Sigmoid colon surgery postoperative period. Removal of a tumor of the sigmoid colon Surgery to remove the sigmoid colon

For abdominal injuries and tumors that damage the large intestine, an operation called sigmoid resection is performed. In 80% of cases, such an operation is performed as an emergency. Resection of the intestine is divided into several types - operation using the Hartmann or Mikulicz method in the case of intestinal volvulus with gangrene; in case of cancer, a specific intestinal part is removed. Before surgery, the patient must adhere to the procedure for preparing for surgery. This helps to eliminate negative consequences after resection of the sigmoid colon.

What it is?

Resection is the removal of part of an organ. In case of pathologies of parts of the gastrointestinal tract, for certain medical indications, a section of the sigmoid colon must be removed. The choice of a specific removal method is determined by the characteristics of the pathology itself. To perform a laparoscopic operation, specialized medical equipment is used - a laparoscope. When using a laparoscope, several small incisions are made in the umbilical area to insert surgical parts. Unlike open surgery, the laparoscopic method is more gentle and less traumatic.

Methods of execution

There are 2 methods used to perform resection of the sigmoid colon - laparoscopic resection and open surgery. Laparoscopy is performed intracorporeally. The disadvantage of this technology is its cost and technological complexity. Open resection is performed in case of severe damage to the sigmoid colon or the presence of a tumor on its walls, to remove which it is necessary to remove part of the wall itself. Intestinal volvulus with developing gangrene also requires immediate removal of part of the intestine followed by its restoration.

Indications for use

Resection of the sigmoid colon is prescribed for a developing tumor at an early stage, progressive polyposis, or the presence of large benign tumors, which can subsequently lead to serious complications. Whenever there is a violation of innervation, which causes an increase in intestinal volume and chronic ulcerative damage to the mucous membranes of the intestinal walls, resection is prescribed. In case of injury in which the abdomen and its organs are damaged, there is often an emergency need for resection of the sigmoid colon.

Preparation for resection of the sigmoid colon

Before the day of resection, the patient must undergo preparation. It is imperative to completely clean the intestines to eliminate the possibility of infectious infection during resection. This will avoid further postoperative complications, since the colon contains a large number of bacteria that can cause inflammation. Laxatives and enemas are used for cleansing. The method is chosen individually for each client; laxatives are prescribed in such a proportion that taking them does not cause diarrhea. The preparation period can last all day.

A few days before the operation, you need to adhere to a special diet - do not eat solid or hard-to-digest foods. You can eat liquid dishes - soups, milk porridges.

Before resection of sigma, the doctor always prescribes the necessary medications. These include medications to normalize blood pressure, diuretics and inhibitors. These drugs help normalize blood pressure during surgery, reduce the risk of cardiac complications, and help remove fluid from the operation. A few weeks before surgery, you should stop taking medications with an anti-inflammatory effect (Aspirin, Nurofen, Ibuprofen). Their action is aimed at changing the functioning of platelets, which can affect blood clotting. The intake of dietary supplements and vitamins should be discussed with your doctor; it is better to exclude them for a certain period before resection of the sigmoid colon. 4-5 days before surgery you need to stick to a diet.

Before resection of the sigmoid colon, the patient is examined by an anesthesiologist. The anesthesiologist assesses the general condition of the patient, which influences the prescription of anesthesia. While preparing the bowel for resection, you should not eat any food, and after midnight before the operation, you should not drink water or other liquids.

Technique for resection of the sigmoid colon

The course of the operation directly depends on the nature of the pathology. If a volvulus of the sigmoid colon occurs, which provokes the development of gangrene, a Hartmann or Mikulicz operation is prescribed. The operation using the Hartmann method involves removing the dead part of the sigma with further suturing of the distal end and removal of the passage hole. This method is most often performed on weak and elderly patients. The Mikulicz method is performed in 2 stages as follows:

• after removing part of the sigmoid colon, its ends are sutured over a length of 5 centimeters, after which they are sewn into the peritoneal wall under the guise of a double-barreled shotgun;
• after 3.5 months, the intestinal fistula is closed.

Methods for resection of the sigmoid colon directly depend on the nature of the pathology.

