Extended left hemicolectomy. Technique of right hemicolectomy. Repeated consultation with a gynecologist with prescription of a treatment regimen

Indications: stage 11B-III cancer, left-sided complicated ulcerative colitis, polyposis with malignancy, complicated diverticulitis, etc.

During this operation, the left third of the transverse colon, the left flexure, the descending colon and the sigmoid colon to the middle or lower third are removed (Fig. 25), with the imposition of a transversosigmoid anastomosis (incomplete left-sided hemicolectomy), more often the entire sigmoid colon is removed to the rectum ( Fig. 26) with transversorectal anastomosis or ileocoloplasty (complete left-sided hemicolectomy).

Operation: wide median laparotomy. After opening the abdominal cavity, an inspection is performed. The nature and distribution of the pathological process is clarified. The scope of the operation is outlined.

The loops of the small intestine are moved to the right and fenced off with a damp towel.

To mobilize the left half of the colon, the sigmoid colon is retracted to the midline. Using scissors, the outer layer of the peritoneum is dissected at the root of the mesentery of the sigmoid colon along the left lateral canal, extending the incision under visual control downward to the rectum and upward along the outer edge of the descending colon to the left bend (Fig. 27, a). To facilitate the dissection of the peritoneum and its detachment, a 0.25% solution of novocaine in an amount of 100-120 ml is first injected under it along its entire length.

Rice. 26. Complete left-sided hemicolectomy (the inferior mesenteric artery was ligated with a transversorectal anastomosis (diagram).

Rice. 25. Incomplete left-side hemicolectomy (the left colic and sigmoid arteries are ligated) with a transversosigmoid anastomosis (diagram).

The retroperitoneal tissue together with the mesentery is displaced with a tupper towards the intestine. In this case, at the root of the mesentery of the sigmoid colon in the retroperitoneal space, the ureter is exposed, which is retracted outward so as not to damage it during manipulation. The sigmoid colon is retracted outward, while its mesentery is slightly stretched, which makes it possible to freely dissect the internal layer of the peritoneum at the root of the mesentery of the sigmoid colon, where the inferior mesenteric artery and its branches are exposed.

In case of incomplete hemicolectomy, the inferior mesenteric artery is preserved, but is crossed between the clamps and only one or two superior sigmoid arteries (except the lower) and the left colic artery are ligated at the place of their origin from the inferior mesenteric artery (Fig. 27, b). During hemicolectomy for cancer in order to prevent hematogenous metastasis, it is advisable to first ligate the indicated vessels along their length before mobilizing the intestine. For the same purpose, especially with disintegrating cancer, it is recommended to bandage the intestine with two gauze strips 3-4 cm above and below the tumor. In case of incomplete hemicolectomy, the inferior sigmoid artery and the superior rectal artery, which supplies the upper parts of the rectum, are preserved.

With a complete hemicolectomy (see Fig. 26), the inferior mesenteric artery is crossed between clamps at the site of its origin from the aorta and ligated with two silk ligatures (b/o). The incision of the inner layer of the mesentery of the sigmoid colon is continued downwards to the rectum and upwards, onto the mesentery of the left third of the transverse colon, thereby exposing the inferior mesenteric vein, which is also crossed between the clamps and tied with silk. The next stage of the operation is the mobilization of the left flexure of the colon and the left third transverse colon. To do this, the diaphragmatic-colic ligament is crossed between the clamps and tied with silk, and then the gastrocolic ligament to the middle third of the transverse colon, preserving the vessels of the greater curvature of the stomach. When isolating the left flexure, care must be taken not to damage the vessels of the spleen and tail of the pancreas. In this regard, the transverse colon and descending colon are slightly pulled downward and inward, thereby facilitating access to the diaphragmatic-colic and gastrocolic ligaments. The greater omentum is cut off with scissors to the level of resection of the left third of the transverse colon with ligation of the vessels with 4/0 silk (for cancer of the greater omentum, the entirety of the omentum is removed) .

