Reseccin anterior baja

Reseccin AbdominoperinealMondragn R3CG

Generalidades1908 por Ernest Miles

2 Cx Sincrnica.

Inicialmente 2 etapas colostomia y FM

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

IndicacionesCa Recto

Tumores menos de 8 cm del margen anal

Menor a 5cm

Invasin al canal anal y de elevadores

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Preparacin preoperatoria Colonoscopa o enema de Bario

TAC evaluacin del tumor y enfermedad METs

Preparacin intestinal

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica Quirrgica2 Equipos Qx

Posicin Perineolitotoma, Trendelemburg Mod.

Sx Compartimental

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Posicin

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaSutura de la regin perineal en bolsa de tabaco Sutura no absorbible

Incisin: Linea media suprainfraumbilical

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaExploracin en bsqueda de Enf Metastsica

ID parte superior del abdomen con 3 compresas hmedas 1 Sobre ciego, 2 descendente 3 lado a lado

Movilizacin del colon sigmoide y recto a lo largo de la corredera parietoclica izquierda

Incisin del peritoneo con identificacin del urter

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaDiseccin roma a nivel del promontorio sacro .. Hemorragia Presin directa

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaTraccin Suave del recto y sigmoides Espacio presacro identificando fascia presacra

Identificacin de nervios simpticos presacros

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Tcnica Quirrgica

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaContinuar hacia ligamentos laterales (ramas de la rectal media, ramas de nervios autnomos a la pelvis) y vasos hemorroidales medios

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaElevacin del sigmoides hacia herida, creacin de estoma.

Pinzas Kocher Incisin de piel

Diseccin de fibras del recto en sentido longitudinal

Evitando lesin de vasos epigstricos inferiores

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaLa colostomia se madura con seda, 8 puntos a travs de todo el espesor del intestino y la piel

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaDiseccin perineal Se inicia cuando se determina que la lesin es resecable

Al completar tiempo abdominal

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaIncisin elptica fuera del esfnter, cada borde de la piel es tomado con pinzas Kocher

Diseccin con electrocauterio

Se indentifican vasos hemorroidales inferiores

Identificacin del msculo transverso perineal

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaSeparadores automticos una vez que se llega a la fosa isquiorectal

Entrada al espacio presacro dividiendo el msculo rectococcgeo punta del coxis

Fascia presacra Vs Entrar al recto

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaSe inciden los elevadores cerca de los ligamentos accesorios de la pared plvica, cuidado de lesin de uretros

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaSeccin de Msculos rectoureteral y fascia visceral Evitar lesin de uretra y prstata, lesin de recto

Incide fascia de DenonvilliersEntrada a cavidad.

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica QuirrgicaCierre primario de herida

Colocacin de drenaje a travs de herida quirrgica

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Reseccin Anterior BajaMondragn R3CGGeneralidadesLa primera reseccin de sigmoides 1833 Lyon

Indicaciones

Ca de recto 5 cm del margen anal

Margen anal Complejo esfinteriano

Comprende movilizacin completa del recto, divisin de los ligamentos laterales y arterias hemorroidales medias

Anastomosis se efecta en el recto extraperitoneal Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Posicin: Perineolitotoma o decbito supino

Verificacin de resecabilidad.

Presencia de enfermedad metastsica

Fijacin del tumor a la pelvis

Pasos iniciales iguales que la RAPCorman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Escisin total del mesorectoEvita recidiva en lnea de suturaEvitar devascularizacin y fuga anastomtica

Al llegar al margen distal Incisin transversal

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgicaSutura convencional

Colocacin de pinzas allis abren el recto distal, se prepara la anastomosis TT

Puntos interrumpidos de sutura no absorbible

Muscular de la mucosa no hay serosa se completa el plano posterior

Al finalizar punto de colchonero para invaginar mucosa

1 plano o Lembert.

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica2 Opcin es realizarlo con sutura continua

Doble armada.

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007OmentopastaRealizar cobertura de la anastomosis con omento

Retrasar dx de fuga anastomtica

Drenajes cerrados

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Tcnica quirrgica Instrumentos de grapado

Paciente en posicin de perineolitotoma

Creacin de sutura en bolsa de tabaco con monofilamento Prolene

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Instrumentos de grapado

De igual manera, bolsa de tabaco en segmento distal

Colocacin del yunque sobre segmento distal

Accionar engrapadora

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Se evala la integridad de la anastomosis con la tcnica neumtica

Reparacin con sutura del sitio de fuga en caso de presentarse

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Alternativas a la anastomosis TT

Ileo recto anastomosis trmino lateral

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007Tcnica quirrgica Alternativas a la anastomosis TT

Colo recto anastomosis latero lateral

Corman, Marvin L. Colon and Rectal Surgery, 5th Edition 2005 Lippincott Williams & Wilkins.Philip H. Gordon Principles and Practice of Surgery for the Colon, Rectum, and Anus 3er ed. 2007