Excision Of Rectal Tumor

RECTAL TUMOR EXCISION REASON FOR VISIT: • • • • • • • • •

Rectal bleeding Feeling of incomplete evacuation and tenesmus. Abdominal pain Bowel obstruction Pelvic pain Diarrhea Constipation Rectal tumor Rectal polyp

RISK ASSESSMENT • • • • • • •

Old age Bleeding disorders Hyper tension Diabetes Heart diseases Allergy to the medication Allergy to the anesthesia

PREPARATION OF THE PATIENT: • • • • • • • • • • • • • •

Blood tests Urine tests EKG/ECG Barium enema Fecal occult blood test Rigid Proctosigmoidoscopy Endorectal ultrasound Endorectal surface-coil MRI Chest radiograph CT scan MRI CEA scan Preoperative antibiotics were administered to the patients with diseases of the heart valves. Oral feeding was stopped for ____hrs before the procedure.

• • • • •

Aspirin and other blood-thinning medications were stopped several days before the surgery Laxative was administered Enema was given Part was prepared and draped in sterile fashion Antibiotic bowel preparation was done

ANESTHESIA: General anesthesia POSITION OF THE PATIENT Prone position THE PROCEDURE TRANSANAL EXCISION • • • • •

Tumor was located in the lower one third of the rectum The tumor was ______ size The tumor was excised with full thickness of the rectal wall, leaving a 1-cm margin of normal tissue. The two ends of bowl loops were anastomosed with sutures The involved lymph nodes were resected

TOTAL MESORECTAL EXCISION • • • • • • • • • • •

Pelvic abdominal incision was given Abdomen was opened in layers Tumor was noted Tumor was located in ________ part of the rectum The tumor was excised with removing the rectal part The two ends of bowel loops were anastomosed with the sutures 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 The removed tumor/ polyp is sent to the histological /pathological examination/biopsy

FINDINGS: •

Tumor/ polyp was present in _______part of Rectum

AFTER PROCEDURE: • • •

Immediately after surgery the patient will be taken to a recovery area Monitoring the blood pressure/pulse/temperature Nothing is taken by mouth 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 • • • • • • • • • • • •

Infection Bleeding Intestinal injury Anastomotic leak Bladder and sexual function alterations Constipation Outlet obstruction Myocardial infarction Pulmonary embolus Deep vein thrombosis Hernia Tumor regrowth

FOLLOW UP _________ days after surgery