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Colonic Resections (Screenshot 2019-11-21 at 16.25.49 (Hartmann’s…

- - - - Emergency procedure
      - Sigmoid colectomy
      - Proximal bowel exteriorised as an end colostomy
      - Distal bowel oversewn to form a rectal stump
      - May be reversed after 3-6mo (>50% of pts. aren’t reversed)
- - - - Midline laparotomy
        
        Laparoscopic ports
- - - - Midline laparotomy
        
        Laparoscopic ports
- - - - Excision of part of the rectum and sigmoid colon
      - May be high or low depending on site of tumour
      - WITH total mesorectal excision for tumours in the middle or lower 1/3
      - Rectal blood supply is poor so colorectal anastomosis covered by
        temporary loop ileostomy.
    - - Midline laparotomy
      - Laparoscopic port scars
      - Scar or stoma in RIF
    - - End Ileostomy
        
        Panproctocolectomy: UC, FAP
        
        Subtotal colectomy: acute severe UC
        
        Cystectomy and ileal conduit
      - Loop Ileostomy
        
        Temporary diversion: Crohn’s
- - - - All colon, rectum and anus removed
      - Permanent end ileostomy
    - - Midline laparotomy
      - Laparoscopic port sites
    - - End Ileostomy
        
        Subtotal colectomy: acute severe UC
        
        Cystectomy and ileal conduit
      - Loop Ileostomy
        
        Temporary diversion: anterior resection or Crohn’s
- - - - Sigmoid, rectum and mesorectal nodes removed via abdominal incision
      - Anus removed via perineal incision
    - - Midline laparotomy
        
        No anus
- - - - Midline laparotomy
        
        Transverse muscle splitting
        
        Laparoscopic ports
- - - - All colon excised except distal sigmoid and rectum.
      - Temporary end ileostomy
      - Rectosigmoid stump may be exteriorised as mucus fistula
      - Followed after ~3mo by either:
        
        Ileorectal anastomosis (IRA)
        
        Completion proctectomy + IPAA or permanent end ileostomy
    - - Midline laparotomy
      - Laparoscopic port sites
    - - End Ileostomy
        
        Panproctocolectomy: UC, FAP
        
        Cystectomy and ileal conduit
      - Loop Ileostomy
        
        Temporary diversion: anterior resection or Crohn’s