Javascript er ikke aktivert i din nettleser. Dette er nødvendig for å bruke Oncolex. Kontakt din systemadministrator for å aktivere JavaScript.

Hartmann's Operation of colorectal cancer

Implementation

Dissection

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.

Reconstruction

  • Sigmoideostomy is made in the marked area of the left rectal sheath.
  • Vacuum drain is put in the pelvis.
  • The abdomen is closed.

Oslo University Hospital shall not be liable for any loss whether direct, indirect, incidental or consequential, arising out of access to, use of, or reliance upon any of the content on this website. Oslo University Hospital© 2017