If oncology is detected, the tumor of which is located in the middle third of the sigmoid colon, the entire sigmoid colon is removed. Resection using the Grekov method is divided into 2 stages (removal of the loop and application of anastomosis). With the development of oncology at the 2nd stage, left-sided ulcerative colitis, diverdiculitis, malignancy, polyposis of the sigmoid colon, left-sided removal of half of the intestine is performed. Intestinal polyps are treated by resection of the damaged part of the sigmoid colon with further suturing of the remaining area.

Postoperative period

After resection of the sigmoid colon, you need to follow a strict diet, eliminate physical activity and stressful situations. Semi-finished products are contraindicated for consumption; it is advisable to prepare food using a slow cooker or steam. Improper nutrition can cause intoxication of the body or an inflammatory process in the first days after surgery, so during the first week of rehabilitation the diet should consist only of liquid food, vegetable puree, light low-fat broth and porridge. Over time, solid foods are included in the diet. The diet must be structured so that the body receives enough vitamins and microelements necessary for recovery.

For the first time after resection, it is strictly forbidden to eat canned foods, smoked and fried foods, and alcohol.

10 days after resection, you can eat eggs, lean meat, fish, and low-fat sour cream. After 1 month, the patient’s diet can consist of regular dishes. The main thing is that the food is well chopped. With optimal nutrition, the digestive system performs its function smoothly. Food should be easily digestible and not cause heaviness during digestion. Avoid eating food that causes indigestion and diarrhea.

Resection of the sigmoid colon (sigmoidectomy) is a radical surgical procedure that involves removing part or all of the sigmoid colon. The volume of removal is determined by the severity of the pathology, which is an indication for surgery. If the lesion of the sigmoid colon is benign and a rather limited area is involved in the pathological process, then it seems possible to save most of the organ. In this case, the operation involves excision of a small fragment of the intestinal tube.

Indications

There are a number of pathologies for the treatment of which there is a need for this surgical intervention:

• traumatic injuries (in this case, emergency surgery is necessary);
• benign neoplasms that lead to partial or complete obstruction of the intestinal lumen or there is a high risk of malignant degeneration of the tumor;
• malignant neoplasms (if there is cancer, the operation is performed with regional lymphadenectomy to prevent relapse);
• complicated diverticulitis (diverticula are pouch-like protrusions of the intestinal wall that can appear in any part of the gastrointestinal tract, but most often occur in the large intestine);
• volvulus of the sigmoid colon, leading to intestinal obstruction;
• ulcerative lesions of the mucous membrane, which leads to severe discomfort for the patient (pain, constipation, frequent bleeding) and cannot be treated with medication.

Contraindications

Contraindications for sigmoidectomy:

• acute inflammatory process in the large intestine (the operation is performed after drug treatment of inflammation);
• advanced forms of cancer with the presence of distant metastases;
• severe concomitant diseases in the stage of decompensation.

Preparation

Proper preparation for surgery significantly reduces the risk of complications and shortens rehabilitation time:

1. 7-10 days before the intervention, the patient is prescribed a special dietary regimen, which completely eliminates the consumption of heavy, indigestible and fermentable foods.
2. A complete examination of the patient is carried out. General clinical examinations are prescribed (general and biochemical analysis of blood, urine, FLG). This is carried out to identify concomitant diseases and their timely treatment. An undiagnosed general somatic disease can complicate the operation and worsen the prognosis for the patient. If the patient is constantly taking any medications, the doctor can stop them or change the dosage if necessary.
3. The gastrointestinal tract is examined in detail. Colonoscopy is performed (according to indications, a biopsy is taken from the affected areas), sigmoidoscopy. In some cases, the surgeon may prescribe a survey radiography of the abdominal cavity or irrigoscopy. Indications for these studies are determined on an individual basis.
4. The day before surgery, bowel cleansing is required. Cleansing can be done in several ways: taking laxatives, cleansing enemas. A more modern method is the use of osmotic solutions (Fortrans), but these solutions are quite expensive. The choice of cleansing method depends on the doctor’s prescription and the patient’s preferences. It is important that the patient adheres to the prescribed diet for the week before surgery, as this also has a cleansing effect.
5. The last meal and water intake should be 12-16 hours before surgery.
6. Several hours before the start of surgery, antibacterial drugs are administered, since bacterial contamination of the intestines is very high and there is a risk of developing infectious complications in the postoperative period.

