6. Colorectal cancers
• Right sided
▫ Present with anaemia, weight loss, mass
▫ Later presentation
• Left sided
▫ Present with altered bowels
▫ PR bleeding
7. Dukes staging
• A mucosa of the colon or rectum
• B through the muscular propria
• C spread to at least one lymph node in the area
• D metastatic spread
8. Operations for colorectal cancers
• Right Hemicolectomy
• Left Hemicolectomy
• Anterior resection
• Abdomino-perineal resection (APR)
• Hartmann’s procedure
9. Right hemicolectomy
• Ascending colon, appendix and part of
transverse colon
• Superior mesenteric artery
• Ileocolic anastomosis
13. Anterior resection
• =sigmoid colectomy
• Sigmoid colon and part of
rectum
• Primary anastomosis or
stoma formations
14.
15. Abdomino-perineal resection (APR)
• Low rectal tumours
• Associated total mesorectal excision (TME)
• Anus closed and rectum removed
• Colostomy formation
16.
17. Hartmann’s Procedure
• Emergency procedure
▫ Rests the bowel
▫ If anastomosis will be poor
• Sigmoid colectomy
• Oversewn rectum to form a stump
• End colectomy
• Reversible
20. Anastomotic leak
• 7-10 days post-op
• Higher risk with lower anastomosis
• Contributing factors:
▫ Surgeon
▫ Patient – male
▫ Pre-op radiotherapy
• Leads to pelvic abscess, fistulation, peritonitis,
mortality
21. Paralytic Ileus
• Bowel “goes to sleep!”
• Caused by toxins or handling
• Conservative management
• Most spontaneously resolve
22. Stomas
• “mouth”
• Ileostomy or colostomy (gastrostomy, urostomy)
• To divert faeces from anastomosis or fistula
• Due to removal of distal colon and rectum
23. Ileostomy
• Small bowel
• Right sided
• Spouted
• Temporary – usually a loop
• Permanent – usually an end ileostomy
25. Colostomies
• Large bowel
• Loop or end
• Where rectum or anal canal is not suitable for
passing faeces
▫ Such as abdominal surgery/cancer
▫ Crohn’s/UC
• Left sided (can be anywhere)
26. Complications of stomas
• Bleeding
• Prolapse or retraction
• Stenosis
• Skin excoriation
• Parastomal hernias
• Fistulation
27. Ileostomy v. colostomy
Feature Ileostomy Colostomy
Bowel Small Large
Contents Liquid, bilious colour Solid, feculent
Opening Spout Flush to skin
Site Right/higher Left/lower
Output Large vol Small vol
28. Summary
• Large bowel anatomy is key in deciding on the
appropriate operation
• Common surgical procedures
• Ileostomies and colostomies and their
differences and complications
