[New method of abdominal cavity opening in surgery of rectum].
The paper presents a new method of surgical access to the small pelvis in which laparotomy is performed by using the transverse incision through both inguinal canals and cutting off the public insertions of the straight muscles of the abdomen. The inguinal canals with the posterior wall were opened according to the Shouldice procedure, and they were closed suturing the public insertions of rectus abdominis, in 8 cases the inguinal canals were repaired by using the Halsted procedure with our modification [1] and in three case our own method was used [2]. From April 28, 1998 to September 06, 2000, 11 operations for rectal carcinoma were performed using this method. Simultaneously, in 5 patients inguinal hernias were repaired. In 6 cases of rectal carcinoma, the abdominoperineal resection of the rectum was performed using the Miles method (in one case accompanied by total hysterotomy, partial ileoectomy and appendectomy, "en bloc"). In 2 cases resection of the rectum using the Hartman method was done. In 2 case the anterior rectal resection by the Dixon method and in another one partial rectalctomy were performed. The abdominal wounds healed by first intension. Among complications showed: difficult healing of the perineal wound was observed in 1 patient, another one required reoperation due to obstruction, in 1 patient inguinal reherniation was found and in another one the hernia around the colostomy occurred. Surgical access suggested by us enables extensive removal of the tissues around the rectum, including adjacent organs (considering easy technical terms), the simultaneous supply of inguinal hernias, in the cases of abdominoperineal resection of the rectum the abdominal anus was created through the left straight muscle of the abdomen, leaving more than 4 cm between a colostomy and an abdominal wound. The low, transverse incision caused only slight surgical discomfort (and patients quickly resumed ambulation) and good cosmetic effect of scar.
Kuśnierczyk
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Oddział Chirurgiczny "Centrum Medycznego Nowa Huta" w Krakowie. kusnierczyk@poczta.onet.pl
Kostarczyk
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D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D014945:Wound Healing
Nowy sposób otwarcia jamy brzusznej w chirurgii odbytnicy.