Stein G. Larsen MD
Recently updated 26.04.2014
Oslo University Hospital
The resection is performed similar to a mesorectal excision.
- A mid-line incision from the symphysis is normally extended to the right of the navel.
- The sigmoid colon is released laterally.
- The inferior mesenteric vessels are identified and divided distal to the left colic vessels.
- The upper resection level is identified and the bowel is divided with a staple/dividing instrument.
- The peritoneum is split on both sides of the rectum. The perimesorectal plane is followed dorsallyi and laterally. In front the plane is behind the vesicles and prostate/vagina. The dissection is followed all the way to the pelvic floor if the tumor is less than 12 cm from the anal verge, or 5 cm below the tumor if it is higher than 12 cm.
- The sympathetic hypogastric nerve is identified if possible on the pelvic wall.
- The parasympathetic pelvic plexus is often difficult to identify on the pelvic wall.
- If possible, the bowel is closed at least 1 cm below the tumor.
- The distal end is rinsed with distilled water.
- A new row of staples is set at the desired level and the bowel is split between the rows of staples.
- Sigmoideostomy is made in the marked area of the left rectal sheath.
- Vacuum drain is put in the pelvis.
- The abdomen is closed.
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