Choice of Radical Resection

The choice of radical resection in most cases is determined by the level and location of the rectal cancer. Sphincter invasion is a clear indication for APR, whereas proximal rectal cancers can almost always be treated by AR and primary colorectal anastomosis. The challenge is to properly manage rectal cancers located between the two extremes. In general, the more distal the rectal cancer, the greater the technical challenge to perform a reliable anastomosis. Obesity and a narrow pelvis, as noted in most males, add to the technical challenge. In addition, other patient factors, such as preexisting partial incontinence or immobility, must be considered when making the choice of anastomosis versus permanent colostomy. The risk of perioperative anastomotic leakage is significant if an anastomosis is performed within 5 cm of the anal verge after extended low AR and colo-anal anastomosis. Anastomoses involving irradiated bowel are especially prone to leakage. In such cases, a temporary diverting loop ileostomy is often performed to minimize the risk and consequences of pelvic sepsis. Three months after resection (if the patient's medical status permits), a water-soluble contrast enema is performed to establish the soundness of the anastomosis and the diverting loop ileostomy may then be reversed.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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