colon resection

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Relevant Anatomy Sigmoid Colon
antibiotics
Colon cancer
Familial polyposis
Intussusception (when one part of the intestine pushes into another)
Precancerous polyps
Ulcerative colitis
http://www.medicinenet.com/diverti culosis/page3.htm
Special Considerations bowel technique-instruments, sponges and gloved hands that come in contact with the
open bowel are considered contaminated.(It's recommended the ST create two mayo
set ups, one for surgical wound and colon resection and the other for wound closure.)
Resection of cancerous colon requires a distal margin of at least 5 cm and proximal
margin is determined by the colonic blood supply and a greater portions of mesentery
are removed.
https://www.jptrev.com/frequently-asked-questions/what-is- general-anesthesia/
As far laterally as possible
https://medlineplus.gov/ency/present ations/100171_3.htm
of upper towel placement chest lateral towels place using anterior superior iliac spine
as guides and edge of lower towel place just above line of symphysis pubis) and a
laparotomy sheet. For anastomosis add under the buttocks and legging drapes.
Foley catheter
Active Drain (Hemovac or Jackson-Pratt)
For colostomy -glass rod and tubing with colostomy bag and loop colostomy
Instruments Major set
Extra crile hemostats
Extra large hemostats
Long & deep sets
GI Staplers
Surgeon runs the colon.
Colon is freed. Window created in mesentery and division begins. Colon is
mobilized
*surg tech will need many peans & silk ties in sizes 1-0, 2-0, and 3-0available
colon is covered with saline soaked sponges
4 intestinal clamps placed. 10 blade or bovie divides colon between clamps
handing the bowel section to the tech (linear cutter to transect and staples may
also be used). Bowel is placed into a sterile basin and passed to circulator.
*Surg tech remember clamps may still be on the specimen when counting
Procedural steps ( cont. For colostomy) End bowel technique
A stoma site is created
- The circular incision is made with a 10 blade then the
subcutaneous tissue is removed using a bovie pencil,dissecting
down to the anterior fascia then the muscle fibers are split then
transversalis fascia and peritoneal fat are dissected in the
peritoneum is opened
The end segments of colon are brought through the stoma site
and extended beyond skin surface
The colon is sutured to the peritoneal defect and then to the
skin surrounding the stoma
Procedural steps (cont. For anastomosis) -if linear cutter was used corners of the bowel are removed so the stapler can fit back
in. Bowel ends are brought together. Surgeon uses silk or vicryl to suture together
interrupted or a stapler
*tech should have multiple packs of staples ready
-second layer of absorbable suture is placed and continued until anastomosis is
complete
-third layer of suture is placed (interrupted vicryl or silk)
-bowel technique ends
Procedural steps (cont. For anastomosis) -remove sponges, bovie, suction, & contaminated instruments from field
-Regown & glove. Redrape. New suction, bovie, laps, & instruments brought to field
-Laparotomy closure performed.
Counts Prior to the skin incision
When closure of peritoneum is initiated or any first layer of a cavity
When closure of fascia is initiated or layer before subcutaneous
As soon as skin closure is initiated
Dressing Material May need pillow bolster for when pressure will be applied like when patient needs to
cough or sneeze.
-vaseline gauze
- ABD pad
-transpore tape
Specimen Care (if taken out because of cancer) excised colon taken to the lab to check margins in
basin.
Prognosis no complications- return to most normal activities in 6-8 weeks. Somewhat altered
lifestyle and diet. Bowel habit may be altered depending on the location of resection.
Complications incisional hernia
http://medical-dictionary.thefreedicti onary.com/dehiscence