Rice. 27. Left-sided hemicolectomy. Stages of the operation.

a - dissection of the peritoneum of the left lateral canal, diaphragmatic-colic and part of the gastrocolic ligament with ligation of blood vessels; b - dissection of the mesentery of the sigmoid colon and part of the mesentery of the transverse colon with intersection and ligation of the left colon and sigmoid arteries and veins (the dotted line indicates the boundaries of resection):

1 - left colon artery; 2 - sigmoid artery

After mobilization of the sigmoid colon, descending colon and left flexure with the left third of the transverse colon, check the sufficiency of blood supply to the remaining upper and lower segments and, within healthy, well-supplied areas, apply intestinal clamps to the left third of the transverse colon (closer to the left flexure) and on the mobilized segment of the sigmoid colon or

rectosigmoid section (hard clamps on the part to be removed, soft clamps on the remaining ends of the intestine). The intestine is crossed between the clamps and the entire left half of the colon is removed along with the retroperitoneal tissue. The remaining ends of the transverse colon and sigmoid colon (or rectosigmoid colon) are treated with a 3% alcohol solution of iodine or a 0.02% aqueous solution of chlorhexidine. Next, the end of the transverse colon is brought down and a transversosigmoid (or transvesorectal) anastomosis is applied end to end with two rows of interrupted silk sutures according to the usual technique. After anastomosis, the edges of the mesentery are sutured and the integrity of the peritoneum of the left lateral canal is restored. In order to unload the anastomosis, a wide gas outlet tube is passed through the anus beyond the anastomosis line into the colon. For the same purpose, in case of insufficient bowel preparation or when completing the operation with ileocoloplasty, it is advisable to apply a unloading cecostomy. A drainage tube with one or two side holes is brought to the anastomosis area, which is removed through an incision in the left lumbar region and fixed to the skin. The abdominal wall wound is sutured in layers.

When tensioning the anastomosed ends of the transverse colon and rectum, in order to avoid possible divergence of the anastomosis, it is recommended to cut in parts between the clamps and ligate the gastrocolic ligament to the right bend, and, if necessary, mobilize it by crossing the hepatocolic ligament between the clamps and ligating it. However, sometimes this does not allow the transverse colon to be brought down in order to impose a direct transversorectal anastomosis (with a short, scarred or fatty mesentery, scattered vessels, pericolitis phenomena). In these cases, in order to avoid the imposition of a permanent unnatural anus, replacement of a large defect in the distal colon with a gonocolic transplant (ileocoloplasty) is indicated.

16357 0

For colon cancer, the extent of resection, depending on the location of the tumor, ranges from distal resection of the sigmoid colon to colectomy, i.e. removal of the entire colon. The most commonly performed are distal resection of the sigmoid colon, segmental resection of the sigmoid colon, left-sided hemicolectomy, resection of the transverse colon, right-sided hemicolectomy (Fig. 1), subtotal resection of the colon. These operations differ from each other in the volume of resection of the colon, the anatomy of the transected vessels and, accordingly, the removed area of lymphogenous metastasis.

Rice. 1. Scheme of resection of the large intestine for cancer of various localizations: a - resection of the sigmoid colon; b - left-sided hemicolectomy; c - right hemicolectomy; d - resection of the transverse colon.

Distal resection of the sigmoid colon consists of resection of the distal two-thirds of the sigmoid colon and the upper third of the rectum with ligation of the sigmoid and upper rectal vessels. Restoration of the colon is carried out by forming a sigmorectal anastomosis.

Segmental resection of the sigmoid colon- resection of the middle part of the sigmoid colon with ligation of the sigmoid vessels and the formation of an anastomosis.

Left hemicolectomy involves removal of the left half of the colon (sigmoid, descending and distal half of the transverse colon) with ligation and intersection of the inferior mesenteric vessels and the formation of a transversorectal anastomosis.

Transverse colon resection involves ligation and intersection of the middle colon artery at its base and the formation of an anastomosis.

Right hemicolectomy consists of removing the cecum with the distal part of the ileum (10-15 cm), the ascending colon and the proximal third of the transverse colon with ligation and intersection of the ileocolic vessels, the right colon artery and the right branch of the middle colic artery. Restoration of intestinal continuity is carried out by forming an ileotransverse anastomosis.

Subtotal colon resection- removal of the entire colon, with the exception of the most distal part of the sigmoid colon, forming an ileosigmoid anastomosis. In this case, all the main vessels supplying the colon are crossed.

