What is included in the preoperative evaluation of proctitis and anusitis?

Updated: Mar 27, 2020
  • Author: David E Stein, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

As always, general surgical preparation includes optimizing medical status and providing deep vein thrombosis (DVT) prophylaxis, bowel preparation, and preoperative antibiotic prophylaxis. A Foley catheter will be placed after induction of anesthesia.

Preoperative nutritional status may be the most significant predictor of outcomes. Every effort should be given to assess the patient's nutritional status and improve it if necessary. The author's current practice is to obtain a prealbumin level on all patients scheduled to undergo laparotomy. If it is low, the author will delay the surgery and place them on nutritional supplementation.

If the patient is going to have a stoma, preoperative counseling with a trained enterostomal nurse is essential. The nurse will educate the patient about life with a stoma and also mark the patient preoperatively to ensure optimal stoma placement.

For patients requiring a subtotal colectomy, an assessment of their sphincter complex is helpful in determining postoperative fecal continence. This is also true for patients undergoing a total proctocolectomy with an ileal pouch.

In addition, for patients undergoing a proctectomy, it is important to discuss their sexual and urinary function before performing the procedure; there is a small but real possibility of diminished sexual function and bladder continence after pelvic surgery.


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