Recommended
More Related Content
What's hot
What's hot (20)
Similar to Resection and anastomosis - Dr Keyur Bhatt
Similar to Resection and anastomosis - Dr Keyur Bhatt (20)
More from DrKeyurBhattMSMRCSEd
More from DrKeyurBhattMSMRCSEd (6)
Recently uploaded
Recently uploaded (20)
Resection and anastomosis - Dr Keyur Bhatt
- 1. Dr. Keyur Bhatt MS, MRCS (UK), FACS (USA) ASIA BOOK & INDIA BOOK Record holder for “Grand Master of laparoscopic cholecystectomy” LIMCA BOOK & INDIA BOOK Record holder “longest foreign body removal from stomach”
- 2. Greetings from our teaam
- 3. Resection and Anastomosis Tips and Tricks GUJ ASICON 2019
- 4. • The word anastomosis comes from the Greek “ana” without and ‘stoma’ , a mouth, i.e. when a tubular viscus is jointed after resection or bypass without exteriorisation with stoma
- 5. Healing of anastomosis • Early phase (0-4 days): There is an acute inflammatory response but no intrinsic cohesion • Fibroplasia (3-14 days): Fibroblast proliferation occurs with collagen formation • Maturation phase (>10 days): This is the period of collagen remodelling, when the stability and strength of the anastomosis increase
- 7. If it heals it heals If it doesn't it will never
- 8. Leakage • Early leakage: Within 48 hours of surgery • Technical failure • Intermediate leakage: From 2 to 6 days • Healing failure, Sepsis • Late leakage: from 6 days to 1 month • Immunological failure
- 9. For scientific talk TYPES INDICATIONS PRE OPERATIVE PREPARATION INTRA OPERATIVE PRINCIPLES TECHNIQUES POST OPERATIVE CARE COMPLICATIONS CONTROVERSIES
- 10. Tips and Tricks Practical aspects
- 11. Practical types of anastomosis • Orientation of bowel • Side to side • End to end • End to side • Technique • Hand sewed • Stapling technique • Based on the number of layers • Single layer • Double layer • Part of the bowel involved • Gastro jejunostomy • Jejuno jejunostomy • Ileo colic anastomosis • Colo colic anastomosis • Bilio pancreatic to bowel anastomosis • Esophago gastric anastomosis • Transposition anastomosis • Condutes , Grafts
- 12. Whether Lap or Open The principles of surgery never changes
- 13. Factors responsible for anastomosis healing •Viability •Blood supply •Sepsis •Tension on ends •Level of S. Albumin •Haemoglobin • Sutures and its types • Margins • Orientation of mesentery • Decompression • Inversion • Eversion • Spillage • Decompression • Clamping • Adequate exposure
- 14. Our DATA •1632 anastomosis till now • 27 had a leakage • 1.65 % leak rate. • Most common factors responsible for leaks in our series • Lower one third of rectum (8) – All had covering stoma • Sigmoid diverticular disease (5) – All had covering stoma • Low albumin status / sepsis (5) – converted to stoma • Stapler malfunction (3) – All had covering stoma • Early closure of stoma (6)- controlled fistula, kept conservatively eventually healed
- 15. SIDE TO SIDE Stapled anastomosis - Ileal
- 16. Laparoscopic side to side
- 17. Side to side Manual anastomosis - Jejunal
- 18. END TO END – Small bowel
- 19. Colo colic single layer interrupted full thickness
- 20. End to side - Hybrid , Ileo colic
- 21. End to end and side to side dual anastomosis small bowel
- 22. Gastro duodenal end to end
- 23. Hepatico jejuonostomy interrupted - Vicryle
- 24. Hepatico jejuonostomy continues -PDS
- 25. Choledecho duodenal anastomosis - interrupted
- 26. Pancreatico jejunal anastomosis - Lateral
- 27. Pancreatico jejunal anastomosis - End
- 30. THANKS