Rectal resection is the excision of its affected part. The rectum continues the large intestine and extends from the sigmoid to the anus. This is the final part of the digestive tract, the length of which is 13–15 cm. Fecal masses accumulate in it and are subsequently brought out. She got her name because she has no bends. The main ailments of the rectum are: various inflammation processes, Crohn's disease, obstruction, ischemia, cancer. The main treatment for such diseases is surgery.
Types of transactions
The best treatment for rectal cancer is surgery. In medical practice, depending on the location of the tumor and its size, there are several methods for its excision:
- Polypectomy is the simplest operation to remove polyps and minor tumors. When it is carried out, nearby tissues are minimally damaged. Surgery is performed using an endoscope if the neoplasm is located near the anus.
- Anterior resection of the rectum - is done when removing its upper part and the lower end of the sigmoid colon. The rest of it is connected to the sigmoid colon. At the same time, the nervous apparatus and anus are preserved. For quick healing, a temporary colostomy is sometimes applied, which is removed after a second operation after about two months.
- Low anterior resection - performed when removing the pathology in the middle part of the rectum. In this case, the damaged part of the sigmoid colon and the entire rectum are excised, except for the anus. The reservoir function of the intestine is lost. A place for the accumulation of feces is formed from the lowered intestine, which is located above. The sigmoid colon is connected with a direct anastomosis. In almost all cases, an unloading stoma is placed for several months.
- Abdominal-anal resection - performed from the side of the abdominal cavity and anus. Resection of the rectum is done when the pathology is located close to the anus, but does not affect it. The part of the sigmoid colon, completely straight with the share of the anal sphincter, is to be removed. The remaining sigmoid colon is used to form an anastomosis with part of the anal sphincter.
- Abdominal-intermediate extirpation - through two incisions, one of which is on the abdomen, and the other is around the anal canal. In this case, the rectum, anal canal and anal sphincter muscles are subject to resection. Feces are drained through the formed stoma.
Resection technique
Surgery to remove part of the rectum can beperformed in two ways: using laparotomy or laparoscopy. During a laparotomy, an incision is made along the lower abdomen. The surgeon gets a good overview for all manipulations. The laparoscopic method involves several small holes for inserting surgical instruments into the abdominal cavity. The technique of open rectal resection is as follows:
- The surgical field is processed and an incision is made in the abdominal wall. The abdominal cavity is carefully examined and the affected area is located.
- This area is isolated by applying clamps and removed to he althy tissue. At the same time, a part of the mesentery with the vessels supplying the intestine is excised. Vessels are tied up before removal.
- After excision of the neoplasm, the ends of the intestine are sutured, and it can function again.
When moving from one stage of the operation to another, the surgeon changes instruments to avoid infection with intestinal contents.
Laparoscopic anterior rectum resection
As mentioned earlier, resection can be performed not only with an open method, but also with the help of laparoscopy. In this case, several holes are made into which laparoscopic instruments are inserted. The well-established technique for carrying out such operations is becoming increasingly popular due to the low traumatism of the patient and a number of other advantages. The operation of the anterior resection of the rectum in the upper sections begins with the intersection of the vessels. Then the affected part is releasedintestines and is brought out through a small hole in the anterior abdominal wall, where a resection is performed, and the ends of the intestine are sutured.
The same steps are performed for resection of the lower colon. Anastomosis (connection of two parts of the intestine) is carried out based on anatomical conditions. With a sufficient length of the loop, the area with the tumor is brought out through the hole, it is excised, the ends are sutured. Otherwise, when the length of the intestine does not allow it to be brought out, the resection and connection of the ends is performed in the abdominal cavity, using a special circular stapler.
Benefits of laparoscopic surgery
It has been experimentally established that the results of operations performed by the laparoscopic method are not inferior in quality to the results of rectal resection performed using laparotomy (open access). In addition, have the following advantages:
- cause fewer injuries;
- short period of rehabilitation and recovery of the patient after surgery;
- minor pain symptom;
- no suppuration and postoperative hernias;
- low percentage of complications in the initial and long-term period.
Disadvantages of laparoscopy
Disadvantages include:
- Laparoscopy method is not always technically possible. It may be safer for the patient to perform open surgery.
- Resection requires expensive instruments and equipment.
- The operation has its own specifics and is performed by highly qualified specialists, whose training requires certain funds.
