In Partial Fulfillments on the requirements in NCM-103 and Related Learning Experiences (OR Rotation) Operative Review on Sigmoid Resection; Anastomosis Submitted to: Izrafahd U. Basnsuan RN MN Clinical InstructorSubmitted by: John Nichole S.Gaji SN BSN13-C Group # 8 Date Submitted: September 2011.
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Although inappropriate diet & unhealthy lifestyle considerably add to the
risks of sigmoid colon cancer, the disease may also be influenced by an
underlying genetic predisposition. Sigmoid colon cancer statistics reveal that 5 %
of colon cancers globally are caused solely through genetic dysfunctions and
physiological abnormalities. Depending upon their underlying cause, sigmoid
colon cancers may be either unexpected (sporadic colon cancers), or genetically-
inherited. The majority of cases of sigmoid colon cancer occur because of
formation of polyps in different regions of the large bowel (the colon). Colonic
polyps are well-known soft tissues which may become malignant. There are
numerous types of hereditary sigmoid colon cancer; a lot are caused by colonicpolyps. The most common kinds of genetically-inherited sigmoid colon cancers
are adenomatous polyposis and “Gardner’s Syndrome”. Non-polyphonies colon
cancer is alsocommon among hereditary forms of the disease. Unlike other types
of genetically-inherited colon cancer, non-polyposis sigmoid colon cancer does
not always involve the formation of polyps. Uncommon varieties of hereditary
sigmoid colon cancer include juvenile polyposis and Peutz-Jeghers Syndrome.
Unlike non-hereditary types of colon cancer that usually develop in those
older than fifty, hereditary sigmoid colon cancers can arise in younger people. In
fact, some types of the genetically-inherited sigmoid colon cancers are
developed by children and teenagers.
Patients requiring sigmoid or rectosigmoid resection for all colonic
pathologies were included. Criteria for exclusion from an attempted laparoscopic
sigmoid colectomy were body mass index >35 and prior major abdominal
surgeries (exclusive of hysterectomy, cholecystectomy, or appendectomy). Data
collected included age, gender, indication for surgery, American Society of
Anesthesiology class, body mass index, operative duration, length of hospital
stay, complications, mortality, and 30-day readmission.
is the medical term for surgically removing part or all of a tissue, structure
or organ. One very common type of resection is a sigmoid resection, a procedurewhere one or more segments of the large intestine is removed. A resection can
be performed on many different areas of the body and is done for a wide variety
of reasons. Also Known As: resect, resected, surgical resection, resection
surgery.
• Anastomosis
is to join together two hollow organs ( viscus ), usually to restore continuity
after resection , or to bypass an unresectable disease process. Historically such
procedures were performed with suture material, but increasingly mechanical
staplers and biological glues are employed. While an anastomosis may be end-
to-end, equally it could be performed side-to-side or end-to-side depending on
the circumstances of the required reconstruction or bypass .
• Bowel resection and Anastomosis
resection of diseased
intestinal tissue (colectomy)
and anastomosis of the
remaining segments help
treatments help treat
localized obstructive
disorders, including
diverculosis, intestinal
polyps, bowel adhesions,
and malignant or benignintestinal lesions. This
procedure is the preferred surgical technique for localized bowel cancer, but not
for widespread carcinoma, which usually requires massive resection with
surgical removal of part of the liver . This operation is for some types
of liver cancer and for certain cases of metastatic colorectal cancer . Up to half of
your liver can be removed as long as the rest is healthy. During a liver resection ,
the part of your liver that contains cancer is removed, along with some healthy
liver tissue on either side. If the right side of your liver is removed,
your gallbladder , which is attached to the liver, is also is the taken out.
• Large bowel resection
is surgery to remove all or part of your large bowel. This surgery is alsocalled colectomy. The large bowel is also called the large intestine or colon.
Removal of the entire colon and the rectum is called a proctocolectomy. Removal
of part or all of the colon but not the rectum is called subtotal colectomy. The
large bowel connects the small intestine to the anus. Normally, stool passes
through the large bowel before leaving the body through the anus.
• Transurethral resection of the prostate (TURP)
is a surgical procedure by which portions of the prostate gland are
removed through the urethra. TURP is the treatment of choice for BPH, and the
most common surgery performed for the condition.
• Craniotomy for Brain Tumor Resection
is a neurosurgical procedure by which a bone window is created to gain
access to the inside of the skull. Once the patient has been put to sleep by theanesthesiologist, the surgeon shaves and then marks on the scalp where the
incision will go. After the scalp is opened, the bone is opened using special drills.