If lymph nodes are affected, extended resection volumes should be performed. Thus, for cancer of the sigmoid colon of any location in these cases, left-sided hemicolectomy with ligation of the inferior mesenteric arteries and veins and the formation of a transversorectal anastomosis is indicated. For cancer of the descending section or left flexure, distal subtotal resection of the colon with ligation of the trunk of not only the inferior mesenteric vessels, but also the middle colon artery with further formation of an ascendorectal anastomosis is indicated.

In the same situation, but with a right-sided localization of the tumor, proximal subtotal resection of the colon with ligation of the ileocolic, right colic and middle colic arteries and the formation of an ileosigmoid anastomosis is indicated. When the tumor is localized in the middle third of the transverse colon and the presence of lymphatic metastases, the extent of resection should range from subtotal resection to colectomy with ileorectal anastomosis. If the tumor is located in the right or left flexure of the colon, a typical right or left hemicolectomy is performed, respectively. If the lymph nodes are affected, proximal or distal subtotal resection of the colon is indicated, respectively.

When a colon tumor grows into neighboring organs (bladder, small intestine, stomach, etc.), combined operations should be used. Modern surgical techniques, features of anesthesia and intensive care allow simultaneous resection of any abdominal organ and retroperitoneal space. The use of intraoperative ultrasound helps to better differentiate true tumor growth from perifocal inflammation of nearby organs.

In recent years, along with intestinal resection, removal of distant metastases has been increasingly used, in particular liver resections of varying volume and technique (the so-called complete cytoreduction). Palliative resections (incomplete cytoreduction) should also be used in the absence of contraindications, trying whenever possible to avoid symptomatic surgery (formation of colostomies or bypass anastomoses).

Colon resections should be completed with the formation of an anastomosis with restoration of natural intestinal passage. This is possible if the following conditions are met: good bowel preparation, good blood supply to the anastomosed sections, absence of bowel tension in the area of the intended anastomosis.

When forming an anastomosis, the most widely used double-row interrupted suture with an atraumatic needle. It is also possible to use other options: mechanical staple suture, mechanical suture made of absorbable material or metal with shape memory, single-row manual suture, etc. If there is no confidence in the reliability of the colonic anastomosis, a proximal colostomy should be formed.

In case of tumor complications during urgent operations on an unprepared intestine, preference should be given to multi-stage treatment. At the first stage, it is advisable not only to eliminate the complications that have arisen, but also to remove the tumor itself; at the second stage, it is advisable to restore natural intestinal passage. Such methods of surgical treatment include the von Mikulich-Radetzky operation with the formation of a double-barreled colostomy and the Hartmann operation - the formation of a single-barrel colostomy and tightly suturing the distal segment of the colon. Restoration of natural intestinal passage is carried out after 2-6 months after the patient’s condition has normalized.

Savelyev V.S.

Surgical diseases

Hemicolectomy is a surgical procedure used to treat various diseases of the colon. Used in abdominal surgery, oncology and proctology. The history of colon resection begins in 1832, when Dr. Raybord reported the first successful operation with intercolon anastomosis. The first laparoscopic hemicolectomy was performed in the United States in 1990 by Dr. Jacobs.
Depending on the part of the colon removed, a distinction is made between left-sided and right-sided hemicolectomy. Both operations are performed open or laparoscopically. In an open hemicolectomy, half of the intestine is removed through a large incision in the abdominal wall. When using the laparoscopic technique, colon resection is performed through small holes under video camera control using endoscopic equipment. The advantage of the open method is the absence of the need for expensive laparoscopic equipment, better conditions for visual examination, the ability to obtain tactile information about the condition of the abdominal organs, and lower prices. The benefits of laparoscopic hemicolectomy include reduced recovery time, less pain, absence of large scars, reduced risk of infectious complications and incisional hernia, and early recovery of bowel function.

After left hemicolectomy.

