Colon cancer is one of the most common reasons for colonic obstruction. This presentation focusing on benign as well as malignant diseases with its management.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Postoperative adhesions by dr alka mukherjee nagpur m.s.alka mukherjee
Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent. Surgeons should adopt a routine adhesion reduction strategy with good surgical technique. Anti-adhesion agents are an additional option, especially in procedures with a high risk of adhesion formation, such as ovarian, endometriosis and tubal surgery and myomectomy. We conclude that good surgical practice is paramount to reduce adhesion formation and that anti-adhesion agents may contribute to adhesion prevention in certain cases.Any surgery in the abdomen can lead to adhesion formation and potential morbidity. There is evidence to support the use of hyaluronic acid derivatives, PEG based derivatives and solid barrier agents derived from oxidized regenerated cellulose, namely Interceed, during laparoscopy or laparotomy in benign gynaecological surgery to reduce the incidence, severity and proportion of adhesion formation. There is also evidence to support the use of hyaluronic acid derivatives during hysteroscopic surgery to reduce the incidence of intra–uterine adhesion formation. However, there is little evidence to support the use of pharmacological and hydrofloatation agents including Icodextrin in gynaecological surgery. There is no apparent benefit of using adhesion prevention agents at caesarean section. As most of the economic modelling is not based in contemporary health economies, further evidence is required before recommending anti–adhesion agents in current gynaecological practice.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Information about Obstructed Recto Sigmoid Malignancy by Dr Dhaval Mangukiya.
Details of introduction of obstructed recto sigmoid malignancy, Epidemiology, Pathophysiology, Complications, Early Presentation, Stools, History, Late Presentation, Diagnosis, Imaging, Contrast enema, Screenig, Treatment, Management, Surgical management, Surgical options etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
retroperitoneal tumors esp. retroperitoneal sarcoma is most challenging condition to treat in retroperitoneal region inspite of using all treatment modalities.here is brief description of its management acc. to nccn , and other text book ref.
Lt hemicolectomy - Surgical Approach, Complications.Vikas V
This is a detailed Presentation of the surgical procedure - Left Hemicolectomy. It deals with the Surgical anatomy, Indications, Surgical Steps, Complications of the Procedure
Postoperative adhesions by dr alka mukherjee nagpur m.s.alka mukherjee
Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent. Surgeons should adopt a routine adhesion reduction strategy with good surgical technique. Anti-adhesion agents are an additional option, especially in procedures with a high risk of adhesion formation, such as ovarian, endometriosis and tubal surgery and myomectomy. We conclude that good surgical practice is paramount to reduce adhesion formation and that anti-adhesion agents may contribute to adhesion prevention in certain cases.Any surgery in the abdomen can lead to adhesion formation and potential morbidity. There is evidence to support the use of hyaluronic acid derivatives, PEG based derivatives and solid barrier agents derived from oxidized regenerated cellulose, namely Interceed, during laparoscopy or laparotomy in benign gynaecological surgery to reduce the incidence, severity and proportion of adhesion formation. There is also evidence to support the use of hyaluronic acid derivatives during hysteroscopic surgery to reduce the incidence of intra–uterine adhesion formation. However, there is little evidence to support the use of pharmacological and hydrofloatation agents including Icodextrin in gynaecological surgery. There is no apparent benefit of using adhesion prevention agents at caesarean section. As most of the economic modelling is not based in contemporary health economies, further evidence is required before recommending anti–adhesion agents in current gynaecological practice.
In this presentation, I have shown how to do open anterior resection both high and low varieties in a step-by-step manner with clear pictures as if reading an atlas of operative surgery.
Information about Obstructed Recto Sigmoid Malignancy by Dr Dhaval Mangukiya.
Details of introduction of obstructed recto sigmoid malignancy, Epidemiology, Pathophysiology, Complications, Early Presentation, Stools, History, Late Presentation, Diagnosis, Imaging, Contrast enema, Screenig, Treatment, Management, Surgical management, Surgical options etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Recent Update on Management of Ulcerative ColitisDr Amit Dangi
Recent update on the surgical and medical management of ulcerative colitis, including various controversies regarding IPAA and recent medical management incorporating the role of biologicals
Hepatobiliary surgery - role in liver diseases.pptxGian Luca Grazi
Over the past 40 years, liver surgery has become an independent branch of general surgery and abdominal surgery. Liver resections are now well-coded procedures that require sophisticated planning. There are many diseases that can be treated with surgery in the context of liver diseases. This presentation reviews the indications for surgery in the field of primary liver tumors (mainly hepatocellular carcinoma), in the field of benign hepatic tumors, in the field of acute and chronic biliary diseases.