In some cases, during the operation, which was started by laparoscopy, they switch to laparotomy.
What will happen after the operation?
After resection of the rectum, the patient is transferred to the intensive care unit, where he will recover from anesthesia. Then the patient is placed in the ward of the Department of Surgery for further rehabilitation. In the first time after the operation period, the patient is fed intravenously using a dropper. After seven days, it is allowed to switch to the use of regular food prepared in liquid form. Gradually, the transition to solid food is carried out. For a quick recovery, physical activity has a great influence, so the patient is advised to walk and do exercises for the respiratory system. Approximately ten days after the operation, the patient is discharged, but the treatment will still continue in the oncology department.
Resection for polyps
Polyps of the rectum are tumor-like formations, mostly of a benign nature. But sometimes their nature changes and they become malignant neoplasms. In this case, the radical method of treatment is resection of rectal cancer.
In the presence of polyps with symptoms of malignancy, a part of the rectum is excised or it is removed completely. Length of section to be removeddepends on the degree of damage to the polyp. When the cancer process spreads to nearby areas of the rectum, the entire affected part is removed. And if metastases appear, then the lymph nodes are also subject to excision.
Types of intestinal connections after resection
After removing the abnormal part of the intestine, the doctor must connect the remaining ends or make an anastomosis. Opposite ends of the intestine may differ in diameter, so technical difficulties often arise. Surgeons use three types of connections:
- End to end is the most physiological and commonly used way to recreate the integrity of the intestine.
- Side to Side - used to connect ends when their diameters do not match.
- Side to end - used to connect different sections of the intestine.
For stitching, use a manual or hardware seam. If it is technically impossible to restore the intestine or to quickly recreate its functions, a colostomy (outlet) is applied to the front wall of the abdomen. With the help of her feces are collected in a special colostomy bag. The temporary colostomy is removed after a few months, while the permanent colostomy remains for life.
Consequences of rectal resection
An operation to remove part of the rectum sometimes has negative consequences:
- When sterility is violated in the operating room or instruments, infection of the wound occurs. In this case, redness and suppuration of the suture is formed, the patient has a fever, chills and weakness are observed.
- The occurrence of internal bleeding. It is dangerous because it does not appear immediately.
- Intestinal obstruction can occur with scarring of the intestine. In this case, a second operation will be required to correct it.
- Anastomositis is the occurrence of an inflammatory process at the junction of the ends of the rectum. The causes of inflammation are the reaction of the body to the suture material, poor adaptation of the stitched mucous membranes, and tissue trauma during surgery. The disease has a chronic, catarrhal or erosive form.
After resection of the rectum, the operated organs continue to function and can be injured by feces. To prevent injuries, the patient must strictly observe the diet recommended by the doctor and exclude physical activity for six months.
Postoperative nutrition
In the postoperative period, it is especially important to follow a special diet so that it does not injure the intestines, does not cause fermentation and diarrhea. On the first day after the operation, the patient is starving, the necessary vitamins and minerals are administered intravenously. Within two weeks, fermented milk products, legumes, raw vegetables and fruits are excluded. Subsequently, the diet does not greatly restrict the diet of the operated patient. Sample menu after rectal resection:
- Drink a glass of boiled clean water in the morning. Half an hour later, eat oatmeal cooked in water, adding a small amount of walnuts to it, and drink a cup of jelly.
- Three hours later for a snackuse applesauce.
- For lunch, soup with buckwheat and fish dumplings, and tea brewed with herbs will do.
- Snack consists of a handful of crackers and a glass of yogurt.
- For dinner, you can eat rice porridge, steamed chicken cutlets and compote.
There are many different recipes for cooking, so that the food is varied, you can use them.
Prevention of rectal cancer
To prevent colorectal cancer, you should lead a he althy lifestyle, breathe fresh, clean air, drink quality water, eat more plant-based foods, and limit the use of animal fats. An important factor is secondary prevention, timely detection of polyps and their removal. There is a high probability of detecting cancer cells in a polyp, the size of which is more than five centimeters. The polyp develops very slowly over 10 years. This time is used for preventive examinations, which begin at the age of fifty in people who do not have risk factors for developing rectal cancer. For those who are predisposed to the occurrence of cancerous tumors, preventive measures begin ten years earlier. It is important to immediately consult a doctor if there are suspicious symptoms in the work of the intestine and undergo an examination so as not to undergo a resection of the rectum.