Then the tumor/lesion is accessed in order to perform the surgery. The bone is
then usually reattached to the skull at the end of surgery using either sutures or
Arteries and veins . Most vascular procedures, including all arterialbypass operations (e.g. coronary artery bypass ), aneurysmectomy of any type,
and all solid organ transplants require vascular anastomoses. An anastomosis
connecting an artery to a vein is also used to create an arteriovenous fistula as
an access for hemodialysis.
• Gastrointestinal (GI) tract:
Esophagus , stomach , small bowel , large bowel , bile ducts , and pancreas .Virtually all elective resections of gastrointestinal organs are followed by
anastomoses to restore continuity; pancreaticoduodenectomy is considered a
massive operation, in part, because it requires three separate anastomoses
(stomach, biliary tract and pancreas to small bowel). Bypass operations on the GI
tract, once rarely performed, are the cornerstone of bariatric surgery . The
widespread use of mechanical suturing devices (linear and circular staplers)
stage IIC.• StageIIA: Cancer hasspread throughthe muscle layer of the colon wall to the serosa (outermost layer) of the colonwall.• Stage IIB: Cancer has spread through the serosa (outermost layer) of the colon wall but has not spread to nearby organs .• Stage IIC: Cancer has spread through the serosa (outermost layer) of
the colon wall to nearby organs.
In stage IIIA:
• Cancer may havespread throughthe mucosa (innermostlayer) of the colon wall tothe submucosa (layer of tissue under the mucosa)and may have spread to themuscle layer of the colonwall. Cancer has spread toat least one but not morethan 3 nearby lymphnodes or cancer cells haveformed in tissues near the lymph nodes; or • Cancer has spread through the mucosa (innermost layer) of the colonwall to the submucosa (layer of tissue under the mucosa). Cancer has spread toat least 4 but not more than 6 nearby lymph nodes.
the colon wall tothe serosa (outermost layer) of the colon wall or has spreadthrough the serosa but not tonearby organs . Cancer hasspread to at least one but notmore than 3 nearby lymphnodes or cancer cells haveformed in tissues near thelymph nodes; or • Cancer has spread to the muscle layer of the colon wall or to the serosa
(outermost layer) of the colon wall. Cancer has spread to at least 4 but not morethan 6 nearby lymph nodes; or • Cancer has spread through the mucosa (innermost layer) of the colonwall to the submucosa (layer of tissue under the mucosa) and may have spreadto the muscle layer of the colon wall. Cancer has spread to 7 or more nearbylymph nodes.
• Cancer has spreadthroughthe serosa (outermost layer)of the colon wall but has notspread to nearby organs. Cancer has spread to atleast 4 but not more than 6nearby lymph nodes ; or • Cancer has spreadthrough the muscle layer of the colon wall to the serosa (outermost layer) of thecolon wall or has spread through the serosa but has not spread to nearby
organs. Cancer has spread to 7 or more nearby lymph nodes; or • Cancer has spread through the serosa (outermost layer) of the colon walland has spread to nearby organs. Cancer has spread to one or more nearbylymph nodes or cancer cells have formed in tissues near the lymph nodes.
The stapling device is reloaded with a new cartridge, closed around the
mesentery and fired. The mesentery of the resected colon should be resected
widely to include an adequate resection of the supporting lymph nodes. All
oncologic principles should be respected. This procedure is repeated until thecolic specimen has been amputated from the gastro-intestinal tract. Occasional
bleeding sites on the stapled lines will have to be clipped with ENDO CLIP* ML.
The specimen remains until the end of the procedure in the right lower quadrant.
• STEP 4: Creating the Anastomosis
The colic stumps are placed (stapled closed) in proximity to each other. An
atraumatic grasper grasps the corner of the staple line of the bowel stump. Usingan ENDO SHEARS* instrument, the corner is cut (1 cm) and the lumen of the
large bowel is entered. An ENDO BOWEL* Clamp may be used on the proximal
bowel to avoid intraabdominal fecal spillage. (An additional trocar may have to be
bowel limb and are fired. It is then removed. Two atraumatic graspers or ENDOBABCOCK* clamps will grasp the edges of the colic opening and will
approximate the opening in a triangular fashion.
• STEP 5: Retrieving the Specimen
An incision is made to remove the specimen. Two types of incisions can be
made. We prefer a right lateral 1 inch transverse incision at the level of the
umbilicus (as lateral as possible). The specimen is removed and the incisionclosed with a penrose drain. For cosmetic reasons some patients may prefer a
mini-pfannenstiel incision. Once the specimen is removed, a Blake drain is
inserted in the pelvis; the abdomen is desufflated; and all trocars are removed.