Strip operation of the sigmoid colon. Assuta is a leading private medical center in Israel. Rumbling in the intestines

Obstructive resection of the sigmoid colon is the name of a surgical intervention that is used to treat diseases of various etiologies. In clinical practice, the procedure is used extremely rarely.

The structure of the human intestine

Attention! Indications for intervention are determined by the doctor. Before undergoing the procedure, you need to weigh all the benefits and potential harm. Before the operation, you need to try other methods to fix the problem.

Indications for surgery

The sigmoid colon or "sigmoid" is the last section of the large intestine that opens into the rectum. The sigmoid is also called the "colon high pressure zone" in which stool is pushed towards the anus. Since the pressure in this part of the intestine is significant, some patients develop diverticula - saccular protrusions of the intestinal wall.

Diverticulosis is the most common indication for partial colon removal. Rarely, diverticula can develop into carcinoma in the sigmoid colon. In this case, an extended resection (rectosigmoid resection) is usually performed.

Operation

Diverticulum occurs mainly in the sigmoid colon, where increased internal pressure promotes bulging of the mucosa. Diverticula in the sigmoid do not always require surgery. Only after several inflammations of the diverticulum (diverticulitis) is surgical removal of the intestinal section performed.

Diverticulitis is primarily treated with antibiotics. Only with complications of diverticulitis (perforation with peritonitis, fistula in another organ) urgent surgical intervention is recommended. If an abscess occurs, it needs to be pierced.

Inflammation of diverticula (diverticulitis)

In the acute stage of diverticulitis, computed tomography is performed. It is recommended to perform a colonoscopy before surgery and exclude concomitant diseases. In colorectal carcinoma, it is required to exclude secondary tumors and metastases (for example, in the liver).

Contraindications

Colectomy has no absolute contraindications, although the patient's general condition and indications for surgery are evaluated on a case-by-case basis. A patient with severe heart disease, large polyps that are not amenable to colonoscopic removal, is a classic difficult case. The physician must weigh the risks and benefits of the surgical procedure against the predicted outcomes. A patient with severe heart failure should not undergo surgery because the risks outweigh the potential benefits.

Laparoscopic colectomy has some relative contraindications. Intra-abdominal adhesions or scar tissue from previous abdominal surgery may interfere with laparoscopic surgery. Complicates laparoscopic phlegmon colectomy due to perforated diverticulitis.

The surgeon should note if the patient has bleeding or liver disease. Portal hypertension, although not considered an absolute contraindication, can lead to massive hemorrhage during surgery. As a result, the patient risks dying from severe blood loss.

Important! Elimination of polyps during colectomy should be carried out taking into account contraindications. In some cases, patients died during the operation due to massive blood loss.

Types of operations on the sigmoid colon

Types of invasive intervention on the sigmoid:

• Sigotomy - an incision in the intestinal wall;
• Resection - removal of the entire sigmoid.

Training

Patients usually arrive at the hospital the day before surgery. Elderly patients undergo laboratory, radiological and electrocardiographic tests.

An anesthesiologist visits patients and tells them about the type of anesthesia. During resection, combined anesthesia is often used: epidural and intubation. An enema is required in the morning an hour before the procedure. An enema is used to cleanse the intestines.

Resection of the sigmoid colon, the course of the operation

Resection is performed at the location of the diverticula. In addition to the sigmoid, a small portion of the rectum (PC) is removed. The PC is removed to prevent the development of new diverticula.

Diverticulosis and carcinoma of the sigmoid colon are now treated by laparoscopic surgery. This procedure usually requires 5 to 7 points of intervention, for which 5-12 mm skin incisions are made. One incision in the left mid-abdomen is widened during surgery, allowing the bowel to be pulled out and part of it removed.

In a benign condition (diverticulosis), the mesentery is prepared and sutured to the intestine. In the case of carcinoma, it is separated centrally to remove the infected lymph nodes.

During the operation, the entire sigmoid and several centimeters of the PC are cut out to completely remove the so-called high pressure zone.

The descending colon (descending colon) is moved along its entire length to obtain sufficient length to connect to the PC. To do this, the left bend is disconnected from the spleen.

After resection of the rectosigmoid, the connection between the rest of the colon and the rectum is restored using a stapler. At the same time, the smallest titanium staples attach the ends of the intestine to each other.

Complications during the operation are possible: bleeding, damage to the internal organ (spleen, intestines, ureter). Such complications are extremely rare. Timely diagnosis and proper treatment of the injury are essential.

In very rare situations, the anastomosis cannot be performed. Examples include primary perforated diverticulitis with severe peritonitis and postoperative sequelae. In these cases, it is necessary to make a decision about the Hartmann operation. In this case, doctors insert an artificial intestine (colostomy). After healing of peritonitis, in most cases, the integrity of the intestine can be restored.

Colostomy

Operation Hartmann

With this type of operation, the sigmoid is closed with a suture or stapler, and then the doctor forms an end colostomy. In this way, peritonitis and the occurrence of anastomotic insufficiency can be prevented.

Laparoscopic resection of the sigmoid colon

In recent years, laparoscopic bowel resection has become widespread in clinical practice. In this type of resection, the stomach is filled with a non-toxic gas, and instruments and a camera are inserted through small incisions. The intestine is cut with special instruments (staplers optimized for the endoscopic method). In most clinics, another small incision is made. After that, the intestinal suture is performed using another stapler and the path of the intestinal contents is restored.

The advantage of laparoscopic bowel resection is fewer complications (small scars). After such an intervention, patients can leave the hospital and start work earlier than usual. However, the advantages of time can be achieved with the usual method of surgery. In some clinics in Russia, patients stay in the hospital for only 5 days after bowel resection and then leave it.

Laparoscopy

The laparoscopic method is mainly used for the treatment of sigmoid diverticulosis and sigmoid diverticulitis in many hospitals. Some hospitals specialize in laparoscopic surgery and offer laparoscopic management of all parts of the intestine. However, very few hospitals can perform surgery under the same conditions as open surgery. For colon cancer, laparoscopic surgery is not performed as often as standard surgery. However, the chances of recovery appear to be the same as with the conventional method.

Postoperative period

After laparoscopic surgery, patients remain in the ward. On the same evening, you can take a liquid. Liquid food is allowed the next day.

After a few days, the epidural (lumbar anesthesia), urethral and infusion catheters are removed. The incisions are usually closed at the end of the operation with suture technology, which uses a special subcutaneous thread.

After a successful operation, patients can usually return home after a week. Possible complications: bleeding, infection and general complications. If the connection between the large and small intestines does not heal well and stool leaks in the abdomen, the operation must be repeated. In this case, the anastomosis is sutured or repaired. Very rarely, an artificial intestine (stoma) is created, in most cases temporarily.

After a rectosigmoid resection, the patient can continue to live a normal life. However, he will have changes in the frequency of bowel movements. Disturbances can be controlled by a healthy diet and abundant hydration. In rare cases, conservative therapy is required.

Prompt hydration prevents complications

After a month, there may be problems with the stool. In these cases, it is useful to examine the rectum for stenosis at the level of the anastomosis.

After a laparoscopic procedure, it usually takes 2-3 weeks to recover. After laparotomy, the patient is advised to refrain from heavy loads and exercises for 4 weeks. However, he can quickly return to a normal diet. During the rehabilitation period, regular visits to the family doctor are required.

