How is the patient positioned for a colon resection (colectomy)?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

The patient's arms should be tucked in when possible. For left colectomy, sigmoid colectomy, and LAR, the patient is placed in the lithotomy position. Depending on the surgeon's preference and the patient's body habitus, the Lloyd-Davies position may be used.

The Lloyd-Davies position is a modified lithotomy position with 30° of Trendelenburg and the hips flexed at 15°. The advantage of this position is that it provides good exposure for operations in the pelvic area. The disadvantage is that the Trendelenburg position could cause limb ischemia, especially in procedures lasting longer than 5 hours, followed by an increased risk of lower-limb compartment syndrome during the reperfusion period. [30]

For right colectomy and abdominoperineal resection (APR), the authors place the patient in the supine position. For APR, after completing the mobilization of the rectum and creating the colostomy, the authors close the abdomen and place the patient in the prone jackknife position and complete the operation. The exposure from the prone position warrants the time taken to reposition the patient.

For pelvic surgery, it is imperative that patient is secured so that he or she does not slide off the bed toward anesthesia while in the Trendelenburg position. The authors use a beanbag and padded foam on the mattress to add friction. The authors also tape the patient's chest for laparoscopic cases; tilting the patient may be required to facilitate exposure.


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