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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 LOW ANTERIOR RESECTION ULTRALOW ANTERIOR RESECTION COLOANAL PULLTHROUGH 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
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