Technique

Resection can be performed in different ways:

1. Laparoscopic method. The operation is performed using special endoscopic video equipment. During the operation, only a few small incisions are made on the skin of the abdomen, which makes this method more gentle and avoids the appearance of large scars.
2. Laparotomy method (open). It involves a wide dissection of the skin and underlying tissues, therefore it is more traumatic and unaesthetic, but there are pathologies when the surgeon needs to perform extensive intervention (most often oncology), and a minimally invasive operation will be ineffective.

There are several different ways to restore the passage of intestinal contents:

1. Formation of intestinal anastomosis. The parts of the intestine that remain above and below the resected area are sutured.
2. Formation of a colostomy. The afferent segment of the intestine is completely sutured and the afferent end of the intestine is removed to the anterior abdominal wall to form a colostomy (Hartmann operation). This can be either an intermediate or final stage of the operation.

The type, technique and extent of surgical intervention are determined by the attending physician, taking into account the type of pathology, its volume and the degree of intestinal damage. Also, the price for providing this service will depend on the method of operation.

Stages of surgery:

1. Carrying out endotracheal anesthesia.
2. Access to the sigmoid colon. The actions at this stage depend on the chosen method of operation (laparoscopic or laparotomy). For laparotomy access, an inferomedian incision is used.
3. Revision of the abdominal cavity. In a minimally invasive operation, endoscopy is performed; in an open operation, a direct examination of the organ and adjacent tissues is performed.
4. Mobilization of the section of intestine that will be removed. At this stage, the intestinal mesentery is dissected, as well as ligation, intersection of blood vessels and nerves.
5. Resection of the affected area. The estimated volume of intervention is selected in the preoperative period, but the surgeon determines the final length of the area to be removed during the operation (during the revision). A section of intestine is removed along with the mesentery (in some cases, regional lymph nodes are additionally removed).
6. Restoring the integrity of the intestinal tube. Depending on the indications, at this stage an anastomosis is created or a colostomy is placed on the anterior abdominal wall.
7. At the final stage, drainage tubes are installed and the surgical wound is sutured.

If resection was performed for a malignant disease, then the operation is supplemented with chemotherapy and radiation treatments.

Rehabilitation period

The rate of recovery after surgery depends on the volume of intervention performed and the general condition of the body. The rehabilitation period is also affected by the patient’s compliance with the medical and protective regime.

For the first day of the postoperative period, the patient is in the intensive care unit. Antibacterial, anti-inflammatory and analgesic drug therapy is carried out. Chemotherapy drugs may be administered according to indications.

Diet after resection:

• 12-24 hours after surgery, drinking water and unsweetened tea is allowed;
• It is necessary to expand the diet gradually. During the first week, the diet should consist only of liquid and pureed food;
• gradually you can include a small amount of solid foods in the menu;
• the patient will eat small portions 5-6 times a day;
• after a month, the patient can gradually return to his usual diet, but completely eliminate fatty, smoked, spicy and alcohol;
• with a properly selected diet there should be no digestive disorders.

Possible complications

Possible complications:

• bleeding due to inadequate hemostasis;
• failure of postoperative wound sutures or anastomosis;
• infectious complications (life-threatening conditions such as peritonitis and sepsis may develop);
• dynamic intestinal obstruction (intestinal paresis);
• adhesive disease;
• postoperative hernia.

A sigmoidectomy is a major surgical procedure. However, if the operation is performed correctly by qualified surgeons and the patient follows all recommendations, it is possible to achieve a good quality of life for the patient after resection.

The operation is performed in several ways:

• Anterior dissection - access through an incision in the lower abdomen. It is practiced when removing the lower part of the digestive organ. It ends with the connection of the ends of the intestines.
• Anterior low dissection is an approach to remove a large portion of the intestine, up to the anal sphincter muscles. Upon completion, a perianal anastomosis is formed.
• Abdominoperineal extirpation is used only for resection of extensive cancer tumors. Two incisions are made: on the stomach and around the anal canal in the perineum. The surgical intervention ends with the formation of a permanent colostomy.
• Transanal excision is used for small tumors. They are accessed through the anus. Parts of the organ wall with atypical tissues are removed, and the defect is sutured with several stitches.