Possible Complications

In addition to the general risks during surgery and general anesthesia, damage to the spleen, intestines, or stomach may occur in this particular case. As a result of the intervention, the kidneys, bladder, urethra, and also the vessels of the abdominal cavity are occasionally damaged.

The disruption of these structures may be permanent and require further surgery. However, complications occur in very rare situations. An incision in the abdomen can lead to hernias requiring new surgery. In some situations, surgery can lead to disability of the patient.

The sigmoid colon, whose shape resembles the Latin letter S laid on its side, is an extremely important section of the large intestine, in which the final formation of feces occurs.

It is here that they part with nutrients and water, which are absorbed into the blood, and feces enter the rectum (which is a continuation of the sigmoid) and is excreted from the body.

The concept of illness

Cancer of the sigmoid colon is called a malignant tumor that develops from the epithelial tissues of the mucous membrane of this organ.

• Leading importance is attached to surgical intervention: without it, it is impossible to cure this disease. In the presence of small cancerous tumors with clear boundaries, they are removed (resection) along with a part of the affected intestine and adjacent lymph nodes. After that, the integrity of the intestinal tube is restored.

Small tumors with a low level of malignancy can be removed by a sparing (endoscopic) method - without making a skin incision.

During the laparotomy operation, the specialist performs several small punctures through which fiber-optic tubes equipped with a miniature video camera and endoscopic instruments are inserted into the patient's abdominal cavity.

In the treatment of a neglected tumor that has reached stage IV, an operation can be performed to completely remove the sigmoid colon with a performance designed to remove gases and feces.

Sometimes the colostomy is removed temporarily, only to improve the results of the operation. A few months later, the colostomy is removed, restoring the natural excretion of feces through the anus.

In some cases, the colostomy is made permanent. With this variant of the operation, the patient is forced to walk with a colostomy bag for life.

• Chemotherapy- cancer treatment with drugs that destroy cancer cells and inhibit their ability to rapidly divide - comes to the rescue even for patients with advanced disease and can be used both before and after surgery. When using one drug, they talk about monochemotherapy, when using several drugs, they talk about polychemotherapy. Unfortunately, it cannot replace surgical treatment. With its help, doctors only reduce the size of cancerous tumors and slow down their growth. As an independent therapeutic method, it is used only in relation to inoperable patients.
• radiotherapy sigmoid colon cancer is performed very carefully, since there is a high risk of perforation of the walls of this organ. In addition, most types of colorectal cancer are characterized by low sensitivity to this therapeutic method. However, the use of radiation therapy can give good results in reducing the size of the tumor before surgery and in killing cancer cells that may have remained at the border of healthy and diseased tissues.

Prognosis after surgery

The prognosis (most often moderately favorable) for sigmoid colon cancer primarily depends on the level of differentiation of tumor cells: highly differentiated malignant tumors are treated better.

Equally important is the early detection of a cancerous tumor and its immediate treatment.

• Comprehensive treatment of patients (combining surgery with chemoradiotherapy) with single metastases in regional lymph nodes gives a five-year survival rate of 40% of patients. In the absence of such therapy, less than a quarter of patients survive.
• If the cancer of the sigmoid colon is limited only to the boundaries of its mucous membrane, after the operation of resection of tumor tissues, the five-year survival rate is at least 98%.

Since sigmoid colon cancer is one of the least aggressive and most benign forms of malignant neoplasms, with timely seeking medical help, patients have very high chances of a complete cure.

Dietary nutrition for sigmoid colon cancer

The postoperative diet is of great importance in the treatment of sigmoid colon cancer. During the first day, the patient is shown fasting (his nutrition is carried out by intravenous administration of nutrient solutions containing amino acids and glucose).

For six days after surgery, any solid food is contraindicated for the patient. His diet should consist of juices, broths, thin cereals, vegetable purees and herbal decoctions, and after mandatory agreement with the doctor.

Ten days after the operation, the patient's diet is diversified with lean meats, fish and sour-milk products. The ideal ratio of nutrients in a therapeutic diet is 50% carbohydrates, 40% proteins, and only 10% fats.

The patient should completely stop using:

• fatty meats and fish;
• fried foods;
• pickles, marinades and canned food;
• sausages and smoked products;
• sweets, chocolate and sweets;
• coffee, strong tea, alcoholic and carbonated drinks;
• eggs, cheese and whole milk;
• freshly baked bread;
• vegetables containing coarse fiber;
• legume crops.

The methods of culinary processing of products intended for the nutrition of a person who has undergone colon surgery should be boiling and steaming. Portions should be small. Eating should be at least five times a day.

Very useful vegetables, cereals, dairy products, lean fish and meat, fruits, biscuits, dried bread, crackers.

The video shows sigmoid colon cancer using a colonoscopy:

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

The sigmoid colon is the final segment of the colon. It got its name from its S-shape. The sigmoid colon (sigma) has a length of 50-55 cm, is located in the left iliac region above the entrance to the small pelvis, borders on the loops of the small intestine, bladder, uterus in women and prostate in men. The sigmoid colon passes directly into the rectum. It is supplied with blood by a branch of the inferior mesenteric artery, covered by the peritoneum, and has a mesentery.

Diseases of the sigmoid colon occupy a leading place in the structure of the incidence of the large intestine. The rectum and sigmoid colon account for up to 70% of all cases of bowel cancer. In addition to tumors, there are a number of diseases of the sigmoid colon, in which the main method of treatment is surgery.

In what cases are operations on the sigmoid colon indicated?

Types of operations on the sigmoid colon

By type:

By scope of intervention:

1. typical resection. Such an operation provides for the minimum possible removal of part of the intestine for this pathology. The most commonly used distal resection or segmental resection of the sigmoid colon.
2. Combined resection - when the tumor grows into a neighboring organ, not only the intestine is removed, but also another organ.
3. Extended resection. It is used in the advanced stages of cancer with spread. For example, with stage 3 cancer, sigma is carried out or even.

The nature of the operation can be:

• Emergency (with the development of intestinal perforation), are carried out in the first 2 hours after admission.
• Urgent (with intestinal obstruction). They are carried out with the failure of conservative measures within 6-10 hours.
• Planned. Conducted after careful examination and preparation.

According to the purpose of the intervention:

1. Radical. The ultimate goal of the operation is the complete removal of the tumor and the cure of the patient.
2. Palliative - if it is impossible to remove the tumor, conditions are created to alleviate the condition (most often this is the elimination of intestinal obstruction).

By type of restoration of intestinal continuity:

• With the restoration of the natural passage of feces by creating an inter-intestinal anastomosis.
• With the formation of an unnatural anus (colostomy).

By type of access:

1. laparotomy operation.
2. Laparoscopic resection.

Preparation for operations on the sigmoid colon

Almost all reasons for operations on the sigmoid colon are vital indications (this is either cancer or life-threatening complications). Therefore, contraindications for this operation are minimal: the operation will not be performed in a severe agonizing state of the patient.

In other cases, the operation is possible after careful preparation and examination.

To clarify the diagnosis, the following examination methods are used:

• Sigmoidoscopy - examination of the rectum and sigmoid colon.
• Colonoscopy is an endoscopic examination of the large intestine with a biopsy from suspicious areas.
• Survey radiography of the abdominal cavity - with suspicion of intestinal obstruction.
• Irrigoscopy - X-ray contrast study of the colon. It is carried out with contraindications to fibrocolonoscopy or as an addition to it.

