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Lower Anterior Resection by Nezar Jrebi, MD
Authored by
Nezar Jrebi, MD
Authored by
Nezar Jrebi, MD
Lower Anterior Resection by Nezar Jrebi, MD
Operative Steps
Operative Steps
- Trocar sites are identified, and trocars inserted to gain access to the abdominal cavity.
- Initial Access to the abdomen is generally obtained by either:
- Veress needle technique
- Direct trocar view technique
- Explore the abdominal cavity.
- Take down any adhesions.
- Access and divide inferior mesenteric artery after identifying the left ureter.
Gain access to and mobilize distal sigmoid and rectum by dividing the mesentery, performing a total mesorectal excision with an energy device such as ENSEAL™ X1 Curved Jaw Tissue Sealer.
- Perform pelvic dissection.
- Transect rectum, using a stapling device, such as ECHELON™ 3000 Stapler.
- Mobilize the descending colon and splenic flexure with an energy device such as ENSEAL™ X1 Curved Jaw Tissue Sealer.
- Transect the proximal sigmoid colon using a stapling device, such as ECHELON™ 3000 Stapler and remove specimen.
- Perform end to end anastomosis, using a circular stapling device such as ECHELON™ Circular Powered Stapler.
- Consider diverting ileostomy in patients with preop radiation or very low anastomoses.
- Check the anastomosis for bleeding and leakage with a sigmoidoscope or colonoscope.
- May use ICG (indocyanine green).
- Remove fluid from wound and close the fascia using synthetic absorbable monofilament, such as PDS™ Plus Antibacterial suture.
- Subcuticular layer and skin are closed using synthetic absorbable monofilament, such as Monocryl™ Plus Antibacterial suture, and any appropriate dressing.
Potential complications include but are not limited to:
- Surgical bleeding
- Staple line Leak
- Wound infection
- Ileus