Depending on the scope of the event, resection of the sigmoid colon can be distal, proximal, or total.

Procedure process

Preparation

The day before, the patient is given cleansing enemas. This is the key to successful formation of the anastomosis and significantly reduces the risk of postoperative complications.

Resection of the sigmoid colon

Resection of the sigmoid colon is performed using one of the above methods, the feasibility of which is determined by the surgeon. A few important points of manipulation:

• If during the process the wall of the organ and the neoplasm are removed, then 2-3 sutures are applied.
• When most of the abdominal organ is removed, the operation ends with the formation of an anastomosis - a connection of tissues for the normal functionality of the intestine.
• When the entire organ is eliminated, the anal sphincter muscles are excised. Subsequently, the doctor creates a perianal anastomosis or a permanent colostomy.

The operation is completed by suturing the surgical wound.

If the purpose of surgery is to remove a malignant tumor, the proctologist additionally excises lymph nodes along the entire length of the sigmoid artery.

Rehabilitation period

The patient is under the supervision of doctors for 7-11 days. These days he takes anti-inflammatory and painkillers and adheres to a diet.

After discharge, the patient must undergo monitoring and be examined for neoplasms and inflammation.

Indications

Resection of the sigmoid colon is prescribed if conservative treatment does not provide the desired dynamics. It is performed for necrosis, massive bleeding from ulcers and polyps, and extensive damage.

It is also indicated for people with polyposis, stage 1-2 cancer, complicated diverticulitis, volvulus, polyps with malignancy, and nonspecific ulcerative colitis.

Contraindications

Surgery is not prescribed for stage 3-4 cancer, during menstruation, or for acute infectious and viral diseases.

Complications

The list of postoperative consequences includes intra-abdominal bleeding, peritonitis, adhesive intestinal obstruction, and interloop abscesses.

Prices and clinics

The service is provided by an experienced proctologist in a specialized center or clinic equipped with a proctology room. Where to have intestinal surgery in Moscow? The website provides complete information about medical institutions and doctors performing such manipulations.

The main priority in the work of surgeons at the GMS clinic is an integrated approach to the patient. And this means a combination of maximum effectiveness and radicality of the operation with the possibility of quickly restoring the full functionality of the organ and the body as a whole. That is why our doctors prefer modern minimally invasive surgical methods, such as laparoscopic sigmoidectomy.

Advantages of laparoscopic resection of the sigmoid colon:

• low-traumatic intervention;
• minimal amount of blood loss during surgery;
• minimal risk of complications;
• there is no need to remain in bed for a long time;
• fast recovery;
• absence of noticeable traces of the operation.

Thanks to low-traumatic surgical methods, we manage in most cases to maintain normal intestinal motility and avoid intestinal stoma. Our clinic is equipped with expert-class endoscopic equipment, which means that we have the ability to carry out targeted, minimally invasive operations with minimal trauma to healthy tissue.

Why do you need to have surgery?

The sigmoid colon is one of the sections of the large intestine that takes an active part in the digestion process. Diseases of this department negatively affect the functioning of the entire intestine, and many pathologies pose a direct threat to life. The volume and method of surgical intervention depends on the stage and extent of the pathological process.

Cost of sigmoid colon resection

The prices indicated in the price list may differ from the actual prices. Please check the current cost by calling +7 495 104 8605 (24 hours a day) or at the GMS Hospital clinic at the address: Moscow, st. Kalanchevskaya, 45.

The price list is not a public offer. Services are provided only on the basis of a concluded contract.

Our clinic accepts MasterCard, VISA, Maestro, MIR plastic cards for payment.

Make an appointment We will be happy to answer
for any questions Coordinator Oksana

What indications to use

Direct indications for sigmoidectomy are:

• sigmoid colon tumors;
• intestinal obstruction;
• diverticulosis;

• the presence of ulcers, fistulas, polyps with malignancy (malignancy);
• volvulus with necrosis;
• sigmoid colon injury;
• dolichosigma (elongated sigmoid colon).