During planned operations, a general standard examination is prescribed, which is carried out on an outpatient basis:

1. Complete blood count with platelet count.
2. plasma electrolytes.
3. Biochemical indicators - sugar, total protein, creatinine, urea, liver enzymes, amylase.
4. Coagulation indicators - fibrinogen, prothrombin, APTT, INR.
5. Chest X-ray.
6. Electrocardiography.
7. Therapist's review.
8. In patients with chronic lung diseases - the determination of blood gases, the study of the function of external respiration.
9. Patients with concomitant chronic diseases should be examined by specialists - a cardiologist, endocrinologist, bronchopulmonologist, additional examinations are carried out according to their prescriptions.

Bowel cleansing

Before operations on the intestines, it is very important to clean it well of the contents. There are several ways:

Lavage is contraindicated in cases of suspected bowel perforation, intestinal obstruction, bleeding, and severe heart failure.

No food is allowed 6-8 hours before the operation.

In a severe general condition, it is recommended to postpone surgical treatment if possible for preoperative preparation in a hospital setting. Such patients undergo correction of vital body functions (transfusion of blood, plasma, protein hydrolysates, saline solutions, correction of hypoxia, heart failure, etc.)

One hour before the skin incision, twice the average dose of antibiotic is administered.

Preparing for emergency surgery

Quite often, situations arise when a patient is admitted to the hospital with complications (intestinal obstruction, bleeding, peritonitis). These are all indications for urgent surgical intervention, the diagnosis in such a patient is established only on the operating table, and there is very little time to prepare for the operation - several hours.

The main activities in preparation for an urgent operation:

1. Installation of a nasogastric tube into the stomach to unload the upper gastrointestinal tract.
2. Placement of a catheter in a central vein.
3. Anti-shock measures (transfusion of blood, plasma, saline solutions, colloidal solutions).
4. Cleansing or siphon enemas (if there are no contraindications).
5. Bladder catheterization.

Basic principles of surgery on the sigmoid colon

The principles of surgery on this part of the intestine do not differ from the principles of operations on any part of the colon:

• Ablasticity. This principle involves careful handling of the area of ​​the intestine affected by the tumor in order to prevent cancer cells from entering the bloodstream and neighboring organs. This is achieved by early ligation of the vessels, by not touching the tumor, by mobilizing the intestine in an acute way.
• Asepsis. These are all sterility measures used during operations on the intestines, proper preparation of the intestines, the mandatory prescription of antibiotics already before the operation.
• Radicalism. The tumor of the intestine should be removed as much as possible within healthy tissues along with regional lymph nodes, the abdominal cavity is carefully examined for the presence of metastases. At the slightest doubt about the prevalence of the tumor, the choice is made for maximum resection.
• Restoration of intestinal patency. If possible, the natural passage through the intestines to the anus is restored. If it is impossible to do this at once, you can postpone this stage of the operation.

Resection of the sigmoid colon, the course of the operation

Resection is the most common type of surgery on the sigmoid colon. There are two types of resection:

1. Distal resection - when 2/3 of the length of the sigmoid colon and the upper ampulla of the rectum are removed.
2. Segmental resection - up to 1/3 of the sigmoid colon is removed, only the affected area.

The choice of resection volume is determined by the degree and prevalence of pathology. For example, with cancer of 1-2 degrees, located in the middle third of the intestine, it is quite acceptable to perform a segmental resection. If the tumor is located closer to the rectum, a distal resection is performed. For grade 3 cancer, it is more radical to perform a left-sided hemicolectomy.

Operation steps:

The operation time is 2-3 hours.

Operation Hartmann

operation Hartmann

The Hartmann operation (obstructive resection of the sigmoid colon with the formation of a single-barrel colostomy) is used in debilitated, elderly patients with malignant tumors of the sigmoid colon or cancer of the upper rectum.

Access is the lower median incision. The resected section of the intestine is mobilized, it is crossed between the clamps. The discharge end of the intestine is sutured, and the proximal end is brought out through a separate incision in the left iliac region and sutured to the skin.

Some time after the first stage, it is possible to remove the colostomy and form a colorectal anastomosis.

The formation of a colostomy to remove feces is also carried out as a palliative method in patients in whom it is not possible to radically remove the tumor (when the tumor grows into neighboring organs).

Laparoscopic resection of the sigmoid colon

Intestinal resection not by traditional open access, but by laparoscopic method is quite widespread.

Benefits of laparoscopic surgery:

1. Slight trauma: instead of a large incision, three to five small punctures are used, which, after healing, leave almost no marks on the skin (additional cosmetic effect).
2. Several times lower blood loss.
3. Virtually no postoperative pain.
4. There is no need for prolonged bed rest, which reduces the risk of thromboembolic complications.
5. Short rehabilitation period.
6. The risk of developing postoperative adhesions and hernias is almost minimized.

Preparation for laparoscopic resection is the same as for open surgery. The operation is performed under general anesthesia. The steps are almost the same as for open access. The formation of the anastomosis is carried out by a stapler inserted into the rectum.

Laparoscopic resection can be performed for benign neoplasms, diverticulosis, and cancer in stages 1-2. Surgeons are always ready for the transition of such an operation to an open stage.

Laparoscopic surgery can also be performed to restore intestinal continuity some time after the formation of the colostomy.

Disadvantages of laparoscopic resection:

• It requires the use of expensive equipment and a specially trained surgeon, which significantly increases the cost of the operation.
• Laparoscopic resection lasts 1.5 times longer than conventional laparotomy surgery.
• Surgeons are reluctant to go for laparoscopic resection for cancer, when a thorough revision of the abdominal cavity is required.

Postoperative period

After laparotomy, the patient is transferred to the intensive care unit. Bed rest, parenteral nutrition (nutrient solutions are administered intravenously) are prescribed for several days.

Painkillers and antibiotics are prescribed.

Drinking is allowed the next day (still water, decoctions of dried fruits without sugar). Gradually, the diet expands: first, liquid food, mashed potatoes, liquid cereals, kissels are allowed. Then sour-milk products, protein omelettes, boiled meat, baked apples, boiled vegetables, cottage cheese are added to the diet.

Food should not be salty, peppery. Meals are provided in small portions 6-8 times a day.

Drainage is removed for 3-4 days. The sutures are removed on the 6th - 8th day. Discharge from the hospital is usually carried out after 13 - 15 days. Recovery occurs in 1.5 - 2 months after the operation.

After laparoscopic resection, you can get up and walk the very next day, discharge is possible after 5-7 days.

Within 2-3 months it is necessary to follow a diet with a minimum content of toxins. Coarse plant foods, legumes, rye bread, muffins, carbonated drinks, whole milk are excluded.

Dilution of feces is achieved by taking a sufficient amount of liquid or lactulose preparations (duphalac).

Possible complications after operations on the sigmoid colon

1. Bleeding.
2. Damage to the left ureter.
3. Failure of the anastomotic sutures.
4. Infectious complications - peritonitis, sepsis.
5. Thrombophlebitis of the veins of the lower extremities.
6. Paralytic intestinal obstruction.
7. Urinary retention.
8. Adhesive disease.
9. Postoperative hernias.

