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IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
IAPP By Department of Surgery PDU Medical College
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IAPP By Department of Surgery PDU Medical College

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This presentation is a contribution from Dr. Jatin Bhatt, Professor & HOD, Department of Surgery, PDU Medical College, Rajkot.

This presentation is a contribution from Dr. Jatin Bhatt, Professor & HOD, Department of Surgery, PDU Medical College, Rajkot.

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Transcript

  • 1. Ileo-Anal Pouch Procedure (IPAA)
    • Dr. Jatin G. Bhatt (M.S.)
    • Professor & Head
    • Dr. Yogesh K. Raichura (M.S.)
    • Dr. Ajay M. Rajyaguru (M.S.)
    • Dr. G. N. Vaghasiya (M.S.)
    • Asstt. Professor
    • Department of Surgery
    • P.D.U. Medical College
    • Rajkot.
  • 2. IPAA: Indications
    • Ulcerative Colitis
    • Familial Adenomatous Polyposis Coli
  • 3. IPAA: Procedure
    • Removal of diseased caecum, colon & rectum
    • Ileal pouch: reservoir & storage of feces
    • Ileo-anal anastomosis: continence
    • Temporary Diverting Ileostomy/sos
  • 4. IPAA: Preoperative Counseling
    • Functional results are not perfect
    • Pt. selected properly : physically & mentally
    • Contraindications: Crohn’s disease
    • Malignancy Overweight males Fulminating colitis
    • Poor anal continence
  • 5. IPAA: Preoperative Counseling If the patient is fit, understands the less than perfect outcome, and still desires to have the procedure, it should be considered.
  • 6. Barium Enema
  • 7. Endoscopic View
  • 8. Operative Steps
    • Colon & rectum mobilised
    • Terminal ileum transected flush with cecum
    • Rectum transected just above levator ani (5 cm from anus)
    • Root of small bowel mesentary mobilised upto pancreas
  • 9. Mobilisation of Ileum: Dissection till root of SMV (pancreas) ICV ligated, Serosal incisions
  • 10. Different Pouches S Pouch J Pouch W Pouch
  • 11. Operative Steps (J-Pouch)
  • 12. Linear Cutter 55
  • 13. Stapling Technique:
  • 14. J Pouch
  • 15.  
  • 16. Linear Stapler 60
  • 17. Rectal Transection 5cm from anus
  • 18. Stapled Rectal Stump
  • 19. End to End Anastomosis (EEA) Stapler 29
  • 20. Technique of EEA
  • 21. Anvil placed at the apex of J pouch with purse string sutures
  • 22. Stapler introducer P/R
  • 23.  
  • 24. Both ends are joined
  • 25. Stapler closed & fired
  • 26. Both Doughnuts
  • 27.  
  • 28. AIM End Result
  • 29. Case-1 Case-2
  • 30.  
  • 31. Case-1 Case-2
  • 32. IPAA: Without Loop Ileostomy
    • Surgery proceeded smoothly without contamination
    • Good hemostasis
    • No adverse features for anastomotic healing
    • (high dose steroids, malnutrition, medical factors)
    Covering stoma is safer in early learning phase
  • 33. IPAA: With Omentectomy
    • Adheres to small bowel & abd. Wall.
    • Becomes fenestrated leads to intestinal Obstruction.
    • If relaparotomy required causes difficulty in dissection.
    After colectomy omentum becomes abdominal “ busybody” resulting in more harm than help.
  • 34. Postoperative Advises
    • Be aware of added Symptoms & risk factors for dehydration (hot weather, exercise, air conditioning)
    • Maintain adequate oral liquid intake
    • Avoid high solid fibre diet for 6 wks
    • Use bulk forming agent
    • Use Loperamide Hydrochloride
    • Anastomotic finger examination/dilatation every 6wks
  • 35. Results
    • Quality of life
    • Frequency: day and night
    • Perfect continence
    • Fecal spotting
    • Taking all food orally
    • Wt. gain
  • 36. THANKS

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