Abdominal Surgery and StomasCaroline TaylorOctober 2011
Content•Large bowel anatomy
•Common abdominal procedures
•Complications of surgery
•Stomas
•Complications of stomas
Surgical terms•Laparotomy
•Laparoscopy
Gross anatomy of the bowel
Blood supply of the colon
Colorectal cancers•Right sided
▫Present with anaemia, weight loss, mass▫Later presentation
•Left sided▫Present with altered bowels▫PR bleeding
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
Operations for colorectal cancers•Right Hemicolectomy
•Left Hemicolectomy
•Anterior resection
•Abdomino-perineal resection (APR)
•Hartmann’s procedure
Right hemicolectomy
•Ascending colon, appendix and part of transverse colon
•Superior mesenteric artery
•Ileocolic anastomosis
Left hemicolectomy•Transverse colon and descending colon
•Inferior mesenteric artery
•Primary anastomosis
Anterior resection•=sigmoid colectomy
•Sigmoid colon and part ofrectum
•Primary anastomosis orstoma formations
Abdomino-perineal resection (APR)•Low rectal tumours
•Associated total mesorectal excision (TME)
•Anus closed and rectum removed
•Colostomy formation
Hartmann’s Procedure•Emergency procedure
▫Rests the bowel▫If anastomosis will be poor
•Sigmoid colectomy•Oversewn rectum to form a stump•End colectomy•Reversible
Complications of surgery•Anastomotic leak•Infection/abscess/collection•Bleeding•Paralytic Ileus•Adhesions / stricture formation•Fistulas
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
Paralytic Ileus•Bowel “goes to sleep!”
•Caused by toxins or handling
•Conservative management
•Most spontaneously resolve
Stomas•“mouth”
•Ileostomy or colostomy (gastrostomy, urostomy)
•To divert faeces from anastomosis or fistula
•Due to removal of distal colon and rectum
Ileostomy•Small bowel
•Right sided
•Spouted
•Temporary – usually a loop•Permanent – usually an end ileostomy
End and loop ileostomies
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)
Complications of stomas•Bleeding•Prolapse or retraction•Stenosis•Skin excoriation•Parastomal hernias•Fistulation
Ileostomy v. colostomyFeature 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
Summary•Large bowel anatomy is key in deciding
on the appropriate operation
•Common surgical procedures
•Ileostomies and colostomies and their differences and complications
Any Questions??