RECTAL TUMOR EXCISION

REASON FOR VISIT:

• Rectal bleeding
• Feeling of incomplete evacuation and tenesmus.
• Abdominal pain
• Bowel obstruction
• Pelvic pain
• Diarrhea
• Constipation
• Rectal tumor
• Rectal polyp

RISK ASSESSMENT

• Old age
• Bleeding disorders
• Hyper tension
• Diabetes
• Heart diseases
• Allergy to the medication
• Allergy to the anesthesia

PREPARATION OF THE PATIENT:

• Blood tests
• Urine tests
• EKG/ECG
• Barium enema
• Fecal occult blood test
• Rigid Proctosigmoidoscopy
• Endorectal ultrasound
• Endorectal surface-coil MRI
• Chest radiograph
• CT scan
• MRI
• CEA scan
• Preoperative antibiotics were administered to the patients with
diseases of the heart valves.
• Oral feeding was stopped for ____hrs before the procedure.
 • Aspirin and other blood-thinning medications were stopped several
days before the surgery
• Laxative was administered
• Enema was given
• Part was prepared and draped in sterile fashion
• Antibiotic bowel preparation was done

ANESTHESIA:

General anesthesia

POSITION OF THE PATIENT

Prone position

THE PROCEDURE

TRANSANAL EXCISION

• Tumor was located in the lower one third of the rectum

• The tumor was ______ size
• The tumor was excised with full thickness of the rectal wall,
leaving a 1-cm margin of normal tissue.
• The two ends of bowl loops were anastomosed with sutures
• The involved lymph nodes were resected

TOTAL MESORECTAL EXCISION

• Pelvic abdominal incision was given

• Abdomen was opened in layers
• Tumor was noted
• Tumor was located in ________ part of the rectum
• The tumor was excised with removing the rectal part
• The two ends of bowel loops were anastomosed with the sutures
• The peritoneum and fascia of the transversalis muscle was closed
with a running absorbable suture.
• The remaining fascial layers were closed with the running or
interrupted absorbable sutures.
• The skin was closed with a subcuticular absorbable suture such as
Monocryl.
• Collodian or adhesive Steri-strips are placed on the wound
• The removed tumor/ polyp is sent to the histological /pathological
examination/biopsy
FINDINGS:

• Tumor/ polyp was present in _______part of Rectum

AFTER PROCEDURE:

• Immediately after surgery the patient will be taken to a

recovery area
• Monitoring the blood pressure/pulse/temperature
• Nothing is taken by mouth for_____hr

DURATION
_______hrs

POSTOPERATIVE CARE

• Take antibiotic treatment as prescribed

• Take pain medications prescribed
• Observe for in discharge from suture site
• Surgical wound dressings will be kept clean and dry
• Take liquid diet for_____days

COMPLICATIONS

• Infection
• Bleeding
• Intestinal injury
• Anastomotic leak
• Bladder and sexual function alterations
• Constipation
• Outlet obstruction
• Myocardial infarction
• Pulmonary embolus
• Deep vein thrombosis
• Hernia
• Tumor regrowth

FOLLOW UP
_________ days after surgery