Low anterior resection in the community hospital

Summary

The bowel must be well prepared. The anastomosis should not be jeopardized by use of too many sutures. The perineal floor is not closed; the anastomosis is left intraperitoneally where it can be protected by omentum or small bowel in the event of a separation. A tube cecostomy is a valuable adjunct in a difficult resection. Oral feedings should be allowed only after satisfactory restoration of bowel function. Bandages are removed permanently on the first postoperative day, and showers and baths are allowed as soon as the patient is sufficiently ambulatory. Colon surgery can be done effectively without the use of drains, prophylactic postoperative antibiotics, or prophylactic postoperative gastric suction.