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Tumor in the transverse colon


Medical editor Arild Nesbakken MD
Gastroenterological Surgeon
Oslo University Hospital
Norway

General

For cancer in the transverse colon, all of the transverse colon and both the right colic flexure and the left colic flexure are removed. A standard resection of colon- and lymph nodes are performed.

The arteria colica media is divided centrally.



Equipment

  • Laparotomy- or laparascopic equipment

Preparation

Patient preparation:

  • bowel emptying. The routines variy between hospitals.
  • intravenously antibiotic prophylaxis at the latest at the beginning of the anesthesia. It should be considered whether the patients in addtition should have oral antibiotics from the day before the surgery.
  • thrombosis prophylaxis with low molecular weight heparin.

During the surgery it is inserted:

  • epidural catheter for pain management.
  • urinary catheter.
  • naso-gastric tube which is removed by the end of the surgery.

Implementation

Both flexures are included and a resection is performed as illustrated. If the colonic anastomosis does not fall nicely, cecum and all of ascendens can optionally be removed and the anastomosis is performed between the terminal ileum and the descending colon.

Follow-up

  • The patient is mobilized in the evening the day of surgery, or possibly the next day.
  • The patient can carefully start to drink and eat on the first postoperative day.
  • The urinary catheter is removed on the first postoperative day or when the patient is mobilized.
  • The epidural catheter is usually removed on the continues on peroral analgetics. 

Complications

  • Cardiopulmonary complications depend on the patient´s general condition, comorbidity and the extent of the surgery. Cardial infarction and arrythmias and dysrhythmia may occur. Basal atelectasis and/or pleural fluid and possibly pneumonia are more common.
  • Approximately 5% develop anastomosis leakage. Preoperative radiation therapy increases the risk of leakage. Intraperitoneal and/or pelvic infections, diffuse or localized, are rare in the absence of anastomosic leakage.
  • Intraabdominal bleeding, including bleeding from anastomosis is relatively rare.
  • After open surgery wound dehiscence and infection in the abdominal wound occur to varying degrees, from light superficial infection to abdominal wall abscess.
  • Paralytic ileus is common in the presence of another complication, but can also appear without any specific cause.
  • Mechanical ileus is relatively rare, but if there is a lack of intestinal activity in the first week and increasing abdominal pains, a mechanical ileus is suspected.
  • Port-site hernia occurs after a laparoscopy.
  • Deep vein thrombosis and lung embolism are rare if prophylaxis is used according to guidelines.
  • Urinary retention.

Late complications

  • Ventral hernia in the abdominal wound may occur.
  • Postoperative ileus occurs in about 5%.

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