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Enterotomies and the Need for Suturing

Enterotomies and the Need for Suturing. Barry Salky, MD FACS Franz W. Sichel Professor of Surgery Division of Laparoscopic Surgery The Mount Sinai Hospital New York. Enterotomies and the Need for Suturing. Recognized enterotomy requires closure!. Enterotomies and the Need for Suturing.

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Enterotomies and the Need for Suturing

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  1. Enterotomies and the Need for Suturing Barry Salky, MD FACS Franz W. Sichel Professor of Surgery Division of Laparoscopic Surgery The Mount Sinai Hospital New York

  2. Enterotomies and the Need for Suturing Recognized enterotomy requires closure!

  3. Enterotomies and the Need for Suturing “Enterotomy and mortality rates of lap incisional and ventral hernia repair: A review of the literature” 1.78% mortality in 3925 cases 1.7% in recognized cases 7.7% in unrecognized cases LeBlanc K et als JSLS 2008

  4. Enterotomies and the Need for Suturing “Risks of complications from enterotomy or unplanned bowel resection during elective hernia repair” 1998-2002 16 Tertiary VA centers 1124 hernia repairs 7.3% with 20% for prior hernia repairs! ^ po complications 31.7% vs 9.5% (p<.001) ^ OR time ^ Fistula Gray et als ^ LOSArch Surg 2008

  5. Enterotomies and the Need for Suturing The options are intracorporeal sutures, intracorporeal stapling, extracorporeal sutures and extracorporeal stapling.

  6. Enterotomies and the Need for Suturing Intracorporeal stapling requires a 12 mm port (suturing does not), and the alignment needs to be parallel to the enterotomy. Technically, it’s possible, but the angles are sometimes difficult to make happen without extra trocars

  7. Enterotomies and the Need for Suturing Extracorporeal sutures and stapling are very straight forward. The only problem is you have to open to do it.

  8. Enterotomies and the Need for Suturing Making skin incisions with an enterotomy will potentially contaminate the wound. That will lead to a higher incidence of wound infection and incisional hernia.

  9. Enterotomies and the Need for Suturing Intracorporeal suturing and knotting techniques are necessities for advanced laparoscopic (GI) surgery. This is the prime example why.

  10. Intracorporeal Suturing

  11. Video

  12. Enterotomies and the need for Suturing What about unrecognized enterotomies? How can we decrease the risk of occurrence?

  13. Enterotomies and the need for Suturing There is significant morbidity in missed enterotomy. Sharp dissection Appropriate graspers on bowel No energy source next to bowel Double check bowel at end of procedure Any question, bring out and look at it.

  14. April 14 - 17, 2010 Gaylord National Resort and Convention Center Landover, MD(just outside Washington, DC) SAGES & CAGS host the 12thWorld Congress of Endoscopic Surgery Registration & Program Information will be available Summer, 2009 Program Chairs: Barry Salky, MD (SAGES Chair) Daniel Herron, MD (SAGES Co-Chair) Christopher Schlachta, MD (CAGS Chair) Hosted by SAGES & CAGS Society of American Gastrointestinal and Endoscopic Surgeons and Canadian Association of General Surgeons

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