"No Anastomosis" Combined Colon Conduit and Colostomy Diversion with Pelvic Exenteration: An Underutilized, Cost-Effective Technique Reducing Bowel Complications by Sayyid KR, Neal DE, Albo D, Kruse EJ, Wallbillich JJ, Rungruang BJ, Ghamande SJ and Martha K Terris* in Experimental Techniques in Urology & Nephrology
Rupture of a Hydatid Cyst into the Bile Ductasclepiuspdfs
Cholestasis secondary to a cystobiliary communication is a rare complication associated with hepatic hydatidosis. The most established surgical procedure is the evacuation of the contents of the cyst (daughter cysts) without spills, sterilization of the cyst cavity with scolicide agents to prevent the dissemination of the hydatids to the peritoneal cavity, and cavity management (capitonnage) together with the closing of the communication.
Presentation on New Advances in the Treatment of Liver Tumors (Laparoscopic Resections) by Dr. Kimberly Moore Dalal, Surgical Oncology & General Surgery, Peninsula Medical Center.
The classic technique of PD consists of the en-bloc removal of the distal segment of the stomach (antrum), the first and the second portions of the duodenum, specifically the head of the pancreas, the distal CBD, and the gallbladder. Another approach to this procedure is known as the pylorus-sparing PD. In this approach, a small segment of the duo denum is left in situ with the entire stomach to preserve the pylorus and prevent the post–gastrectomy-related symptoms and complications. The classic Whipple and the pylorus-preserving operations are associated with comparable operation times, blood loss, hospital stays, mortality, morbidity, and the incidence of delayed gastric emptying (Mathur et al., 2015). The overall long-term and the disease-free survival is comparable in both groups.
Treatment of Pancreatic Neuroendocrine NeoplasmsDhaval Mangukiya
Information about Treatment of Pancreatic Neuroendocrine Neoplasms in clinical practice guidelines, management and tumors, practice changing study, Gastric NETs etc. by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory bowel disease in history, different investigations and surgery and post op by Dr Dhaval Mangukiya.
Details of Low Anterior Resection(LAR), Arterial Supply, Venous Drainage, Ports, Position, Modified Lithotomy, Vessel Ligation, Lymph Nodes, Nerves Anatomy, Superior Hypogastric Plexus, Lateral Pelvic Nerves, Correct TME, Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Acute abdomen in covid by Dr Dhaval Mangukiya.
Details of Acute abdomen in covid, Liver Injury, Hypotheses, Gastrointestinal manifestations, Critically ill patients with COVID-19 etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about monitoring after therapies for hcc by Dr Dhaval Mangukiya.
Details of Monitoring after therapies for HCC, Staging, Management of Hepatocellluar Carcioma, Limitation, RECIST criteria, Assessment, Target lesion, Special recommendations etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about GIST by Dr Dhaval Mangukiya.
Details of Epidemiology, Classification and Molecular genesis, Prognostic factors, Diagnosis, Management, Followup.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Low Anterior Resection by Dr Dhaval Mangukiya.
Details of GOAL of LAR, Margins, Reconstructions, Anal Anastomosis, End to Side Colorectal Anastomosis, Stapler Vs Hand Sewn, Intersphincteric Resection, Colonic J pouch Anastomosis etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Lap vs Open Colorectal Resection by Dr Dhaval Mangukiya.
Details of Factors compared, COST Trial, CLASSIC Trial, COLOR Trial, COREAN Trial, ALCCS Trial, Summary, SAGES Guidelines,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Inflammatory Bowel Disease by Dr Dhaval Mangukiya.
Details of brief overview of the talk, Surgery in crohn's disease, Scenarios, Localised ileal or ileocaecal disease, Coincidental ileitis, Localised or multifocal colonic disease, Concomitant abscess, Surgical considerations, Anastomotic technique, Laparoscopy etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Hydatid Cyst Biliary Fistula by Dr Dhaval Mangukiya.
Details of Hydatid Cyst Biliary Fistula, USG criteria for intrabiliary rupture, Surgical Options, Post operative bile leak, Treatment and also Algorithm
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Approach to the patients of GI malignancy by Dr Dhaval Mangukiya.