Specialists at the Department of Abdominal Surgery at the GMS Clinic give preference to minimally invasive surgical methods, so the majority of interventions are performed using laparoscopic techniques. But in some cases, only abdominal surgery is required.

Preparation, diagnostics

Preparation for sigmoidectomy is carried out according to the standard scheme. Before the operation, a comprehensive examination is required, which includes:

• blood tests (general, biochemical, blood group and Rh factor, coagulation, infections);
• general and biochemical urine analysis;
• sigmoidoscopy;
• Ultrasound, CT, MRI of the abdominal cavity;
• colonoscopy with biopsy;
• plain x-ray of the abdominal cavity.

Consultations with narrow specialists are scheduled - therapist, proctologist, anesthesiologist, etc. The doctor determines which research methods will be prescribed in your case individually.

The operation for resection of the sigmoid colon requires preliminary preparation:

• 2-5 days before surgery, a slag-free diet is prescribed;
• 1-2 days before the intervention and in the morning on the day of the procedure, intestinal cleansing is carried out.

How is sigmoid colon resection performed?

A sigmoidectomy is performed under general anesthesia. After revision, the intestine is isolated and the affected area is removed, then the integrity of the intestine is restored using anastomosis - stitching together intact sections of the intestine. If simultaneous restoration of intestinal continuity is not possible, a colostomy is formed. In this case, intestinal reconstruction will be carried out in a couple of months.

There are two main ways of performing surgery:

• open sigmoidectomy - the intervention is performed through an incision in the lower abdomen;

• laparoscopic resection of the sigmoid colon - the operation is performed through several small punctures through which surgical instruments connected to a video camera are inserted. The surgeon monitors the progress of the operation using a monitor.

The operation lasts several hours, the volume of intervention depends on the stage and extent of the pathological process, the presence of concomitant pathologies, etc. Laparoscopic sigmoidectomy at the GMS clinic is performed using modern endoscopic stands, which provide high-quality images of the operated area at multiple magnification.

The use of the latest equipment leads to minimal tissue trauma.

You
There is
questions? We will be happy to answer
for any questions Coordinator Tatyana

A) Indications for resection of the sigmoid colon:
- Planned: benign pathological formations in the area of ​​the sigmoid colon, when laparoscopic access is not feasible due to adhesions and previous surgery. In case of malignant processes, it is performed exclusively for palliative purposes.
- Alternative operations: Left hemicolectomy - usually necessary for malignant tumors of the sigmoid colon. The exception is the presence of distant metastases in the liver - in these cases, resection of the sigmoid colon is performed.

b) Preoperative preparation:
- Preoperative studies: endoscopy with biopsy, X-ray contrast study; exclusion of distant metastases of malignant tumors: ultrasound, computed tomography.
- Patient preparation: orthograde lavage of the intestine, central venous catheterization, perioperative antibiotic therapy, bladder catheterization.

V) Specific risks, informed consent of the patient:
- Damage to the left ureter (1% of cases)
- Spleen injury (1% of cases)
- Anastomotic leakage (less than 10% of cases)

G) Anesthesia. General anesthesia (intubation).

d) Patient position. Lying on your back, modified Lloyd-Davis lithotomy position.

e) Surgical access for resection of the sigmoid colon. Median laparotomy below the umbilicus. A Pfannenstiel incision or a left pararectal Lennander incision is also possible. The best choice is the laparoscopic approach.

and) Operation stages:
- Volume of resection
- Reconstruction
- Access
- Inserting a retractor into the wound
- Mobilization of the sigmoid colon
- Circular dissection of the sigmoid colon
- Skeletonization of the mesentery of the sigmoid colon
- Removal of the drug
- Posterior wall anastomosis
- Anastomosis of the anterior wall
- Closure of the defect in the mesentery

h) Anatomical features, serious risks, surgical techniques:
- The sigmoid colon is located near the left ureter, left testicular/ovarian artery and vein, and the lower pole of the spleen.
- The anastomosis must be tension-free; mobilization of the left flexure of the colon is possible.
Warning: Avoid damaging the lower pole of the spleen by traction on the colon during mobilization.