Intestinal resection is divided into several types - an operation by the Hartmann or Mikulich method in case of intestinal volvulus with gangrene, in cancer, a specific intestinal part is removed. Before surgery, the patient must follow the procedure for preparing for surgery. This helps to eliminate negative consequences after resection of the sigmoid colon.

What it is?

Resection is the removal of part of an organ. In case of pathologies of the gastrointestinal tract, for certain medical indications, a section of the sigmoid colon is subject to removal. The choice of a specific removal method is determined by the characteristics of the pathology itself. For laparoscopic surgery, specialized medical equipment is used - a laparoscope. When using a laparoscope, several small incisions are made in the umbilical region for the introduction of surgical details. Unlike open surgery, the laparoscopic method is more gentle and less traumatic.

Ways to do it

There are 2 methods that are used to perform resection of the sigmoid colon - laparoscopic resection and open surgery. Laparoscopy is performed intracorporeally. The disadvantage of technology is its cost and technological complexity. An open resection is performed in case of severe damage to the sigmoid colon or the presence of a tumor on its walls, to remove which it is necessary to remove part of the wall itself. Volvulus of the intestine with developing gangrene also requires the immediate removal of part of the intestine with its subsequent restoration.

Indications for carrying out

Resection of the sigmoid colon is prescribed for a developing tumor at an early stage, progressive polyposis, the presence of large benign tumors, which can lead to serious complications in the future. Always in case of violation of innervation, which causes an increase in the volume of the intestine and chronic ulcerative lesions of the mucous membranes of the intestinal walls, a resection is prescribed. In the event of an injury in which the abdomen and its organs are damaged, there is often an urgent need for resection of the sigmoid colon.

Preparation for resection of the sigmoid colon

Before the day of the resection, the patient must be prepared. It is mandatory to completely clean the intestines to exclude the possibility of infection during the resection. This will avoid further postoperative complications, as the large intestine contains a large number of bacteria that can cause inflammation. For cleansing use laxatives, enemas. The method is chosen for each client individually, laxatives are prescribed in such a proportion that their intake does not cause diarrhea. The preparation period can last all day.

A few days before the operation, you need to follow a special diet - do not eat solid and hard to digest food. You can eat liquid dishes - soups, milk porridge.

Before resection of the sigma, the doctor always prescribes the necessary medications. These include blood pressure medications, diuretics, and inhibitors. These drugs contribute to the normalization of blood pressure during surgery, reduce the risk of heart complications, and help to remove fluid from the operation. A few weeks before surgery, you should stop taking anti-inflammatory drugs (Aspirin, Nurofen, Ibuprofen). Their action is aimed at changing the functioning of platelets, which can affect blood clotting. The intake of dietary supplements and vitamins should be discussed with the attending physician, it is better to exclude them for a certain period before resection of the sigmoid colon. For 4-5 days before the operation, you need to follow a diet.

Before resection of the sigmoid colon, the patient is examined by an anesthesiologist. The anesthesiologist assesses the general condition of the patient, which affects the appointment of anesthesia. During the preparation of the intestine for resection, no food should be taken, and after midnight before the operation, it is forbidden to drink water and other liquids.

Technique of resection of the sigmoid colon

The course of the operation depends on the nature of the pathology. If a volvulus of the sigmoid colon occurred, which provoked the development of gangrene, an operation according to Hartmann or Mikulich is prescribed. The operation using the Hartmann method involves the removal of the dead part of the sigma with further stitching of the distal end and the withdrawal of the through hole. This method is most often performed in weak and elderly patients. The Mikulich method is performed in 2 stages as follows:

• after removing a part of the sigmoid colon, its ends are sutured for 5 centimeters, after which they are sewn into the wall of the peritoneum under the guise of a double-barreled gun;
• after 3.5 months, the intestinal fistula is closed.

Methods of resection of the sigmoid colon directly depend on the nature of the pathology.

If oncology is detected, the tumor of which is located in the middle third of the sigma, the entire sigmoid colon is removed. Resection according to the Grekov method is divided into 2 stages (loop removal and anastomosis). With the development of oncology at the 2nd stage, left-sided ulcerative colitis, diverdiculitis, malignant polyposis of the sigmoid colon, a left-sided removal of half of the intestine is performed. Intestinal polyps are treated by resection of the damaged part of the sigmoid colon with further suturing of the remaining area.

Postoperative period

After resection of the sigmoid colon, you must follow a strict diet, exclude physical activity and stressful situations. Semi-finished products are contraindicated for use, it is advisable to cook food using a slow cooker or steamed. Improper nutrition can cause intoxication of the body or an inflammatory process in the first days after surgery, so during the first week of rehabilitation, the diet should consist only of liquid food, vegetable puree, light low-fat broth and porridge. Over time, solid foods are included in the diet. Nutrition should be designed so that the body receives enough vitamins and minerals necessary for recovery.

For the first time after resection, it is strictly forbidden to eat canned foods, smoked and fried foods, alcohol.

10 days after resection, you can eat eggs, lean meat, fish, lean sour cream. After 1 month, the patient's diet can consist of ordinary meals. The main thing is that the food is well chopped. With the optimal selection of nutrition, the digestive system smoothly performs its function. Food should be easy to digest and not cause heaviness during digestion. Do not eat, which causes indigestion and diarrhea.

Contraindications

Usually contraindications are those factors that cause complications in the process of mobilization of the sigmoid colon and create difficulties in identifying the organs that surround the intestine and vessels. Contraindication for resection will be severe obesity, large tumor size. Adhesive processes in the intestines or a recent operation sometimes make it impossible to carry out a resection.

Possible consequences and prognosis

As a consequence of the operation, there is a risk of internal bleeding due to poor ligation of the vessels. Negative consequences occur in cases where improper preparation for surgery and poor bowel cleansing are carried out, due to impaired tightness of the stitches applied during the closure of the stump. If the drainage of the peritoneum was carried out unprofessionally, this may lead to difficulties in rehabilitation. As a consequence of the operation, sometimes intestinal adhesions occur, which leads to obstruction of the intestinal contents. The prognosis is favorable in most cases. The lethal outcome of the operation is almost zero, with oncological diseases, relapses usually do not occur. The main rule of a successful operation and further recovery is the correct preparation for the operation and its professional conduct.

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Operation on the sigmoid colon (resection)

An operation on the sigmoid colon (resection) involves the removal of this part of the colonic intestine with the development of inflammatory processes in the mucosa or tumor-like formations in it. Usually such an operation is carried out as planned, but there are also emergency cases (for example, with a mechanical injury to the abdomen). The intervention is considered quite difficult, especially when it comes to a malignant tumor.

Where is the sigmoid colon

The length of the human intestine is 4 meters, and the sigmoid colon occupies about an eighth of it (about a cm). It is located on the border of the abdominal cavity and small pelvis, and more specifically, in the left iliac fossa. Next to it is the uterus (in women) or the bladder (in men). The proximity to these organs makes resection technically difficult, because the surgeon must act professionally and extremely carefully.

It is interesting! The shape of the sigmoid colon resembles the Greek letter "sigma" (almost like the English S, but less curved), hence its name.

This arrangement of the sigmoid colon makes it easy to palpate for the preliminary diagnosis of diseases. It is necessary to put 4 fingers of one hand on the left iliac region, slightly bending them. Then the patient should take a breath, and the doctor at this time forms a skin fold with his fingers. The patient exhales and the doctor gently presses on the abdomen to reach the posterior wall of the peritoneum. If you slide your fingers over it, you can feel the sigmoid colon.

