Colectomies

Question 1

What is Hartmann’s procedure

Answer 1

Surgical resection of the rectosigmoid colon
Closure of the distal bowel and left within the abdomen
Formation of end colostomy
Temporary

Question 2

When is a Hartmann’s procedure used

Answer 2

Emergency surgery when immediate anastomosis is not possible

Question 3

What is necessary in order to perform a bowel anastomosis

Answer 3

Good blood supply
No inflammation
No cancerous bowel
Bowel must not be under tension

Question 4

What is a right hemicolectomy

Answer 4

Removal of:-
Part of terminal ileum
Caecum
Ascending colon
Hepatic flexure - where ascending colon meets transverse colon
First 1/3 of the transverse colon

Anastomosis of terminal ileum and transverse colon

No stoma

Question 5

What are the benefits of a right hemicolectomy

Answer 5

They rarely leak

Bowel function returns within 3-5 days

Question 6

When is a right hemicolectomy used

Answer 6

Malignancy

IBD

Question 7

What is a left hemicolectomy

Answer 7

Removal of the splenic flexure and descending colon to sigmoid
Not used very often
If worried about tension of anastomosis or blood supply, do extended right hemicolectomy

Question 8

What is an extended right hemicolectomy

Answer 8

Terminal ileum anastomosed to sigmoid

Question 9

Why would you worry about blood supply in a left hemicolectomy

Answer 9

Due to watershed area at the splenic flexure

Between superior and inferior mesenteric arteries

Question 10

Why is a sigmoid colectomy not a cancer operation

Answer 10

Because removal of the sigmoid artery alone, leaves potentially affected lymph nodes along the base of the inferior mesenteric artery

Complete lymphadenectomy is required during oncological operations

Question 11

When is a sigmoid colectomy performed

Answer 11

For benign disease eg. diverticulitis

Question 12

What is anterior resection

Answer 12

Removal of part of the rectum

Does not include resection of the anus, or the total resection of the rectum

Get loop ileostomy (reversible)

Restoring bowel continuity is possible with anterior resection

*Blood supply at the lower end of the rectum is quite poor

Question 13

How do you perform an oncological resection on the rectum

Answer 13

Must do a total mesorectal excision

Keep mesorectal fascia intact

Question 14

What is the mesorectum

Answer 14

Mesorectum contains blood supply and lymph nodes to rectum

Question 15

What is an APR

Answer 15

Abdominoperineal resection
Resection of rectum and anus

Permanent end colostomy

Question 16

When is an APR performed

Answer 16

When there is malignant invasion of the sphincters

malignancy less than 4.5cm from anal verge

Question 17

How do you differentiate between a patient requiring an anterior resection or an APR

Answer 17

Depends on the distance of the tumour from the sphincter

Perform DRE to feel sphincters

If you can feel above the sphincter and below the tumour, an anterior resection can be performed

Question 18

How might a patient with malignant invasion of the sphincters present

Answer 18

Bowel incontinence
Severe urgency
Faecal leaking

Question 19

What surgery do you perform on a patient with a sigmoid tumour

Answer 19

Anterior resection