Download - Colorectal surgery and stomas
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Abdominal Surgery and StomasCaroline TaylorOctober 2011
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Content•Large bowel anatomy
•Common abdominal procedures
•Complications of surgery
•Stomas
•Complications of stomas
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Surgical terms•Laparotomy
•Laparoscopy
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Gross anatomy of the bowel
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Blood supply of the colon
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Colorectal cancers•Right sided
▫Present with anaemia, weight loss, mass▫Later presentation
•Left sided▫Present with altered bowels▫PR bleeding
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Dukes staging•A mucosa of the colon or rectum
•B through the muscular propria
•C spread to at least one lymph node in the area
•D metastatic spread
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Operations for colorectal cancers•Right Hemicolectomy
•Left Hemicolectomy
•Anterior resection
•Abdomino-perineal resection (APR)
•Hartmann’s procedure
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Right hemicolectomy
•Ascending colon, appendix and part of transverse colon
•Superior mesenteric artery
•Ileocolic anastomosis
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Left hemicolectomy•Transverse colon and descending colon
•Inferior mesenteric artery
•Primary anastomosis
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Anterior resection•=sigmoid colectomy
•Sigmoid colon and part ofrectum
•Primary anastomosis orstoma formations
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Abdomino-perineal resection (APR)•Low rectal tumours
•Associated total mesorectal excision (TME)
•Anus closed and rectum removed
•Colostomy formation
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Hartmann’s Procedure•Emergency procedure
▫Rests the bowel▫If anastomosis will be poor
•Sigmoid colectomy•Oversewn rectum to form a stump•End colectomy•Reversible
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Complications of surgery•Anastomotic leak•Infection/abscess/collection•Bleeding•Paralytic Ileus•Adhesions / stricture formation•Fistulas
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Anastomotic leak•7-10 days post-op•Higher risk with lower anastomosis•Contributing factors:
▫Surgeon▫Patient – male▫Pre-op radiotherapy
•Leads to pelvic abscess, fistulation, peritonitis, mortality
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Paralytic Ileus•Bowel “goes to sleep!”
•Caused by toxins or handling
•Conservative management
•Most spontaneously resolve
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Stomas•“mouth”
•Ileostomy or colostomy (gastrostomy, urostomy)
•To divert faeces from anastomosis or fistula
•Due to removal of distal colon and rectum
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Ileostomy•Small bowel
•Right sided
•Spouted
•Temporary – usually a loop•Permanent – usually an end ileostomy
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End and loop ileostomies
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Colostomies•Large bowel
•Loop or end
•Where rectum or anal canal is not suitable for passing faeces▫Such as abdominal surgery/cancer▫Crohn’s/UC
•Left sided (can be anywhere)
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Complications of stomas•Bleeding•Prolapse or retraction•Stenosis•Skin excoriation•Parastomal hernias•Fistulation
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Ileostomy v. colostomyFeature Ileostomy Colostomy
Bowel Small Large
Contents Liquid, bilious colour Solid, feculent
Opening Spout Flush to skin
Site Right/higher Left/lower
Output Large vol Small vol
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Summary•Large bowel anatomy is key in deciding
on the appropriate operation
•Common surgical procedures
•Ileostomies and colostomies and their differences and complications
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Any Questions??