Slawomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA.

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Presentation transcript:

Slawomir Marecik, MD, FACS, FASCRS Advocate Lutheran General Hospital, Park Ridge, IL Clinical Assistant Professor University of Illinois, Chicago, USA

 Anatomy  Colon cancer  Rectal cancer  Diverticular disease  Inflammatory bowel disease  Crohn’s disease  Ulcerative colitis

 How long is your colon?

 picture of the colon  lymph nodes  vessels  retroperitoneal part  perforations

 video full colon inside live

 video of right colon specimen  video of left colon and rectum specimen

 pictures right colon  transverse  left colon  sigmoid

 type of operations  type of anastomosis  how the anastomosis is created  stapling

 Hand-sewn  Stapled  Linear stapler  Circular stapler

 When is colostomy needed?  emergency situation when…  bowel is not prepared (bowel prep)  patient has no healing potential  poor nutrition  poor vascular supply  steroids, other severe conditions

 Anatomy  mesorectum, valves, lymph nodes  sphincter

 Level of tumor

 Type of operations  endoscopic excision  local (transanal) excision  radical surgery (involving bowel and lymph nodes)  radical surgery with sphincter

ANTERIOR RESECTION ULTRALOW ANTERIOR RESECTION LOW ANTERIOR RESECTION COLOANALPULLTHROUGH

 When is colostomy needed?  tumor involving the sphincter  poor preoperative continence  When is (protective) ileostomy needed?  low pelvic anastomosis  if radiation was given before surgery

 Need for proper evaluation  endoscopy  ultrasound  MRI

 Straight connection  J pouch  Side to end  video

 preoperative chemoradiation therapy  when?  how long?  why ileostomy?  why pouchogram and flex sig?

 Video – rectal cancer surgery  Total mesorectal excision