OPERATION: Laparoscopic Hartmann's Procedure
ANAESTHETIC: General anaesthesia
WHO Checklist. VTE prophylaxis. IV antibiotics. Urinary catheter.
Right lateral position then Lloyd-Davis.
FINDINGS: [Obstructing rectosigmoid tumour or perforated diverticular disease].
PROCEDURE:
10mm infraumbilical port via modified open Hasson technique.
x3 5mm ports under direct vision.
Lateral to medial mobilisation of sigmoid colon to mid-transverse. Splenic flexure taken down.
Repositioned to Lloyd-Davis. x2 10mm ports inserted.
Medial to lateral mobilisation. Left ureter identified and protected.
IMA pedicle isolated and taken with Hem-o-lok clips.
TME plane entered to mobilise to mid-rectum. Pelvic nerves protected.
Mesorectum divided. Rectum divided with powered Echelon Flex stapler.
Midline utility incision. Colonic mesentery divided.
Trephine at premarked left iliac fossa site.
Re-laparoscopy to confirm stoma orientation. Haemostasis achieved.
End colostomy matured with 3-0 Monocryl.
CLOSURE:
J-0 PDS to 10mm port sites. Rectus sheath closed with 2-0 PDS.
Skin clips. 20ml levobupivacaine to wounds.
POST-OPERATIVE INSTRUCTIONS:
VTE prophylaxis. Analgesia. Mobilise. Bloods in the morning.
Stoma education. Home when stoma-competent.
28 days LMWH prophylaxis. Outpatient follow-up with histology.