COLECTOMY (PARTIAL) REASON FOR VISIT: • • • • • • •
Colon cancer Diverticulitis Intestinal obstruction Ulcerative colitis Traumatic injuries to the bowel PRE-cancerous polyps. A colorectal polyp Familial adenomatous Polyposis (FAP) Hirschsprung's disease (HD)
RISK ASSESSMENT • • • • • • • • •
Old age Family history of bleeding disorders History of bleeding disorders History of allergy to Medications Anesthesia Having neurological, cardiovascular, or respiratory conditions Obesity Smoking Previous abdominal surgery Acute perforation or infection
PREPARATION OF THE PATIENT: • • • • • • • • • • •
Blood tests Urine tests, Chest x-ray Angiography ECG Plain abdominal radiography Contrast enema Ultrasonography CT scanning Magnetic Resonance Imaging (MRI) Colonoscopy with biopsy samples
• • • • • •
Antibiotics are to be given to the Patients with diseases of the heart valves Stop oral feeding from mid night. Stop aspirin and other blood-thinning medications for several days before the surgery Drink at least eight, 8-ounce glasses of water daily. Follow a special diet, Part was prepared
ANESTHESIA: General THE PROCEDURE Open Laparoscopic OPEN COLECTOMY • • • • • • • • • • • • • •
Patient was carefully positioned, padded, and strapped to the operating table to prevent movement A lower midline incision in the abdomen/ a lateral lower transverse incision was given Abdomen was opened in layers The colon was recognized and the diseased portion was identified. The ascending colon/ transverse colon/ descending colon/ sigmoid colon was retracted Colon attachments were divided Mesentery was divided &mesenteric vessels were dissected and divided The colon was divided with special stapling devices Colon was removed in staple lines. Two healthy portions were sutured/stapled together The peritoneum and fascia of the transversalis muscle was closed with a running absorbable suture. The remaining fascial layers were closed with the running or interrupted absorbable sutures. The skin was closed with a subcuticular absorbable suture such as Monocryl. Collodian or adhesive Steri-strips are placed on the wound
LAPAROSCOPIC COLECTOMY • • • • • • • • • • •
Three to four small incisions were made in the abdomen / in the umbilicus (belly button). Laparoscope was inserted in an incision. The abdomen was filled with gas Camera was inserted through one of the tubes The colon was recognized and the diseased portion was identified. The ascending colon/ transverse colon/ descending colon/ sigmoid colon was retracted Colon attachments were divided Mesentery was divided &mesenteric vessels were dissected and divided The colon was divided with special stapling devices A small abdominal wall incision was made at this point to bring the bowel outside of the abdomen Colon was removed in staple lines. Two healthy portions were sutured/stapled together The small incisions were closed with sutures or surgical tape.
The removed portion of the bowel is sent to the histological /pathological examination FINDINGS: •
In the removed bowel Colon cancer /Diverticulitis /Intestinal obstruction /Ulcerative colitis / injuries to the bowel / polyps /Hirschsprung's disease (HD) was found.
AFTER PROCEDURE: • • •
Immediately after surgery the patient will be taken to a recovery area Monitoring the blood pressure/pulse/temperature Nothing is taken for_____hr
DURATION _______hrs.
POSTOPERATIVE CARE • • • • •
Take antibiotic treatment as prescribed Take pain medications prescribed Observe for in discharge from suture site Surgical wound dressings will be kept clean and dry Take liquid diet for_____days
COMPLICATIONS • • • • • • • • • •
Excessive bleeding Surgical wound infection Incisional hernia (an organ projecting through the surrounding muscle wall, it occurs through the surgical scar) Thrombophlebitis (inflammation and blood clot to veins in the legs) Narrowing of the opening (stoma) Pneumonia Pulmonary embolism (blood clot or air bubble in the lung blood supply) Reaction to medication Breathing problems Obstruction of the intestine from scar tissue
FOLLOW UP After ____days