After the operation, the patient is taken to the department of the department or the department of anesthesiology and resuscitation, where he is monitored for his condition. Continuation of infusion therapy, administration of antibiotics and analgesics to prevent deep vein thrombosis. Every other day the patient can use clear liquids. When the body picks it up and the intestines begin to function, the diet gradually expands. Otherwise, continue infusion therapy and prescribe parenteral nutrition. Patient activation begins the day after surgery.
Sometimes in the postoperative period, patients develop intestinal paresis. To eliminate paresis, sufficient fluid therapy, adequate pain relief, correction of electrolyte imbalance and early activation are necessary. Patients with vomiting and bloating may experience relief from insertion of a nasogastric tube, although this exercise alone does not reverse the intestinal paresis. Drug administration increases intestinal motility, so it is best to use epidural analgesia for anesthesia. Sometimes, when paresis requires medical stimulation of the intestines, its implementation should begin only with the ineffectiveness of other methods, and not from the first day of the postoperative period. For stimulation, prozerin is used (the use of the drug is limited by side effects), metoclopramide and alvimopan. After a few days, the drainage is removed from the abdominal cavity.
After a laparoscopic hemicolectomy, the sutures are removed for 6-7 days, and after an open procedure - for 9-10 days. The patient then goes home. After the trip, short daily walks with gradually increasing duration are recommended. It is allowed to go up and down the stairs; during the initial recovery period, the patient needs the help of another person. Immediately after unloading, you can raise the weight up to 5 kg; after a month, the weight of the load can be gradually increased.
Showering can be done two days after laparoscopic surgery (if the patient is able to do so). Cuts should be thoroughly cleaned, without soap, and thoroughly dried. With open hemicolectomy, hygiene procedures should be postponed until the sutures are removed. Performance is usually restored within 6-8 weeks. If colon resection was performed for a malignant tumor, the patient may require chemotherapy after receiving histological results.

Up to 40% discount and free consultation

Non-surgical treatment of myopia

Unique technique
treatment of myopia.

A course of non-surgical treatment of myopia.

This unique proprietary technique includes a set of procedures, which are compiled individually depending on the patient’s vision condition, age, degree and form of the disease.

Already after the 1st day of treatment, we often see an improvement in vision by 0.25 diopters. And after a full course of treatment according to this program, vision, as a rule, improves by 2-3 diopters .

The unique program “Non-surgical treatment of myopia” includes:

1. A set of exercises for vision correction according to the author’s method - 10 sessions
2. Course of vision restoration using computer programs - 10 sessions
*In addition to the fact that special computer programs have a healing effect, they are also interesting.
**Since the sessions are held in a game format, the patient is involved in what is happening during the entire treatment process.
3. Physiotherapeutic treatment - 10 procedures
*The choice of the type of physiotherapy is carried out taking into account the characteristics of the patient.
4. Therapeutic massage for myopia - 5 sessions
*The patient receives a massage course, which improves blood circulation and enhances the therapeutic effect.
5. Accompaniment of treatment by a medical specialist within the framework of the program - 10 sessions

Doctor participating in the program:

Tsaregorodtseva Marina Alexandrovna

The cost of the program is only 29,160 rubles. instead of 48,600 rub.

Discount up to 50%

Laser removal of skin lesions

Do you have moles, warts, papillomas?
U we have the most modern
way to remove them!

Removal and laser treatment of stretch marks, scars and skin lesions with a discount of up to 50%!

Do you have moles, warts, papillomas?
Stretch marks, scars, skin formations?
We have the most modern way to remove them - laser!

Undoubted advantages of laser removal:

Removal without incision, blood and pain;
Excellent cosmetic effect;
Fast recovery.

all inclusive for3,025₽ instead of 6,050₽ ( 50% discount )

*Included in the price:

specialist consultation

dermatoscopy

local anesthesia

laser removal of skin lesions.

Treatment for stretch marks:

1 zone 10x15 cm (palm) - 1,700₽ instead of 2,000₽

When processing 9 zones –10th zoneFor a present!
When processing 20 zones –19th And20th zonesFor a present!

1 tripe (1 sq. cm) - 560₽ instead of 800₽
When choosing any variations of laser treatment - consultation is free!

Doctors:

Important!

Contact a dermatologist immediately if the skin around the tumor becomes inflamed, itching or bleeding appears.

The promotion period is valid until December 31, 2019.

70% discount

Diagnosis of vein diseases

♦ Consultation with a phlebologist
♦ Ultrasound of the veins of the lower extremities

with a discount of more than 70%

Symptoms:

Are you worried about problems with your legs?
Heaviness!? Burning!? Swelling!? Leg pain!?
Spider veins or more serious stages of varicose veins!?

Our clinic is pleased to offer you a solution to these problems!

