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  • Colon cancer.
  • Colon polyps not amenable to colonoscopic polypectomy.
  • Diverticular disease.
  • Perforation of the colon for which ostomy is not needed.
  • Inflammatory bowel disease.
  • Volvulus.
  • Stricture.
  • Ischemia.
  • Bleeding.
  • Slow-transit constipation refractory to medical therapy.

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  • Widely metastatic colon cancer that is nonoperative or requires a palliative ostomy.
  • Severe peritonitis requiring diverting ostomy, in which primary anastomosis would have an unacceptable leak rate.
  • Hemodynamic instability requiring expeditious ostomy, making primary anastomosis inappropriate.

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  • The patient should be supine, with the entire abdomen prepared and draped.
  • Consider lithotomy position if splenic flexure mobilization may be necessary, and for sigmoid colectomy.

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  • Diet is advanced as tolerated after confirming flatus.
  • A Foley catheter is inserted to monitor adequacy of urine output for the first 24 hours.
  • β-Blockade is continued if appropriate.
  • Deep vein thrombosis prophylaxis should be continued.
  • Patients are encouraged to be ambulatory and should be out of bed three times daily on postoperative day 1.

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Intraoperative and Technical

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  • Injury to the ureter.
  • Injury to the duodenum.
  • Injury to other bowel.
    • Small deserosalizations can be repaired with Lembert stitches. Care should be taken to avoid grasping the bowel during the operation. Epiploic appendages should be grasped instead.
  • Injury to the spleen.
    • A topical hemostatic agent can be applied or splenorrhaphy or splenectomy performed.
  • Inadequate blood supply at the anastomosis.
    • Additional bowel should be resected. Consider using Doppler ultrasound to evaluate blood flow to the anastomosis if concerned.
  • Anastomosis under tension.
    • Additional bowel can be mobilized.
  • Stool spillage and tumor cell spillage, creating the potential for abscess or "drop metastases."
    • Noncrushing bowel clamps should be used proximal and distal to the line of colonic division.

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Early Postoperative Period

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  • Wound infection.
    • Staples should be removed as needed, followed by confirmation that fascia are intact. The wound should then be packed and allowed to heal by secondary intention.
  • Anastomotic leak.
    • In some patients, tachycardia may be the only sign; others may have prolonged ileus or appear septic.
  • Intra-abdominal abscess.
    • Typically diagnosed by CT scan on postoperative days 5–7.
    • Can often be treated using a percutaneous drain placed by the radiology service.
    • May be secondary to an anastomotic leak.
  • Colocutaneous fistula.

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Late Postoperative Period

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  • Anastomotic stricture.
  • Anastomotic recurrence of cancer.
  • Incisional hernia.
  • Internal hernia.
  • Ureteral stricture from ureteral devascularization.

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