By palpation, several indicators can be determined at once: the thickness of the intestine, its approximate consistency (thick or liquid), surface texture, intensity of peristalsis. The patient also reports pain on pressure and rolling.

In the normal state, the sigmoid colon is dense, does not growl and has a thickness of about 2.5 cm. It can be mobile. If the doctor feels a tumor, excessive density, or the patient complains of pain even with light pressure, additional diagnostic methods are used. The patient is sent to donate feces and blood for analysis, he is prescribed sigmoidoscopy and (or) radiography and (or) irrigoscopy. Women are additionally sent to a gynecologist, because many female diseases have symptoms similar to pathologies of the sigmoid colon.

Indications for resection of the sigmoid colon

What problems can arise with this part of the intestine? What could happen that would require surgery? Really it is impossible to recover conservatively? It is possible, but only if it is sigmoiditis - inflammation of the sigmoid colon. This disease is characterized by a pronounced pain syndrome, impaired stool and a general deterioration in well-being (weakness, high fever, sometimes fever).

But sigmoiditis is not the case when the patient needs a resection. Inflammation is treated with antibiotics and diet therapy (table No. 4). In rare situations, it is necessary to carry out plastic surgery of the vessels that feed the large intestine. The operation is necessary for more severe pathologies of the sigmoid colon.

• The presence of tumors (benign or malignant). They can be manifested by intestinal obstruction and severe heaviness in it, constipation. If the patient delays with this and does not go to the doctor until he loses consciousness, an emergency resection is performed.
• diverticular disease. Diverticula are called sac-like processes on the intestinal walls, which are often localized precisely in the sigmoid colon. If there are few of them, and they are small, the disease may be asymptomatic, and the person will not even know about it. With an increasing number and size of diverticula, surgery on the sigmoid colon is necessary. Otherwise, the growths can burst and cause intestinal bleeding with further complications.
• The presence of polyps with suspicion of their cancerous nature.
• Volvulus of the sigmoid colon. This is a congenital pathology that can manifest itself at any time in life. An immediate resection is required.
• Other causes of intestinal obstruction (the presence of dense fecal stones or foreign bodies).

It is the sigmoid colon that accounts for almost 70% of bowel cancer cases. Therefore, this organ is often subject to complete resection.

How is a resection done?

If the operation is planned, then the patient is previously placed in the hospital for all necessary examinations. On the eve of the intervention, he will have to follow a special diet, which includes only liquid and grated meals in small quantities. This will allow you not to burden the intestines. Also, doctors prescribe a "medicated diet", which excludes drugs that affect blood clotting.

On the morning of the operation, the patient is given a cleansing enema. Then he is taken to the operating room, where he is given general anesthesia. The resection technique will depend on the type of pathology of the sigmoid colon.

Classic laparoscopic resection

One of the most popular methods of operating on the sigmoid colon without malignant tumors. It is characterized by minimal trauma and low blood loss, quick rehabilitation and no pain in the suture area. Everything that happens inside the abdominal cavity is displayed on the screen, so the entire operation team can control the progress of the operation.

Open resection

Or a laparotomy. It is performed for cancerous tumors. The doctor can not only fully visualize the intra-abdominal space, but also prevent the spread of metastases right during the intervention, quickly separating the affected area of ​​the sigmoid colon. The operation is complex and requires a long and difficult recovery. After it, it is necessary to install a temporary drainage and colostomy.

Operation according to Hartmann or Mikulich

It is carried out for weak or elderly patients with intestinal volvulus. There is only one principle: the dead section of the sigmoid colon is removed, then the stumps are partially sutured and removed in the form of a temporary colostomy into the peritoneal cavity (outside). After a few months, the colostomy is closed (a colostomy is performed).

Possible complications after resection

Like any operation, resection of the sigmoid colon involves the presence of complications. No one is immune from them, although, of course, the medical team is trying to minimize the risks. The patient himself should also strive for this and follow all the doctor's instructions.

Of the most frequent complications, intestinal bleeding is distinguished. Older people suffer more from them because of the deterioration of tissues. Although, the human factor can also play a role in this: if imperfect sutures are applied. Also, due to damage to the left ureter, the patient may experience pain during urination or urinary retention. Infectious complications (especially after laparotomy) are not excluded. And if a person lies for a long time, and his legs are not bandaged, then thrombophlebitis develops.

Features of nutrition after resection of the sigmoid colon

The main function of the sigmoid colon in the body is to suck out moisture from the feces and give them a solid consistency. When a person is deprived of this part of the intestine, it turns out that the feces will be liquid and almost uncontrollable. Moreover, it will come out through a colostomy - the withdrawal of the intestinal stump through the abdominal cavity. This causes some inconvenience, so a person must radically change his diet after surgery on the sigmoid colon.

Eating in the late period of rehabilitation will also have to be limited. The patient is prescribed a diet with a minimum content of toxins. And, therefore, no fried, very fatty, smoked, as well as spicy and spicy. It is not recommended to eat rough plant foods, legumes, muffins, soda and whole milk to prevent gas formation.

Resection of the sigmoid colon - causes, indications, prognosis and consequences

The most common colon surgery in abdominal surgery, after appendectomy and rectal surgery. This operation belongs to the category of both planned and emergency. Emergency are carried out in about 80% of cases.

Patients are admitted to a medical institution with a clinic of intestinal obstruction due to volvulus of the sigmoid colon, or obstruction by a tumor, or a clinic of intestinal bleeding (tumor ulceration, or bleeding from polyps), abdominal injuries with extensive damage to the sigmoid colon (gunshot wounds, explosive trauma, blunt abdominal injury). In 20% of the disease are detected during routine examinations. The surgeon takes the tactics and the choice of the volume of surgical intervention directly during the operation and it depends on the disease, the spread and localization of the process, the condition and age of the patient.

Reasons for resection of the sigmoid colon

Tumor obstruction, necrosis, perforation, massive bleeding from ulcers or polyps, extensive damage to the intestine.

Indications for resection of the sigmoid colon: Dolichosigma (Megosigma) with recurrent volvulus, polyps with malignancy, polyposis with recurrent bleeding, cancer stage 1-2A, complicated diverticulitis, ulcerative colitis with recurrent bleeding, extensive trauma.

Tactics for choosing the volume and method of operation

1. When the sigma is twisted with gangrene, the Hartmann or Mikulich operation is performed. During the Hartmann operation, a resection of the non-viable section of the sigma is performed with suturing of its distal end and removal of the unnatural anal opening. It is used in debilitated and elderly patients.

Mikulich's operation involves resection of the sigma. The adductor and efferent ends of the intestine are sutured together for 4-5 cm, then sewn into the abdominal wall in the form of a double-barrel. At the second stage, after 3-3.5 months, the intestinal fistula closes.

2. Cancer of the sigmoid colon: In the presence of a tumor in the middle third of the intestine, the entire sigmoid colon is removed in a single block with the surrounding tissue and lymph nodes. Also read about stage 4 bowel cancer.

3. Two-stage resection of the colon according to the Grekov method. It is carried out in 2 stages. A - a combination of external and internal removal of intestinal contents. (removal of a loop with a tumor with the imposition of an anastomosis side to side)

4. Left-sided hemicolectomy: indications - cancer stage 2B-3, left-sided ulcerative colitis, diverticulitis with complications, malignancy of polyposis of the colon and sigmoid colon. Many do not know how to treat polyps in the intestines correctly.

