1 / 78

Tips and Tricks of Avoiding and Management of Anastomotic Complications

Tips and Tricks of Avoiding and Management of Anastomotic Complications. Feza H. Remzi, MD, FACS,FASCRS., FTSS (Hon) Chairman Department of Colorectal Surgery Professor of Surgery Rupert B Turnbull Jr,. MD Chair Digestive Disease Institute Cleveland Clinic, Cleveland, OH. Introduction.

adina
Download Presentation

Tips and Tricks of Avoiding and Management of Anastomotic Complications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Tips and Tricks of Avoiding and Management of Anastomotic Complications Feza H. Remzi, MD, FACS,FASCRS., FTSS (Hon) Chairman Department of Colorectal Surgery Professor of Surgery Rupert B Turnbull Jr,. MD Chair Digestive Disease Institute Cleveland Clinic, Cleveland, OH

  2. Introduction • Colorectal / anal • Ileal Pouch anal anastomosis • Ileocolic anastomosis • Small bowel to small bowel

  3. Colorectal / Anal Anastomosis

  4. Acute Management • Not diverted, • Take back for washout with diverting loop ileostomy and avoid taking down the colorectal anastomosis • Drain; I still prefer penrose drains • Diverted • If leak is proven with CT or GGE; EUA and transanal, anastomotic drainage through the defect • If leak is not proven with CT or GGE; CT guided drainage. Drain injection study before removal • Prefer mushroom catheter • IV ATBS, and conservative management and control of sepsis and wait, wait, and wait

  5. Longterm Management of Colorectal / Anal Anastomotic Leak • Wait 6 to 12 months • Periodic EUA, I & D of cavity, GGE • If it heals, proceed with ileostomy closure • If there is still a persistent large cavity with drainage of pus……. Redo coloanal / Turnbull Cutait pull through procedure • Incomplete healing / closure of the defect • Ileostomy closure and explain the possibility of recurrence • Presacral sinus with a wide mouth/opening usually does better • Cavity that got epithelized with mucosa also does well

  6. Turnbull- Cutait Pull Through

  7. Turnbull Cutait

  8. Ileal Pouch Anal Anastomosis

  9. TPC and IPAA

  10. Reach Issues

  11. Difficulty in Reach

More Related