And) Measures for specific complications:
- Anastomotic leakage: if the surgical site is well drained, expectant management with parenteral nutrition is used until the fistula spontaneously closes. If there is any sign of peritonitis, perform an urgent relaparotomy and create a diverting stoma or remove the anastomosis, close the rectum as a cecum and create an end stoma of the descending colon (Hartmann procedure).
- Anastomotic stricture: develops only if the anastomosis is under tension. If possible, perform endoscopic dilatation or repeat surgery will be required.

To) Postoperative care:
- Medical care: remove the nasogastric tube on days 1-3 and drains on days 7-8.
- Resumption of nutrition: allow sips of liquid from the 3-4th day, solid food - after the first post-operative stool, from approximately the 7th day.
- Intestinal function: treatment with a prokinetic agent from the 4th-5th day. A mild oral laxative may be prescribed during the first weeks after bowel function returns.
- Physiotherapy: breathing exercises.
- Period of incapacity: 2-3 weeks.

l) Stages and techniques of resection of the sigmoid colon (sigmoid colon):
1. Volume of resection
2. Reconstruction
3. Access
4. Inserting a retractor into the wound
5. Mobilization of the sigmoid colon
6. Circular dissection of the sigmoid colon
7. Skeletonization of the mesentery
8. Removal of the drug
9. Anastomosis of the posterior wall
10. Anastomosis of the anterior wall
11. Closure of the defect in the mesentery

1. Resection volume. Tubular resection of the sigmoid colon (that is, exclusively resection of the colon without complete removal of its mesentery) is indicated for inflammatory processes and diverticula. The extent of resection is determined by the degree of pathological changes in the intestinal wall. The dissection is carried out close to the bowel wall.

2. Reconstruction. Restoring bowel continuity by anastomosis between the descending colon and rectum is usually straightforward. Mobilization of the splenic flexure is necessary only with extensive resection.

3. Access. Access is through an inferior midline laparotomy, which can be extended around the umbilicus. In women, a Pfannenstiel incision can be performed for cosmetic reasons.

4. Inserting a retractor into the wound. After opening the abdominal cavity, a retractor with a ratchet is inserted. The Golyer frame has proven to be very useful for this purpose. After examining the small intestine, it is covered with a damp towel, along with the greater omentum, moved to the upper abdominal cavity, where it is held by the long blade of a medium-sized Golyer retractor.

5. Mobilization of the sigmoid colon. The small intestine and greater omentum are moved cranially under the medium blade of a Golyer retractor. In the operating field on the left is the sigmoid colon with the root of its mesentery, on the right is the barely visible cecum and the ureter, visible through the thin peritoneum. Dissection begins with separation of the left-sided attachments of the sigmoid colon. The sigmoid colon is released from its retroperitoneal attachments close to the bowel wall along the linea alba using forceps and scissors and moved medially with gentle traction using two Duval forceps.

6. Circumferential dissection of the sigmoid colon. Complete mobilization of the sigmoid colon allows the posterior surface of the mesentery to be exposed. The extent of resection is determined by the degree of inflammatory changes. The resection margins are marked with rubber loops. The ureter should always be clearly defined within the retroperitoneal space. It is easiest to detect where it crosses the iliac vessels. The more lateral ovarian/testicular vessel must also be identified and protected.

7. Skeletonization of the mesentery of the sigmoid colon. After complete mobilization of the sigmoid colon, the mesentery is divided in portions between Overholt clamps, close to the bowel wall. Here, too, care must be taken not to damage the ureter. The vessels are ligated with 3-0 PGA. Dissection continues proximally to the descending colon and distally to the proximal rectum. To avoid tension on the anastomosis, it is necessary to completely mobilize the descending colon. Mobilization of the splenic flexure is usually not required.

8. Removing the drug. After complete mobilization and skeletonization, the intestine is resected between crushing clamps on the side of the preparation and elastic intestinal clamps on the side of the remaining sections of the intestine. The surgical site is covered with towels moistened with an antiseptic solution.

9. Posterior wall anastomosis. An end-to-end anastomosis is performed using a manual or hardware suture. The manual method requires that the proximal and distal ends be stabilized with stay sutures. Single sutures of 3-0 PGA are used. The anastomosis is created with a single-row suture, with an oblique direction of the stitch in the intestinal wall (more serous membrane, less mucous membrane), the gaps between the sutures should be 0.5 cm.