With these indications, a B-resection of the area of ​​the damaged excreted intestine is performed, the stump is tightly sutured.

Complications after surgical treatment

1 - intra-abdominal bleeding, usually from poorly bandaged vessels, eruption of ligatures.

2- The development of peritonitis due to inadequate sanitation of the abdominal cavity, insolvency of the sutures of the anastomoses, incomplete tightness of the sutures when closing the stumps and anastomoses.

3- Inadequate drainage of the abdominal cavity.

4- Early adhesive intestinal obstruction.

5- Interloop abscesses.

Adhesive disease, adhesive intestinal obstruction.

Forecast

As a rule, favorable, Violations of the water-electrolyte balance are not noted in the literature, Cancer recurrences are rare, the survival rate of patients after resection of the sigmoid colon is %. After planned surgical treatment, after preparing the patient for surgical treatment, the percentage of postoperative complications is minimized, the postoperative period proceeds more smoothly.

Consequences of ovarian resection

Resection (from Latin resectio - I cut) the ovary is an operation that consists in the partial excision of the affected organ.

Thyroid resection

What is a resection?

Surgical removal of a diseased thyroid gland or part of it is called thyroid resection.

Atypical lung resection

Surgical operations on the lungs are performed to remove lung tissue that has been altered by irreversible disease processes. Some lung diseases cannot be cured otherwise than by physically removing the focus of inflammation or tumor degeneration of the parenchyma and its surrounding structures. Highly qualified specialists are engaged in this work - thoracic surgeons, and the section of thoracic surgery is called "thoracic surgery".

Submucosal resection of the nasal septum

Submucosal resection of the nasal septum (syn. septoplasty) is a surgical intervention, the purpose of which is to correct the shape of the deformed nasal septum while preserving its cartilage and bone base.

Colon cancer stage 4

Depending on the localization, cancer of the small and large intestine is distinguished. Therefore, in the topic of stage 4 bowel cancer, they can be considered separately. The length of the small intestine is 80% of the length of the entire intestine, but the incidence of tumors in this area is very small: benign neoplasms - 3-5%, malignant - 1%.

How to cleanse the intestines without an enema

The whole life of a modern person, with all its stresses, malnutrition, bad water that we drink and bad air that we breathe, leads to the fact that even children already have chronic diseases.

Rumbling in the intestines

Rumbling in the intestines is most often associated with such a well-known condition as flatulence - that is, bloating, which appears due to excessive accumulation of gases in the intestines. A moderate accumulation of gases in the stomach is even necessary, as this contributes to the movement of food in the intestines and, accordingly, for the normal functioning of the stomach.

Bleeding from the anus

The appearance of blood from the anus can be both a symptom of diseases that do not threaten a person’s life, or a sign of very serious diseases in which one should not hesitate to consult a doctor, as this can be of vital importance. Bleeding from the anus during a bowel movement or independently of it is a symptom of a pathological process, most often occurring in the large intestine or near the anus.

Features of the early period after operations on the intestines

The reason for surgical intervention on the intestine can be various factors, including the formation of cancerous tumors, fistula, inflammatory processes, mechanical damage to the intestine (gunshot wounds, ruptures due to blows) and many different diseases that are not amenable to therapeutic treatment. In order to avoid all sorts of complications, a sparing diet after intestinal surgery and rehabilitation therapy is necessary.

Features of operations performed on various parts of the intestine

It is known that most human diseases directly depend on the state of the intestine. A variety of failures in its work can lead to such consequences as bloating, the presence of pain, the appearance of shortness of breath and the complication of the functioning of the respiratory system.

Surgical intervention is resorted to only if various methods of treatment do not bring positive results. When performing a number of operations, such as hemicolectomy (partial removal of the colon), excision of a fistula, treatment of purulent peritonitis, and others, there is a high probability that the contents of the intestine will enter the operation area and become heavily contaminated.

This fact can lead to infection of the intestinal section, which can manifest itself in the form of inflammation in the early postoperative period. In this regard, it is carefully cleaned and isolated using a special tool. Most often, the following types of operations are performed on the intestines:

• treatment of mechanical injuries and injuries of the abdominal cavity
• treatment of the infected part of the intestine
• elimination of breakthrough ulcers of the stomach (duodenum) and fistula (rectum, sigmoid colon) to prevent their contents from entering the abdominal cavity
• stitching of intestinal wounds
• resection (removal) of various intestinal sections
• opening of the abdominal cavity to remove foreign bodies

Period after bowel resection

Resection (removal) of any part of the intestinal section is prescribed in extreme cases. It may be prescribed when a cancerous tumor occurs, for example, the sigmoid or colon. In this case, the damaged area is removed, and the free intestinal ends are sutured. If this is not possible, then a colostomy is used - a surgical intervention using an external fistula, which is brought out (a colostomy bag is articulated with it for artificial defecation). After some time, this defect is eliminated by a second operation to restore the work of the intestinal section.

A gentle effect on the abdominal organs is exerted by intestinal laparoscopy, in which a special tube with a camera and instruments is inserted into the intestinal cavity through a small incision in the skin of the abdomen. This surgical procedure is considered less traumatic, while the patient is discharged in some cases on the 3rd-4th day, which is almost 2 times faster than with an open type of intervention in the abdominal cavity. In addition, the postoperative period passes almost without complications, but it is recommended to refrain from physical activity in the first 1-1.5 months.

Fistula of the rectum: after surgery

Treatment of a fistula in the rectum can be carried out both surgically and conservatively. The latter implies antiseptic treatment (washing), the use of sitting baths, as well as exposure to the fistula with antibiotics. However, in most cases, such procedures do not bring the desired therapeutic effect, so they often resort to a surgical method of treatment.

Fistula of the rectum

There are many methods of surgical treatment, but they all involve dissection of the fistula. Often, surgery is accompanied by opening the inflamed area with further drainage of the cavities in which pus has accumulated. The wound surface around the excised fistula heals within a week.

In the first days of postoperative time, minor bleeding may occur. Less often - relapses of the disease, which are eliminated by repeated surgical intervention. In most cases, recovery occurs fairly quickly.

Tip: In the first days after the surgical treatment, a balanced and proper diet is of great importance, which will help to achieve a soft bowel movement and avoid constipation.

• eat fractionally during the day (5-6 times) in small portions
• do not eat fried foods, smoked meats and pickles
• eat cereals, foods rich in vegetable fiber
• consume dairy products
• drink at least 1.5 liters of water
• eliminate carbonated water from the diet

With a sharp increase in temperature, pain during bowel movements, the appearance of blood or pus during emptying, the patient should urgently contact a treating specialist.

Operations on the sigmoid colon

Tumor of the sigmoid colon

A common cause of surgical treatment of the sigmoid colon is the occurrence of polyps, fistulas and cancer. Treatment of a cancerous tumor is performed surgically with the peranal introduction of special equipment (sigmoidoscope). Surgery of this intestinal section implies a dissection of the corresponding part of the abdominal wall, after which doctors remove the tumor, as well as part of the damaged intestinal tissues.

In the presence of metastases that have penetrated the lymph nodes, they are disposed of. In more severe cases (stage 3), chemotherapy is used before surgery. Its main purpose is to inhibit the growth rate of malignant tumors.