Individual approach;
Doctors of the highest category;
Modern treatment technologies;
Fast rehabilitation;
Outpatient and inpatient

What is included in the price of the promotion:

Consultation with a phlebologist
Ultrasound of the veins of the lower extremities

Total: 5,560 rub.RUB 1,669 (Up to 70% off)

Doctor:

The promotion is valid until December 20, 2019.

More than 40% discount

Comprehensive examination by a proctologist

♦ Consultation with a coloproctologist
♦Sigmoidoscopy
with a discount of more than 40%

Proctology is a very delicate science..

Representatives of past generations of humanity needed the services of a coloproctologist much less often than people of the present time. This is due to the dynamic pace of life, stress, emotional stress, physical inactivity and poor nutrition.
TO Unfortunately, people turn to a coloproctologist for help when there are severe symptoms of the disease. But it is much easier to help a patient if you contact a doctor at the first complaint, which may be: abnormal stool, discomfort in the rectal area, itching, pain...

Proctologist deals with the diagnosis and treatment of various diseases of the rectum and colon:

oncological
inflammatory
congenital.

One of the main diagnostic methods in proctology is anoscopy.
Sigmoidoscopy is a highly informative instrumental research method that allows you to visually assess the condition of the anal canal and identify diseases at the earliest stages.

Individual approach;
Doctors of the highest category;
Modern methods of treatment;

What is included in the price of the promotion:

Consultation with a coloproctologist
Sigmoidoscopy

Total: RUB 3,800 . RUB 2,269 (over 40% discount)

A doctor of the highest category is participating in the promotion:

More than 50% discount

Plasma therapy of the scalp with a discount of more than 50%!

Consultation with a trichologist
Plasma therapy for the scalp
with discountmore than 50%

Plasma therapy (plasmolifting)

This is a procedure that acts directly on the scalp.

Injections into the scalp during plasma therapy are made pointwise, in places where the most severe baldness is observed. New hairs will grow from the awakened bulbs, making the hair thicker and stronger. A course of such procedures will help revitalize stem cells and normalize skin condition. The number of procedures is prescribed by a trichologist.
Plasma therapy - painless procedure. The doctor reduces discomfort to a minimum, especially since the resulting effect is impressive!

Our clinic is pleased to offer you:

Individual approach;
Doctors of the highest category;
Modern methods of treatment;
Expert class equipment.

What is included in the price of the promotion:

Consultation with a trichologist - 1,850 ₽ - free
Plasma therapy for the scalp - 9,680 ₽ - 4,840₽

Total: 11,530 ₽ 4,840 ₽ (discount more than 50% )

A trichologist is participating in the promotion:

The promotion is valid until December 20, 2019.

More than 50% discount

"Women Health"

Consultation with a gynecologist
Ultrasound of the pelvic organs

with a discount of more than 50%

COMPLEX 2 in 1

« Women Health»

"Women Health" - this is not only external attractiveness, but also an attentive attitude to one’s reproductive organs, since it is disorders in the gynecological sphere that, first of all, affect the beauty, well-being, pace of life and energy of a woman.

Our clinic is pleased to offer you:

Individual approach;
Doctors of the highest category;
Modern methods of treatment;
Expert class equipment.

What is included in the price of the promotion:

Consultation with a gynecologist
Ultrasound of the pelvic organs

Total: 3,700 rub. RUB 1,669 (more than 50% discount)

A gynecologist is participating in the campaign:

The promotion is valid until December 20, 2019.

More than 60% discount

Breast examination

Consultation with a mammologist
Ultrasound of the mammary glands

with a discount of more than 60%

Breast examination

A large number of breast diseases are asymptomatic. In order not to miss the initial stages of disorders and to begin treatment on time, it is extremely important to diagnose the disease in a timely manner. One of the effective diagnostic methods in this area of medicine is ultrasound of the mammary glands. It is carried out to study the structure of tissues, as well as the state of blood flow and ducts. Echo diagnostics in the early stages makes it possible to detect the presence of benign and malignant neoplasms, inflammation, mastopathy and other diseases.

A mammologist specializes in the prevention, detection and treatment of breast diseases.

Our clinic is pleased to offer you:

COMPREHENSIVE SURVEY 2in 1:

Consultation with a mammologist
Ultrasound of the mammary glands with Color Doppler

Total: RUB 5,010 RUB 1,669 (over 60% discount)

An oncologist-mammologist is participating in the campaign:

The promotion is valid until 12/20/2019

70% discount

Find out your metabolism!

