Senior Surgery>Colorectal

Question 1

Define colorectal resection

Answer 1

A colectomy is a surgical procedure in which all or part of the large intestine is resected.

If the prefix “procto-“ precedes the term colectomy (ie, proctocolectomy), the procedure involves the removal of the rectum in addition to the colon. Removal of only the rectum is referred to as a proctectomy.

Question 2

AP resection

Answer 2

An abdominoperineal resection, formally known as abdominoperineal resection of the rectum and abdominoperineal excision of the rectum or simply abdominoperineal excision, or the Miles operation is a surgery for rectal cancer or anal cancer

The principal indication for AP resection is a rectal carcinoma situated in the distal (lower) one-third of the rectum.[1] Other indications include recurrent or residual anal carcinoma (squamous cell carcinoma) following initial, usually definitive combination chemoradiotherapy.

APRs involves removal of the anus, the rectum and part of the sigmoid colon along with the associated (regional) lymph nodes, through incisions made in the abdomen and perineum.

Question 3

Hartmann’s procedure

Answer 3

A proctosigmoidectomy or Hartmann’s procedure is the surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy. It was used to treat colon cancer or inflammation (proctosigmoiditis, proctitis, diverticulitis, etc.).

Question 4

Hemicolectomy

Answer 4

When a segment of the colon is removed, it may be called a segmental colectomy, and it may be labeled a hemicolectomy to differentiate the right and left halves of the large intestine

Question 5

Anterior resection

Answer 5

Low anterior resection classically refers to removal of the sigmoid colon and upper rectum and derives its name from the fact that the dissection is below the anterior reflection of the peritoneal lining

Question 6

Total colectomy

Answer 6

A colectomy that involves removing the entire colon is called a total colectomy. If most of the colon is removed, the procedure is called a subtotal colectomy.

Question 7

Colostomy: Definition, indications, complications

Answer 7

Stoma coming from large intestine or colon
Indications:
-Colon resection (eg cancer)
-‘Resting’ the colon
-Faecal incontinence resistant to treatment

Differences between ileostomy

• LIF
• Formed contents
• Flushed against the skin

Complications:

• Rupture
• Hernia
• Ischaemia
• Psychological

Question 8

Ileostomy: Definition, indications, complications

Answer 8

Ileostomy is a stoma (surgical opening) constructed by bringing the end or loop of small intestine (the ileum) out onto the surface of the skin, or the surgical procedure which creates this opening

-LIF, liquid contents, spouted (to protect skin against pancreatic enzymes)

Indications:
Ileostomies are necessary where injury or a surgical response to disease has rendered the large intestine incapable of safely processing intestinal waste, typically because the colon and rectum have been partially or wholly removed.

Diseases of the large intestine which may require surgical removal include Crohn’s disease, ulcerative colitis, familial adenomatous polyposis, and total colonic Hirschsprung’s disease. An ileostomy may also be necessary in the treatment of colorectal cancer or ovarian cancer. One example is a situation where the cancer tumor is causing a blockage. In such a case the ileostomy may be temporary, as the common surgical procedure for colorectal cancer is to reconnect the remaining sections of colon or rectum following removal of the tumor provided that enough of the rectum remains intact to preserve internal/external anal sphincter function.

In a temporary or loop ileostomy, a loop of the ileum is surgically brought through the skin creating a stoma, but keeping the lower portion of the ileum for future reattachment in cases where the entire colon and rectum are not removed but need time to heal. Temporary ileostomies are also often made as the first stage in surgical construction of an ileo-anal pouch, so fecal material doesn’t enter the newly made pouch until it heals and has been tested for leaks—usually requiring a period of eight to ten weeks. When healing is complete the temporary ileostomy is then “taken down” (or reversed) by surgically repairing the loop of intestine which made the temporary stoma and closing the skin incision.

In an end ileostomy, the end of the ileum is everted to create a spout and the edges are sutured under the skin to anchor the ileum in place. An end ileostomy can be temporary or permanent, but is normally the choice for a permanent ileostomy. An end ileostomy may be constructed temporarily if some or most of the large intestine is removed and the current state of bowel or overall health is not considered amenable to performing further surgery, such as an anastomosis to rejoin the small and large intestines.