Advice: a patient with a cancerous tumor must adhere to a therapeutic diet that allows you to support the body, especially if you need to use chemotherapy. Dishes in the diet should be boiled or steamed. You can use lean beef, chicken, fish, vegetables and various cereals. Patients can be given dairy dishes, rye crackers and biscuits.

How to restore the efficiency of the operated intestine and its microflora

Surgical intervention in the intestinal sections requires further restoration of their performance. First of all, the correct functioning of peristalsis (the promotion of food masses in the intestinal cavity) must be restored, the emerging dysbacteriosis as a result of taking antibiotics by the patient, which destroy most of the beneficial bacteria, and the prevention of possible postoperative complications should be prevented.

Surgical patients in the first days after the end of the resection are prohibited from drinking and eating. In this regard, nutrients enter the body intravenously. Usually on the 3rd day it is allowed to take liquid protein foods in small doses and drink water. Gradually, chicken meat, fish products, mashed cottage cheese and boiled eggs are included in the patient's diet. Compliance with the diet plays an important role, as it significantly reduces the risk of various inflammatory processes.

In order to restore the intestinal microflora as quickly as possible, doctors recommend using foods that are rich in vegetable fiber, eat fresh fruits (necessarily unsweetened), consume dairy products, and also eat vegetables and cereals.

You can not eat meat products (except poultry, fish), sweets, drink coffee, eat pastries and white bread, and it is strictly forbidden to drink alcohol. Garlic and onion juice in small amounts are beneficial for the restoration of healthy intestinal flora (to avoid irritation of the mucous membrane).

Sigmoid colon cancer accounts for almost a third of all cases of malignant epithelial neoplasms of the large intestine. Usually the disease is detected at the age of 40-60 years, somewhat more often in men.

At first, the tumor does not give any characteristic symptoms, so its timely detection can be difficult. As cancer grows, its cells spread to all layers of the intestinal wall, move through the blood and lymphatic vessels to the lymph nodes and internal organs.

tumor in the sigmoid colon

Sigmoid colon cancer is one of those types of cancer that can be successfully treated if detected early. In this regard, a timely visit to the doctor in the presence of any changes in the intestine acquires special meaning. In a number of states, diagnostic colonoscopy is recommended as a screening method for detecting cancer, since the number of patients with such a diagnosis is growing from year to year, and along with morbidity, mortality also increases.

In industrialized countries, the number of patients is so large that colon cancer has become the leader in terms of prevalence, giving way only to, and. In Russia, bowel cancer ranks fourth among women and third among the male population, and in the United States, fifty thousand people die from the disease every year. These figures are frightening and require special vigilance not only on the part of doctors, but also on the part of potential patients of oncology clinics.

Causes and stages of sigmoid colon cancer

It is usually difficult to establish a specific cause of neoplasia, since there is a combined effect of environmental factors, heredity, and lifestyle. In relation to neoplasms of the intestine, by right, the main place belongs to the nature of nutrition and the associated features of the stool. The causes of colon cancer are equally applicable to the sigmoid, but this organ is more prone to tumors for a number of reasons:

• Longer time of contact of the mucosa with the contents of the intestine;
• More dense feces that injure the intestinal wall;
• High incidence of inflammatory and precancerous changes in the sigmoid colon.

The main causes of sigmoid colon cancer are:

1. Constipation;
2. Physical inactivity, lack of physical activity and a sedentary lifestyle;
3. Abuse of products containing carcinogens (smoked meats, fried and fatty foods, animal fats, sweets, etc.), and alcohol;
4. Chronic sigmoiditis,;
5. hereditary factor.

The stages of the tumor are determined by its size, the degree of damage to the intestinal wall, the presence of immediate or distant metastases:

• Stage 1, when the tumor does not exceed 2 cm, does not grow into the muscular layer of the intestinal wall and does not metastasize, is considered the most favorable;
• Stage 2 of the disease is accompanied by a further increase in the size of the tumor node, which occupies up to half the circumference of the intestine, it is possible to identify single metastases in local lymph nodes (stage 2B);
• Stage 3 neoplasia is characterized by the appearance of local metastasis, and the cancer goes beyond the boundaries of half the circumference of the sigmoid colon;
• Stage 4 is the most unfavorable, in which it is possible to detect distant metastases, the germination of surrounding tissues and neighboring organs, the development of complications - fistulas, peritonitis, etc.

Depending on the characteristics of growth, in the sigmoid colon there are exophytic neoplasia protruding into the intestinal lumen, and endophytic, growing infiltratively in the wall of the organ, leading to its significant narrowing. Cancer of this localization is especially prone to endophytic growth, so intestinal obstruction usually becomes its main complication.

Histological structure implies the isolation of adenocarcinoma, mucous cancer, undifferentiated forms.

Most often, adenocarcinoma is found in the sigmoid colon, which, with a high degree of development of tumor cells, is quite sensitive to all types of treatment, which allows achieving good results.

Manifestations of sigmoid colon cancer

In the initial stages of the disease, there may be no signs of a tumor at all, or they may be few and nonspecific. This fact often makes it impossible to detect a tumor in a timely manner if the patient himself does not undergo regular examinations.

The first symptoms of cancer can be dyspeptic disorders - bloating, rumbling in the abdomen, intermittent pain, constipation. These signs do not always force the patient to go to the doctor, especially if the latter suffers from chronic colitis for a long time and is accustomed to such disorders.

As the neoplasm grows, the clinical picture becomes more diverse and includes:

• Pain in the abdomen - localized in the left half, dull, aching or cramping and quite intense, becomes constant over time;
• Dyspeptic phenomena - belching, vomiting, nausea, rumbling, bloating;
• Stool disorders in the form of diarrhea or constipation, in the later stages and with endophytic tumor growth, constipation predominates among the symptoms;
• The presence of pathological impurities in the feces - mucus, blood, pus.

Common symptoms of sigmoid colon cancer are severe weakness, weight loss, fever, fatigue. In a number of patients, due to bleeding of the tumor, anemia develops, the skin becomes pale, and the state of fatigue and weakness worsens.

Cancer of the sigmoid colon may very much resemble an acute inflammatory process of the abdominal cavity, and with the prevalence of symptoms of dyspepsia, the disease is mistakenly mistaken for an ulcer, cholecystitis, pancreatitis, etc.

Operations on the intestines always require careful preparation of the patient, and the surgeon must adhere to the principles of oncological surgery. Ablasticity includes a set of measures aimed at preventing the spread of cancer cells during the operation, including careful handling of the intestine, early ligation of blood vessels. For the most radical treatment, it is necessary to remove a fragment of the intestine with a tumor, retreating at least 5 cm towards healthy tissues, and with a significant amount of damage, it may be necessary to remove the entire half of the colon. Excision of regional lymph nodes that collect lymph from the neoplasm growth zone minimizes the likelihood of subsequent tumor metastasis.

If the neoplasia has not yet given complications, the patient is scheduled for a planned operation, before which it is necessary to follow a slag-free diet for three to five days, during the same period laxatives and cleansing enemas are prescribed. It is possible to wash the digestive tract with special preparations (fortrans, for example). Antibiotics are indicated to prevent infectious complications.

Types of operations for cancer of the sigmoid colon:

• Distal resection;
• Segmental resection;
• Left hemicolectomy.