Metabolism (Metabolism)- a series of chemical processes active in every cell that convert calories into energy. Even when we do nothing, the body spends energy on basic needs...

Our multidisciplinary family clinic offers you to undergo only 2 studies and

learn everything about your metabolism!

Metabolism (Metabolism) - a series of chemical processes active in every cell, they convert calories into energy. Even when we do nothing, the body spends energy on basic needs: maintaining respiratory function, immune processes, normal temperature, synthesis of hormones and enzymes, mental activity, digestion of food , transporting nutrients through the bloodstream. At rest, the body spends half of the energy received to maintain the functioning of the brain, heart, liver, kidneys, the rest goes to the digestive system, muscles and fat.

Bioimpedance testing (BIA) is a diagnostic method with which you can determine the percentage of muscle tissue, fat, water and some other parameters of the human body. The method is absolutely harmless to the body and is indispensable in the treatment of obesity.

What data can be obtained during the study?

Bioimpedance analysis is a simple and, at the same time, very informative diagnostic method. After the study, the device automatically calculates the following indicators:

The basal metabolic rate is the minimum amount of energy that is necessary to maintain the most important functions of the body in a state of relative rest.
Body mass index is the ratio of a person's height and weight.
The value of the phase angle is an indicator that characterizes the general condition of the body, its endurance, performance, and metabolic characteristics. Phase angle is often used to determine biological age.
Percentage of fat tissue, muscle tissue, water, active cell mass. These indicators characterize the characteristics of protein or fat metabolism, correlate with physical activity, and indicate physical development.
Ratio of waist circumference to hip circumference. This index is used to assess the degree of obesity and the associated risk of complications.

The obtained indicators have important practical applications. They allow you not only to develop an individual weight loss program, but can also promptly warn about the high likelihood of developing the following diseases:

Diabetes.
Hypertonic disease.
Urolithiasis disease.
Diseases of the skeletal system.
Cardiovascular diseases.
Diseases that are accompanied by high catabolic activity (cirrhosis, hepatitis, malignant tumors, etc.).

Knowing about these risks, you can undergo additional examination and develop a prevention plan that will help reduce the likelihood of developing these diseases or identify them at an early stage, when the chances of a full recovery are highest.

Glycated hemoglobin – a biochemical blood indicator that reflects the average glucose level in the blood over a period of up to three months. This test is considered the main screening test for the presence or absence of diabetes mellitus and prediabetes (a reversible condition in which the risk of developing type 2 diabetes mellitus is very high).
This indicator is also important when diagnosing hypoxia; the higher the glycated hemoglobin level, the greater the oxygen starvation of the body.

The promotion period is up to 20 .12.2019

20% discount

Check-Up "Women's Health"

Comprehensive examination of women's health with a 20% discount!

Check-up "Women's health".

This is a universal comprehensive diagnostic program aimed at a comprehensive assessment of women’s health and timely identification of risk areas.

*To maintain your health, it is recommended to undergo a medical examination annually. This allows you to identify dangerous symptoms in time and avoid the development of chronic diseases.

The program includes:

Appointment with a gynecologist, therapeutic and diagnostic, primary

*A gynecologist is a doctor who deals with the prevention, diagnosis and treatment of diseases of the female reproductive system, taking into account the woman’s age and her individual characteristics.

Extended colposcopy

*Colposcopy is a diagnostic method for assessing the mucous membrane of the cervix and vagina. The method is based on a visual examination using a special colposcope. Extended colposcopy differs from conventional colposcopy in that during its implementation special methods of staining the mucous membrane are used to assess its structure and the nature of changes.

Ultrasound diagnostics:

Ultrasound of the pelvic organs with color circulation
Ultrasound of mammary/breast glands with Color Doppler
Ultrasound of the thyroid gland with colorectal dosage

Collecting material for research

Laboratory research:

Femoflor-16 (DNA)
Microecology of the genitourinary system (vaginal discharge)
DNA of STD pathogens
Cervical Cancer Screening (BD ShurePath Liquid Cytology) with HPV Test (ROCHE COBAS4800)

Repeated consultation with a gynecologist with prescription of a treatment regimen

(providing examination results, further recommendations and prescribing a treatment regimen)