Details of GI malignancy, HPB malignancy, Liver, Pancreas, Biliary,
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
GERD is most common gastric problem in community affecting large number of people. Diagnosis and management is very simple with understanding.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Gerd surgical management by Dr Dhaval Mangukiya.
Details of both sides of Gerd, Introduction, Surgical Anatomy, Hiatus Hernia, Esophageal dearance, Investigation etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Gej leak by Dr Dhaval Mangukiya.
Details of GE Junction Leak, Case 1, Case 2 etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Diverticular disease by Dr Dhaval Mangukiya.
Details of Diverticular disease, Differential Diagnosis, CT Scan Protocol, Point to look in CT, Options, Indications for Elective Surgery, Exploraion, Primary Resection, Opinion, Management etc.
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about Acute pancreatitis by Dr Dhaval Mangukiya.
Details of Acute Pancreatitis Multidisciplinary Approach, Case Scenario, CT, Post Operative Course,
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
https://drdhavalmangukiya.com/
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Information about Abdominal sepsis and peritonitis final by Dr Dhaval Mangukiya.
Details of Anatomy, intra abdominal infections, physiology, peritonitis, risks for failure of source control, management of critical issues.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
4. Staged Procedure
location of the obstructing lesion, condition of the proximal colon, and medical comorbidities of the patient, their
life expectancy, goals of care, and presence of proximal perforation
1. Biondo S, Parés D, Kreisler E, et al. Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies.
Dis Colon Rectum 2005; 48:2272.
2. De Salvo GL, Gava C, Pucciarelli S, Lise M. Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged
resection? Cochrane Database Syst Rev 2004; :CD002101.
3. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol 2004; 13:149.
5. Bowel preparation
Not recommend using any type of bowel preparation (preoperative or intraoperative)
The absence of mechanical bowel preparation is not a contraindication to primary anastomosis
Jiménez Fuertes M, Costa Navarro D. Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe
procedure? World J Surg 2012; 36:1148.
6. Bowel preparation
Intraoperative colonic lavage (combined antegrade/retrograde technique has been used by some surgeons for
hemodynamically stable patients but is generally not necessary
Dudley HA, Racliffe AG, McGeehan D. Intraoperative irrigation of the colon to permit primary anastomosis. Br J Surg 1980; 67:80.
7. Bowel preparation - On Table Lavage
Two small randomized studies comparing decompression alone with on-table lavage (OTL) did not show any
benefit for OTL
1. Nyam DC, Seow-Choen F, Leong AF, Ho YH. Colonic decompression without on-table irrigation for obstructing left-sided colorectal
tumours. Br J Surg 1996; 83:786.
2. Lim JF, Tang CL, Seow-Choen F, Heah SM. Prospective, randomized trial comparing intraoperative colonic irrigation with manual
decompression only for obstructed left-sided colorectal cancer. Dis Colon Rectum 2005; 48:205.
8. Bowel preparation - On Table Lavage
The disadvantages of performing OTL are that it significantly increases operative time (from 25 to 60 minutes in
one study) and may increase soilage
Accumulating evidence has determined that primary anastomosis without OTL is safe and associated with
acceptable morbidity
1. Torralba JA, Robles R, Parrilla P, et al. Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon
carcinoma. Dis Colon Rectum 1998; 41:18.
2. Nyam DC, Leong AF, Ho YH, Seow-Choen F. Comparison between segmental left and extended right colectomies for obstructing left-sided
colonic carcinomas. Dis Colon Rectum 1996; 39:1000.
3. Ortiz H, Biondo S, Ciga MA, et al. Comparative study to determine the need for intraoperative colonic irrigation for primary anastomosis in
left-sided colonic emergencies. Colorectal Dis 2009; 11:648.
9. Bowel preparation
Numerous studies show that successful bowel preparation with combined oral and mechanical bowel
preparation prior to elective colorectal resections decreases rates of deep and superficial surgical site
infections, anastomotic leaks, and ileus
1. Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces
surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262:416.
2. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical
Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection: An Analysis of Colectomy-Targeted ACS NSQIP. Ann Surg
2015; 262:331.
10. Procedures to manage colorectal obstruction - One Stage
Curative intent – without proximal fecal diversion.
Preferred treatment, in practice, this option is usually chosen for patients with longer life expectancy (based
on tumor size, age, comorbidities)
The anastomotic leak rate is 2.2 to 6.9 percent
Deen KI, Madoff RD, Goldberg SM, Rothenberger DA. Surgical management of left colon obstruction: the University of Minnesota experience.
