Colon Cancer

Notes by a Modesto General Surgeon for Medical Students and Surgical Residents

Disclaimer:  This web page does not substitute for a one-on-one consultation with your medical doctor or surgeon.  Medical science rapidly changes, one cannot depend on static sources of information.

Other resources:

• Colon Cancer on Wikipedia
• Colon Cancer on NIH, with great illustrations

Colon Cancer Operations:

Low Anterior Resection of the Rectosigmoid: 

Indications

• Malignant cancer lesions / polyps / masses in the rectosigmoid or low sigmoid area in order to reestablish bowel continuity, and avoid colostomy.
• A low anastamosis is easier and safer in the female than in the male, especially if a hysterectomy has already been done.

Position

• Trendelenburg position, reverse Trendelenburg when mobilizing splenic flexure
• Stirrups

Incision

• Midline from the symphysis to a level above and to the left of the umbilicus.

Details of the colon cancer procedure (LAR)

• Wall off the small intestines (in a bag, or use those blue towels)
• Self retaining retractor is inserted.
• Free the peritoneum of the pelvic colon from the sigmoid downward on either side
• Anatomy at this point:
  • Left colic artery, sigmoidal artery, superior hemorrhoidal artery, middle hemorrhoidal artery
  • Peritoneal reflection
  • Ureter
  • Marginal artery of drummond
  • Inferior mesenteric artery
• Free the rectum anteriorly and posteriorly by blunt finger dissection
• IMA ligation, IMV ligation.
• Consider mobilization of the splenic flexure and divide the lateral peritoneal attachments of the left colon
• TA staple the distal end of the bowel
• O-Vicryl ties for the specimen mesentery and ligate the bleeders / mesentery.
• Kocher clamp and use a keith needle/purse stringer for the proximal bowel.  It doesn't matter what type of suture because it will be cut out as a "donut" with the EEA stapler.
• Clean the area free of fat and check to avoid diverticuli.
• Remove the specimen.
• EEA staple
• Test for leak
• Close mesentery
• Consider NG/Rectal Tube/Drains.  Probably won't need any of them.
• Close abdominal wall.

Whew!  When it's all done, find out more about Modesto, California:

• Modesto Bee - Modesto's newspaper.  Lots of Lasik ads
• Modesto Craig's List - Looking for jobs?  Have trouble reading the ads?  Try Lasik Surgery.
• Modesto Chamber of Commerce - Lots of Lasik doctors are part of the Modesto Chamber of Commerce
• City of Modesto - Official Modesto, CA City website.
• Modesto Symphony
• Modesto Junior College (MJC)
• Lasik Modesto Directory: http://www.the-lasik-directory.com - use this website to find a Modesto Lasik Eye Surgeon
• Lasik Modesto Directory through http://www.locateadoc.com/ - be sure to enter Lasik or Laser Eye Surgery as the search terms.
• Lasik news at http://www.ndri.com/ - All about Health News, Articles about Lasik included.
• http://www.allaboutvision.com/ - a vision and Lasik related website.  Find a Modesto Lasik specialist here.
• Laser surgery for the eyes - http://www.lasersurgeryforeyes.com/ a website related to finding Lasik Surgeons.
• Finally, just plain Modesto - Modesto's official website
• McHenry Museum - The McHenry Museum is a great place to reminisce about a time before lasik surgery.

Our Modesto office:

2336 Sylvan Ave. Suite C
Modesto, CA 95355.

Located next to the Post Office on Sylvan Ave, Modesto, CA

telephone: 209-551-1888,
email: staff [at] surgerytoday.com

Meet Dr. Calvin Lee.

web page last updated: 07/29/2007

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