By Steven D. Wexner
Grasp recommendations generally surgical procedure: Colon and Rectal surgical procedure: Anorectal Operations is a quantity in a sequence that provides universal and complicated systems within the significant subspecialities of common surgical procedure. The sequence is overseen via Josef F. Fischer, MD, editor of the vintage two-volume reference Mastery of Surgery.
Master thoughts quite often surgical procedure: Colon and Rectal surgical procedure: Anorectal Operations is written via said grasp surgeons, emphasizes surgeries, and is lavishly illustrated with unique full-color drawings. The members totally clarify their most popular concepts in step by step, completely illustrated aspect, verify symptoms and contraindications, provide instructions on preoperative making plans, and talk about results, issues, and follow-up.
Coverage comprises hemorrhoidectomies, anal fistula and sphincter systems, strategies for perineal prolapse and excision of rectal carcinoma, between others.
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Additional info for Colon and Rectal Surgery Anorectal Operations
5 Circular anal dilatator in place. & Placement af pursestring suture. 7 Insertion of stapler. 1 Closure of stapler. 9 Location af staple line above physiological hemorrhoidal plexus. Furthermore, transvaginal examination is recommended to prevent accidental inclusion of the posterior vaginal wall. Finally, the stapler can be fired and carefully removed from the distal rectum. Checking Staple Line and Resected Specimen The staple line is regularly checked for completeness and for hemostasis. If bleeding from the staple line occurs, oversewing with absorbable sutures is mandatory (Vicryl 3/0; Ethicon).
Prior to more invasive tests the anal resting tone and voluntary sphincter "squeeze" pressure are also assessed clinically. Sphincter defects may be palpable and, deformity of the anal canal due to anorectal sepsis or previous surgery, is noted. The findings often influence the choice of operative procedure. culty in mobilizing a rectally basad advancement flap in this situation. It is the authors' practice to perform a colonoscopy or flexible sigmoidoscopy for complex or recurrent fistulae, to help exclude associated gastrointestinal disease.
The measurement of blood loss was not included in the study design, but the surgeons observed a reduction of postoperative bleeding using LigaSure1 "'. Postoperative bleeding occurred in three patients in both groups. Harmonic Scalpel™ hemorrhoidectomy has the same advantage as the LigaSureTM system of producing less thermal injury and less postoperative pain. However, it requires a longer operating time. Armstrong et al (14) and Khan at al. (8) reported operating time using Harmonic Scalpel to be even longer than conventional diathermy owing to the time-consuming hemostasis.
Colon and Rectal Surgery Anorectal Operations by Steven D. Wexner