Surgical approach and mobilization
The surgical procedure begins by ensuring visualization and access to the pelvic and abdominal organs. To achieve this, the surgeon performs an exploratory laparotomy through a lower midline incision.
The next crucial step is the mobilization of the mesentery of the intestinal segment to be resected. At its base, the vessel supplying blood to the resected segment is ligated. The mesentery itself is incised in a wedge shape — from the root directly to the planned resection zone. While doing this, a mandatory condition is strictly controlled: the marginal feeding vessel on the proximal intestinal segment must remain intact.
Preparation for removal and resection
Before transecting the bowel, it is necessary to prevent contamination of the surgical field with intestinal contents. For this purpose, crushing clamps are applied to the ends of the resected segment to completely occlude the lumen. Non-crushing (soft) clamps are placed on the viable parts of the intestine that are to be preserved.
Having completed the isolation, the surgeon transects the bowel. The pathological segment is removed en bloc along with the mobilized mesenteric fragment.
Restoration of intestinal continuity
After removing the affected part of the bowel, the final stage of the surgery begins — the formation of the anastomosis. The restoration of gastrointestinal tract integrity is achieved by performing an end-to-end anastomosis.
To ensure the reliability and tightness of the connection, a three-layer intestinal suture is applied. The first layer of sutures is formed using a continuous catgut suture.
Briefly: answers to topical questions
Which specific arteries are ligated at the root of the mesentery during sigmoid colon resection?
In the source material regarding single-stage primary resection of the sigmoid colon, specific names of the arteries ligated at the root of the mesentery are not specified: it is stated that the vessel supplying the resected segment of the bowel is ligated at the base of the mesentery. At the same time, the marginal feeding vessel must be preserved on the proximal segment.
What types of sutures are used to form all three layers of the intestinal suture during resection?
To form the three-layer intestinal suture, a combination of edge-to-edge and seromuscular sutures is used.
- First layer — inner edge-to-edge continuous catgut suture.
- Second and third layers — outer seromuscular sutures.
This multi-layer construction provides high tightness of the connection and good surgical hemostasis during anastomosis placement.
Which layers of the bowel wall are penetrated when placing the first continuous catgut layer of the anastomosis?
When placing the first continuous catgut layer of the anastomosis, the suture is passed through all layers of the bowel wall.
This inner full-thickness suture is placed on the posterior edges (lips) of the anastomosis. The suture sequentially captures the mucosa, submucosa, muscular layer, and serosa according to the principle: from inside out on one edge (mucosa → serosa) and from outside in on the other (serosa → mucosa).
What are the main indications for sigmoid colon resection?
The source lists the indications for colon resection:
- cancer;
- volvulus and intussusception accompanied by intestinal necrosis;
- extensive colon trauma;
- fistulas;
- ulcerative colitis.
Approach — Mobilization — Clamps — Resection — Anastomosis (AM-C-RA)
Class and exam questions
What surgical approach is used in single-stage sigmoid colon resection?
The intervention is performed through a lower midline incision, providing necessary access to the abdominal cavity.
What clamps are applied to the resected and remaining segments of the bowel?
Crushing clamps are applied to the ends of the resected segment, and non-crushing clamps are applied to the remaining part of the bowel.
How is the bowel connected after resection and how many layers of sutures are used?
The connection is performed end-to-end using a three-layer intestinal suture, where the first layer is a continuous catgut suture.
What else to study on this topic
- Anatomical structure and blood supply of the sigmoid colon
- Rules of precision technique when handling the intestinal mesentery
- Features of forming soft and crushing intestinal clamps
- Technique of placing the second and third layers of the intestinal suture
- Prevention of anastomotic leakage in colon resections
Master the complete topic in the "Topographic Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on «Sigmoid colon resection» and 2,777 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 91 video lessons on the subject
Other topics in the "Abdominal Surgery" section
Free video lessons: topographic anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.