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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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