Prior to surgery, the patient undergoes a full mechanical bowel preparation, again as aforementioned. Parenteral steroids are administered when indicated. After undergoing general anesthesia, the patient is placed in the lithotomy position. A midline incision, extending from the symphysis pubis to the supraumbilical region is generally utilized. Exploration of the abdomen is carried out with particular attention to the small intestine, looking for any signs of Crohn's disease involving that organ. The ileum is first divided close to the ileocecal valve, preserving as much small bowel length as possible. The right colon, transverse colon, and left colon are then mobilized from their lateral peritoneal and omental attachments. Care is taken to avoid injury to the duodenum, when mobilizing the hepatic flexure, and the spleen when mobilizing the splenic flexure. The sigmoid colon is then carefully dissected free from the left iliac fossa, with care taken to identify and protect the left ureter. The mesentery to all of the above segments of colon is then divided along with the vascular supply, including the ileocolic, right colic, middle colic, left colic, and sigmoid vessels. As dissection proceeds into the pelvis, a second surgical team begins with a perineal dissection. The abdominal surgeon carefully enters the pelvis, sharply dissecting the rectum and its mesentery from their posterior and lateral attachments. The sympathetic and parasympathetic nerves are preserved to the extent possible in the lateral and posterior dissections. Anteriorly, in men, the seminal vesicles are identified and retracted. Dissection close to the rectum is carried out to the level of the levator muscles. The technique of the proctectomy differs from that performed with cancer in that it is carried out in the intersphincteric plane, very close to the anal canal and rectum. This technique has been shown to significantly lower the incidence of nonhealing of the perineal wound. Once the dissection of the perineal and abdominal operators meet, the entire colon and rectum are removed from the operating field. While the perineal operator is closing the perineal wound, the abdominal operator creates an end ileostomy as described in the previous chapter and closes the abdominal wound.

Baby Sleeping

Baby Sleeping

Everything You Need To Know About Baby Sleeping. Your baby is going to be sleeping a lot. During the first few months, your baby will sleep for most of theday. You may not get any real interaction, or reactions other than sleep and crying.

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