Right hemicolectomy

- Ileo-colic anastomosis

Question 2

What type of resection and anastomosis would you perform for distal transverse, descending colon cancers?

Answer 2

• Left hemicolectomy

- Colon-colon anastomosis

Question 3

What type of resection and anastomosis would you perform for sigmoid colon cancer?

Answer 3

• High anterior resection

- Colo-rectal anastomosis

Question 4

What type of resection and anastomosis would you perform for upper rectum cancer?

Answer 4

• Anterior resection

- Colo-rectal anastomosis

Question 5

What type of resection and anastomosis would you perform for low rectum cancers?

Answer 5

• Anterior resection (low)

- Colo rectal +/- defunctioning stoma

Question 6

What type of resection and anastomosis would you perform for anal verge cancers?

Answer 6

• Abdomino-perineal excision of rectum

- no anastomosis

Question 7

How does an emergency setting influence what procedure is performed?

Answer 7

• Emergency setting: if bowel has perforated - risk of doing an anastomosis is greater, especially if it is colon-colon. Surgeons prefer making end colostomy and reversing it later.
• Hartman’s procedure: resection of sigmoid colon and make end colostomy
• Left sided resections are more risky in emergency setting
• Ilio-colic anastomosis are relatively safe in emergency settings - don’t usually need to be defunctioned

Question 8

What is the use and location of a gastrostomy?

Answer 8

• Use: gastric decompression or fixation, feeding

- Common sites: epigastrium

Question 9

What is the use and location of a loop jejunostomy

Answer 9

• Seldom used - very high output
• May be used following emergency laparotomy with planned early closure
• Can be any location according to need

Question 10

What is the use and location of a percutaneous jejunostomy?

Answer 10

• Usually performed for feeding purposes and in site in the proximal bowel
• usually LUQ

Question 11

What is the use and location of a loop ileostomy?

Answer 11

• Defunctioning of colon eg following rectal cancer surgery
• Does not decompress colon (if ileocaecal valve is competent)
• Usually RIF location

Question 12

What is the use and location of a end ileostomy?

Answer 12

• Usually following complete excision of colon or where ileocolic anastomosis is not planned
• May be used to defunction colon but reversal is more difficult
• usually located in RIF

Question 13

What is the use and location of a end colostomy?

Answer 13

• Where a colon is diverted or respected an anastomosis is not primarily achievable or desirable
• Either LIF or RIF

Question 14

What is the use and location of a loop colostomy?

Answer 14

• To defunction a distal segment of colon
• Since both lumens are present - the distal lumen acts as a vent
• May be located in any region of abdomens, depending on colonic segment used

Question 15

What is the use and location of a caecostomy?

Answer 15

• Stoma of last result where loop colostomy is not possible

- RIF

Question 16

What is the use and location of a mucous fistula?

Answer 16

• To decompress a distal segment of bowel following colonic division or resection OR where closure of a distal resection margin is not safe/achievable
• May be located in any region of abdomen according to clinical need