The first two types of operations are possible with localized forms of tumor growth and involve the excision of a portion of the sigmoid colon with a neoplasm. With the progression of the disease or a significant spread of the tumor, the removal of the entire left half of the colon (left-sided hemicolectomy) will be indicated.

An important point in the treatment of sigmoid colon cancer is the restoration of the natural passage of intestinal contents. If possible, the edges of the intestine are sutured as soon as the tumor is removed. In other cases, it is possible to create a temporary fecal fistula on the anterior abdominal wall (colostomy), which is usually sutured afterwards.

Removal of a fragment of the intestine with the restoration of the passage of feces can be carried out simultaneously or in several stages. With a general good condition of the patient and adequate preparation for surgery, if the tumor has not gone beyond the second stage and has not given complications, it is possible single operation, in which the affected area of ​​the intestine, lymph nodes and a fragment of the mesentery are excised, after which the ends of the intestine are immediately sutured and its patency restored without a colostomy.

In cases where the tumor has led to intestinal obstruction, the patient's condition is severe, and the operation is performed urgently or urgently, there is no question of a one-time intervention, since the risk of postoperative complications is high. Such patients are shown two- or three-stage interventions.

At the first stage, the affected area of ​​the intestine is removed with the formation of a colostomy (fecal fistula) on the anterior abdominal wall. Until the condition normalizes, the patient is forced to live with a colostomy, and when the condition becomes satisfactory, it is possible to restore intestinal continuity with the removal of feces in a natural way. Usually between these stages passes from two months to six months.

Three-stage operations are indicated for acute intestinal obstruction due to the closure of the intestine by a neoplasm. At the first stage, a colostomy is created to decompress the intestines and remove the contents, then the tumor and the intestine section are removed, and after the patient's condition stabilizes (the third stage), the colostomy is eliminated, and the excretion of the contents through the rectum is restored.

Palliative surgical treatment is carried out in the advanced stages of the disease, when it is no longer possible to radically get rid of the tumor, there are distant metastases, and the patient's condition does not require long-term and traumatic interventions.

As a palliative care, a colostomy is created on the anterior abdominal wall or bypass anastomoses (connections) are applied to pass the contents of the intestine bypassing the site of cancer growth.

The presence of a fecal fistula on the anterior abdominal wall requires careful skin care around such an opening, constant hygiene procedures and a diet that prevents constipation. A sparing diet is usually recommended with the exception of smoked meats, fatty and fried foods, flour and "fast" carbohydrates. If necessary, laxatives are prescribed.

The early postoperative period involves detoxification therapy, if necessary - intravenous fluid infusions. To facilitate bowel movements, vaseline oil is prescribed, from the second day it is possible to introduce light liquid food, and after the formation of a normal stool, the patient is transferred to a normal diet.

The prognosis after surgery is determined by the initial state of the patient and the stage of the disease. In the case of timely diagnosis of early forms of cancer, the 5-year survival rate reaches 90%, while only a third of patients survive in the third stage. Recurrence after surgical treatment, as a rule, is associated with insufficient radicalness of the intervention or with a violation of the surgical technique. In the absence of distant metastasis, local cancer recurrence can be treated with a second operation.

Surgical tactics in complicated forms of sigmoid colon cancer

The most common complication of a tumor growing in the sigmoid colon is bowel obstruction. It develops several times more often with this localization of the tumor than with cancer of the right half of the large intestine due to the narrower lumen of the sigmoid colon, denser contents as it approaches the anal canal. In addition, a tumor in this section often grows into the wall of the organ and leads to stenosis (narrowing) of the lumen, which further complicates the passage of feces.

Intestinal obstruction is a formidable complication, often requiring emergency surgical intervention, when there is no time to prepare the patient, therefore, there can be no talk of a one-stage operation either. Usually, the obstruction is immediately eliminated by imposing a colostomy or an intestinal anastomosis. If a patient is diagnosed with stage 4 cancer, then such an operation becomes the final treatment, since the removal of the affected intestine is no longer advisable and technically impossible.

At the initial stages of cancer, after bowel decompression and stabilization of the patient's condition, the second stage of treatment is performed - resection of the sigmoid colon or the left half of the colon. There are usually several months between stages. The Hartmann operation, proposed for the treatment of cancer of the sigmoid colon, consists in excising the tumor-affected fragment of the intestine with the creation of a colostomy, and subsequently restoring intestinal continuity.

Another formidable complication of sigmoid colon cancer can be peritonitis when perforation of the intestinal wall leads to the release of contents into the abdominal cavity with inflammation of the serous membrane. Peritonitis can be combined with intestinal obstruction. In such cases, a three-stage Zeidler-Schloffer operation can be performed. The intervention involves the creation of a sigmostoma to divert feces, then the part of the intestine with the neoplasm is removed and intestinal continuity is restored, but the sigmostoma is preserved. After 2-3 weeks, when the patient's condition returns to normal, and the stitches on the intestines heal, the surgeon eliminates the colostomy, and the intestinal contents are discharged naturally.

Chemotherapy and radiation

Chemotherapy for sigmoid colon cancer has no independent value, but is used as part of combination therapy. It is possible to use both one drug and several at once.

For monochemotherapy 5-fluorouracil is usually used, which is administered intravenously in a total dose of 4-5 grams per course, or ftorafur intravenously or orally (up to 30 grams).

Polychemotherapy involves the use of several drugs at once, the most effective against this type of tumor - 5-fluorouracil, ftorafur, vincristine, adriamycin and others. The regimen is determined by the chemotherapist. The patient may require several courses of polychemotherapy with an interval of 4 weeks.

Chemotherapy often entails a lot of side effects in the form of excruciating nausea, vomiting, severe weakness, so symptomatic therapy with the appointment of antiemetic drugs, heavy drinking, vitamin and mineral complexes are necessary for the patient.

Irradiation for cancer of the sigmoid colon is used very rarely. This is due to the low sensitivity of the tumor to radiation, as well as the risk of complications in the form of intestinal perforation at the site of neoplasm growth. Irradiation may make sense before the planned operation, since in this case it is possible to achieve a reduction in the size of the tumor, respectively, and the intervention will be safer and more effective. After removal of the cancer, radiation can be directed to the elimination of cells that may have remained in the growth zone of the neoplasm.

Prognosis for sigmoid colon cancer and its prevention

Forecast in sigmoid colon cancer favorable only at the first stage of the disease, when more than 90% of patients survive. As the cancer worsens, this rate drops to 82% in stage 2. At stage 3 of the tumor, about 55% of patients live for five years, and at the fourth - only every tenth.

Prevention of sigmoid colon cancer is possible, and the sooner it is started, the higher the likelihood of avoiding a dangerous disease. First of all, it is worth normalizing the nature of nutrition and stool. Constipation is an important risk factor for tumors, so eliminating them greatly helps prevent cancer. Reducing the proportion of meat products in favor of plant fiber, fresh vegetables and fruits can reduce the likelihood of a tumor.

Another important measure can be considered the timely treatment of inflammatory processes (sigmoiditis), intestinal polyps, diverticula (protrusions). Regular visits to the doctor, especially by patients at risk, make it possible to detect not only precancerous conditions in time, but also to diagnose the initial forms of cancer, when a stable cure for the disease is possible.

Video: Colon Cancer, Live Healthy!

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