Laparoscopic Mainz Ii Pouch Sigmarectum Pouch Patient Preparation

Prior to creation of a rectosigmoid pouch, anal continence should be assured. The sphincteric mechanism is tested by instilling 250 mL of fluid into the rectum. The patient must hold this for 2 to 3 hours. Preoperative sigmoidoscopy is performed to exclude colonic disease including polyposis and diverticulosis. Informed consent is obtained with a discussion of risks including but not limited to adjacent organ injury and unrecognized bowel injury. Patients are made aware that safety is paramount, and open conversion may be required for completion of the planned procedure. Patients undergo a full mechanical bowel preparation and oral antibiotics covering normal intestinal flora are given on the day prior to surgery. Preoperative antibiotic prophylaxis with an intravenous second-generation cephalosporin is given at induction of anesthesia and continues for the first postoperative day. Lower extremity compressive devices are applied. Once general anesthesia is induced, the gastric contents are emptied with a nasogastric tube, which remains in place postoperatively. The legs are gently abducted and a 26-French rectal tube is placed.

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