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Laparoscopic Colon and Rectal Surgery
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
Lee E. Smith, Philip H. Gordon
Cobb et al. (180) examined the results of HAL colon surgery for benign disease in 37 patients. Indications for operation were: polyp (thirteen), uncomplicated diverticular disease (eight), complicated diverticular disease (i.e. colovesical fistula, phlegmon, etc.) (seven), chronic constipation (four), rectal prolapse (two), ulcerative colitis (one), endometriosis (one), and fecal incontinence (one). Procedures performed were sigmoidectomy (fourteen), right colectomy (nine), lower anterior resection (seven), subtotal colectomy (five), cecectomy (one), and transverse colectomy (one). There were no deaths. One case was converted to celiotomy (unable to rule out malignancy). The median operative time was 122 minutes. Return of flatus was noted (median) at postoperative day 3 and the median length of stay after operation was 4 days. One patient developed a superficial wound infection and there was one pelvic abscess (drained percutaneously) and one patient developed urinary retention. There were no reoperations.
Removal of the cecum affects intestinal fermentation, enteric bacterial community structure, and acute colitis in mice
Published in Gut Microbes, 2018
Kirsty Brown, D. Wade Abbott, Richard R. E. Uwiera, G. Douglas Inglis
The surgical procedure used to remove the cecum was described previously.8 Mice were anesthetized with isoflurane and placed in dorsal recumbency while receiving continuous anaesthetic. The abdomen was shaved and scrubbed twice with a chlorhexidine surgical solution, rinsed with 70% ethanol, and a final scrub of prepodyne solution was applied just prior to surgery. A surgical drape was placed on the abdomen and a 1.5 to 2.0 cm incision was made along the lower abdomen. The cecum was gently exteriorized, and a sterile barrier drape rinsed in phosphate buffered saline (PBS; pH 7.2) was placed under the cecum, the distal ileum, and the proximal colon. The cecum was ligated at the ileocecal junction, and the cecum was excised. Any remaining excess cecal tissue was trimmed. Care was taken to ensure that cecal contents were not released into the peritoneal cavity, and any residual ingesta on mucosal surfaces was irrigated with sterile PBS. The intestine was kept moist throughout the procedure and following the cecectomy, the intestine was returned into the abdomen cavity. The abdomen muscle layers were then closed with 4-0 or 5-0 Vicryl sutures and skin was closed with Michel suture clips (7.5mm x 1.75 mm). Clips were removed 7 to 10 days post-surgery. Each surgery lasted ≈10 min. For sham control mice, the surgical procedure described is above; the cecum was exteriorized and left outside the abdominal cavity for 2 min, and the cecum was then replaced in the peritoneal cavity and the abdomen and skin closed. During surgical induction, mice were provided meloxicam and buprenorphine subcutaneously while under general anaesthesia. A second dose of buprenorphine was administered 2 to 3 hr after surgery based on the level of discomfort exhibited by individual mice. Upon recovery from anesthesia, mice were administered a subcutaneous injection of warmed saline. Meloxicam was administered once daily to all mice for 2 days post-surgery. Mice were fed a conventional low fiber diet (Prolab RMH 3500, Canadian Lab Diets, Leduc, AB), and allowed to drink ad libitum. The surgical incision sites were monitored daily until fully healed, and animals were examined daily for changes in body temperature and behavioural manifestations of post-surgical distress.