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[Type the document title]Management Conventional

and Laparoscopic LargeBowel Tumor

Colectomy Surgery

2/17/2013

Erwin Wahid

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Management Conventional and Laparoscopic Large Bowel TumorBy

Dr Erwin Wahid M.D., M.S., student Ph. D.

Curative treatment will be achieved when done in the early stages. Palliative

surgery is still one of the best efforts to prolong life and improve quality of life.

Frequency in Indonesia 38-48 percent obtained at the age below 40 years.

Once the diagnosis is made clinically, laboratory, radiological, and if

necessary, colonoscopy and biopsy, then prepared surgery action.

As early determined whether surgery will be curative or palliative: it can be

determined by assessing whether there is metastasis to the clinical, radiological

and ultrasound. Further surgery and contraindications tolerable checked by

examining all the function of organs such as lung function, cardiovascular,

hemostasis, liver, kidney and hormonal. If you need help, and there is less time

then the function can be improved first. It certainly can not be done when surgery

is acute, such as the intestine obstruction. With this test, then it is no preparation

to prevent postoperative complications.

Then set the operating timing, followed by preoperative preparation, the

blood supply, preparation of the colon with a colonic cleansing mechanic and

reduction of germs in the colon with the appropriate antibiotics. As a final

preparation phase of the disease.

Due possible or colonic stoma must be made permanent or temporary,

then the patient must be prepared mentally and surgeon should explain it as best

as possible. It should also be determined in the colon where the stoma will be

placed so as not to interfere with the way people dress and work.

Surgery is generally performed with a midline incision and after open

abdominal reassessed stage carcinomas with felt and saw the liver, regional

lymph nodes and distant, as well as the assessment of tumor infiltration into the

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surrounding tissue. Based on this new one can determine whether surgery will be

curative or palliative and surgical techniques can be determined precisely.

In curative surgery performed en block resection was the operation of

palliative resection can, by pass or colostomy alone. In the en block resection of

the colon is resected at least 15 cm proximal to the tumor and 5 cm distal tumor.

In this resection should also be included vessels and lymph nodes that run

concurrently with the blood vessels to the proximal as possible. For the location

of the tumor in the cecum and ascending colon hemicolectomy done right: to do

transverectomy or transverse colon hemicolectomy extended; to the descending

colon, left hemicolectomy; for sigmoid, sigmoidectomy, for rectum whose tumors

more than 5 cm from the line annocutan anterior resection and the less than 5

cm procedures Miles. In the Miles procedure must be made permanent

colostomy.

Palliative surgery depending on the circumstances found; several

benchmark used is: wherever possible resection anastomosis; this if all by pass

and not be then only colostomy alone.

Postoperative care must be done carefully taking into account all organ

function and fluid and electrolyte balance. New anastomosis can be declared

safe if no leakage after the tenth day.

Giving citostatica and or radiotherapy depending on stage. Stage Dukes A

does not need adjuvant therapy, in stage further adjuvant therapy should be

considered. If the patient is wearing a colostomy, colostomy care then it should

be taught.

The laparoscopic approach continues to gain popularity and has evolvedto include not just pure laparoscopic techniques but also hand-assist devices.

Hand-assisted surgery can be used as a bridge for surgeons who are not

completely familiar or facile with laparoscopic techniques, and even for the most

experienced laparoscopic surgeons, it is often the preferred technique for surgery

involving left-sided pathology.

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Laparoscopic left colectomy or laparoscopic total colectomy, the patient is

placed supine in a 20 degree Trendelenburg position. The surgeon and first

assistant are on the side of the patient. The second assistant stands between the

legs of the patient. The video monitor is placed to left of the patient.

When laparoscopic right colectomy or laparoscopic rectopexy for rectal

prolapse, the patient is placed supine. A Trendelenburg position is required at the

initial stage of the operation with some left rotation. The surgeon stands to the

left of the patient, and the first assistant to the surgeons left. The second

assistant is positioned between the patients leg.

Laparoscopic colectomy surgery usually 6 hole is two 10-mm trocars,

three 5-mm trocars, and then A 12-mm trocar with reducers.

Reading.

Phillips, R.K.S. (2006). A Companion to Specialist Surgical Praetice, 3 rd edn.Elsevier, Philadelphia.

Jean-Louis D. (2006). Tip and Techniques in laparoscpic Surgery, SpringerFrance

.