Transsacral approach for rectal polypectomy

Treating diseases: rectal polyps Indication Transrectal rectal polypectomy is applied to: 1. The polyps are large or the base is wide, and it is not suitable for anal resection. 2. Polyps are cancerous but limited to the mucosa and submucosa. Contraindications 1. The rectal tumor is located above the peritoneal reflex line. 2. The anal sphincter function is significantly reduced. Preoperative preparation 1. Try to improve the general condition of the patient, such as correcting anemia, hemoglobin should be above 12g; if serum protein is too low or weight loss is significant, intravenous nutrition should be done first. 2. Female patients should have a vaginal examination to see if there is cancer infiltration. Those who need to remove the posterior wall of the vagina should wash the vagina every day for 2 days before surgery. 3. The lower fixed tumor, or the cancer is located in the anterior wall of the rectum and has urinary symptoms. Cystoscopy and retrograde ureterography or intravenous pyelography should be performed to understand whether there is any invasion of the genitourinary system. 4. After anesthesia, place the catheter under strict aseptic technique, preferably with a Foley balloon catheter, and then fix the scrotum and penis (along with the catheter) to the inside of the right thigh with an adhesive plaster. The catheter is connected to the operation. Under the bottle. Surgical procedure 1. Take the prone position: pad the cushion on both sides of the head, the shoulders and the lower abdomen, the abdomen and the lower chest are suspended to facilitate breathing, the hands are placed beside the head, and the legs are slightly drooping. 2. Incision: 1 lateral finger next to the humerus, 3 transverse fingers on the tip of the tailbone and 6-8 cm long incision parallel to the tibia. Cut the skin and subcutaneous tissue, reveal the posterior margin of the gluteus maximus, and pay attention to identify the external sphincter. The levator ani muscle, the anal ligament and the sacral ligament. Because the sphincter and the levator ani muscle are intertwined, it is difficult to distinguish between the levator ani muscle and the sacral ligament. 3. Clamp, cut, and sew part of the gluteus maximus, levator ani muscle, sphincter as far as possible without cutting, muscle must be sewed after cutting, the suture is not cut. When the incision is to be resected, the lines on both sides are ligated to each other to reconstruct the pelvic floor. 4. After the levator ani muscle is opened, the Waldyers fascia is revealed, the Waldyers fascia is cut from top to bottom, and the Waldyers fascia is ligated to reveal the Denonvines fascia. At this time, attention should be paid to the lateral nerves and blood vessels, and the separation should be performed close to the rectal wall. 5. After separating the tissue around the rectum, freely revealing the rectum, and releasing the rectum, use a gauze strip to lift the rectum through the anterior wall of the rectum. Then cut the intestinal wall and remove the polyps. 6. After suturing the rectum in the whole layer, suture the rectal outer layer. The incision is then sutured layer by layer. The bleeding should be carefully stopped during the operation. complication 1. Wound bleeding. 2. Anal incontinence. 3. The incision leaks.

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