J Am Coll Surg 1998; 187:573.
Breitenstein S, Rickenbacher A, Berdajs D, et al. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction.
Br J Surg 2007; 94:1451.
11. Procedures to manage colorectal obstruction - One Stage
Palliative intent – decompressed usually using a transverse loop colostomy or endoscopic stenting
12. Procedures to manage colorectal obstruction - Two Stage
The obstructing lesion is resected and the colon is either reanastomosed with a proximal diverting loop ostomy
or brought out as a colostomy.
At a second operation, the ostomy is reversed.
13. Procedures to manage colorectal obstruction - Three Stage
Hartmann's operation involves only proximal diversion to decompress the obstructed colon
Second operation involves resecting the obstructing lesion with either a primary anastomosis with proximal
diverting ostomy, or end-colostomy.
Third operation is then required to restore gastrointestinal continuity, if not already performed, and to reverse
the ostomy.
In most series, the mortality rate was approximately 10 percent, and the morbidity rate approximately 30
percent
14. Segmental resection versus subtotal colectomy
When a distal obstructing lesion presents in combination with a more proximal colonic perforation, serosal
tearing or ischemic changes from severe colonic distention, or synchronous polyps (found in up to 11 percent)
A primary ileocolonic anastomosis is likely appropriate in this situation, but depending on the clinical
circumstances, an end ileostomy might be chosen instead
Hennekinne-Mucci S, Tuech JJ, Bréhant O, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J
Colorectal Dis 2006; 21:538.
15. Stapled versus sutured anastomosis
2011 Cochrane review of 11 trials (1125 ileocolic anastomoses; 441 stapled, 684 handsewn) reported
fewer leaks following stapled anastomosis than handsewn anastomosis (2.5 versus 6.1 percent)
Choy PY, Bissett IP, Docherty JG, et al. Stapled versus handsewn methods for ileocolic anastomoses.
Cochrane Database Syst Rev 2011; :CD004320.
16. Stapled versus sutured anastomosis
1. 2015 European Society of Coloproctology collaborating group. The relationship between method of anastomosis
and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit.
Colorectal Dis 2017.
2. Gustafsson P, Jestin P, Gunnarsson U, Lindforss U. Higher frequency of anastomotic leakage with stapled
compared to hand-sewn ileocolic anastomosis in a large population-based study. World J Surg 2015; 39:1834.
3. Frasson M, Granero-Castro P, Ramos Rodríguez JL, et al. Risk factors for anastomotic leak and postoperative
morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of
1102 patients. Int J Colorectal Dis 2016; 31:105.
4. Nordholm-Carstensen A, Schnack Rasmussen M, Krarup PM. Increased Leak Rates Following Stapled Versus
Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study. Dis
Colon Rectum 2019; 62:542.
5. Jessen M, Nerstrøm M, Wilbek TE, et al. Risk factors for clinical anastomotic leakage after right hemicolectomy.
Int J Colorectal Dis 2016; 31:1619.
17. Intraoperative anastomotic perfusion assessment
Indocyanine green (ICG) angiography using near-infrared (NIR) imaging has emerged as a new technology
that permits real-time assessment of intestinal microvascularization
Shen R, Zhang Y, Wang T. Indocyanine Green Fluorescence Angiography and the Incidence of Anastomotic Leak After Colorectal Resection for
Colorectal Cancer: A Meta-analysis. Dis Colon Rectum 2018; 61:1228.
18. Primary closure versus ostomy
Although a primary anastomosis is the preferred goal for patients with perforated or obstructing lesions, it may
not be possible if the patient is too sick to undergo a definitive procedure (eg, intraoperative medical instability,
generalized peritonitis), in which case a staged approach may be needed if the latter were used.
19. Anastomotic Complications
Minor bleeding
Does not require blood transfusion and/or intervention
approximately 50 percent of patients who present initially with minor bleeding will progress to major bleeding and
require a blood transfusion
Bleeding occurs secondary to inadequate clearance of the mesentery prior to division and/or stapling of the
bowel
21. Anastomotic Complications
Dehiscence and leaks
Extraperitoneal leak - percutaneous drainage for a low pelvic abscess, proximal fecal diversion
Intraperitoneal leak - broad-spectrum antibiotics and bowel rest, image-guided percutaneous drainage of
abscesses, temporary fecal diversion and/or drainage, or resection of the anastomosis
22. Leak Rates
Leak rates for resection and primary anastomosis are low in modern series at approximately 5 percent for either
right or left colectomy, which contrasts sharply with historic series that reported anastomotic leak in up to 50
percent of patients
1. Lee YM, Law WL, Chu KW, Poon RT. Emergency surgery for obstructing colorectal cancers: a comparison between right-sided and left-
sided lesions. J Am Coll Surg 2001; 192:719.
2. Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 2005;
189:384.
3. Aslar AK, Ozdemir S, Mahmoudi H, Kuzu MA. Analysis of 230 cases of emergent surgery for obstructing colon cancer--lessons learned. J
Gastrointest Surg 2011; 15:110.
Whether to choose a staged procedure depends upon the location of the obstructing lesion, condition of the proximal colon, and medical comorbidities of the patient, their life expectancy, goals of care, and presence of proximal perforation [74]. For right-sided lesions, there is general consensus that the most appropriate treatment is resection with primary anastomosis as a single-stage procedure [17]. In general, primary resection and immediate anastomosis is also preferred over staged resection for uncomplicated left-sided obstruction [75]. For larger left-sided lesions, primary anastomosis is more controversial.
Whenever possible, a one-stage curative procedure is the preferred treatment for right or left-sided colon obstruction, whether benign or malignant [89,90].
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Curative intent – For a one-stage procedure with curative intent, the obstructing lesion and proximal dilated bowel are resected and re-anastomosed during the initial surgery without proximal fecal diversion. Although this approach should be the preferred treatment, in practice, this option is usually chosen for patients with longer life expectancy (based on tumor size, age, comorbidities) and a strong aversion to a stoma [89,90]. The anastomotic leak rate is 2.2 to 6.9 percent [72,86,91]. (See "Overview of the management of primary colon cancer", section on 'Management of localized disease'.)
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Palliative intent – For palliation, the bowel can be decompressed usually using a transverse loop colostomy or endoscopic stenting. Placement of cecostomy tube is an alternative for gastrointestinal decompression, but this option is rarely used because of issues with ongoing care of the tube, which frequently obstructs [5,92]. Nevertheless, for patients with a short life expectancy who are high-risk surgical candidates, cecostomy may still be a reasonable option (right- or left-sided lesions). The procedure is performed using local anesthetic in an interventional suite or operating room using fluoroscopic guidance. For left-sided lesions, colonic stenting is a better option if the lesion is accessible and providing that an appropriately experienced endoscopist is available to perform the procedure.
In patients able to tolerate the resection, a two-stage procedure is associated with a quicker recovery compared with a three-stage procedure. This option is appropriate if the risk of anastomotic leak (and the attendant morbidity) is judged to be high. Risk factors for anastomotic leak are described in detail elsewhere for colon and rectal anastomoses.
subtotal colectomy, rather than a segmental resection, should generally be performed when a distal obstructing lesion presents in combination with a more proximal colonic perforation, serosal tearing or ischemic changes from severe colonic distention, or synchronous polyps (found in up to 11 percent)
2011 Cochrane review of 11 trials (1125 ileocolic anastomoses; 441 stapled, 684 handsewn) reported fewer leaks following stapled anastomosis than handsewn anastomosis (2.5 versus 6.1 percent; odds ratio 0.48, 95% CI 0.24-0.95) [49]. A subgroup analysis of cancer patients confirmed that there were also fewer leaks with stapled anastomosis (1.3 versus 6.7 percent; odds ratio 0.28, 95% CI 0.10-0.75).
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On the contrary, several observational studies from Europe reported more leaks following stapled anastomosis than handsewn anastomosis [50-54]. As an example, the most recent study from Denmark analyzed 1414 patients who underwent colon surgery for right-sided cancer [53]. The leak rates following stapled and handsewn anastomosis were 5.4 and 2.4 percent, respectively. All of these studies were large (involving from 400 to 3400 patients) and contemporary (published between 2015 and 2019); most patients underwent surgery for cancer or Crohn disease. Stapled anastomosis was associated with more leaks with an odds ratio in the range of 1.43 to 2.41. However, these results should be interpreted with caution as the study populations are heterogeneous, and the surgical techniques are not standardized.
NIR imaging with ICG has been associated with reduced rates of anastomotic complications in observational studies [55-57] (meta-analyzed in [58]), but not randomized trials. In one study, ICG angiography was successful in all 504 patients who underwent mostly colorectal surgery, and resulted in a change in the site of bowel division in 5.8 percent with no subsequent leaks in those patients [59]. The overall leak rate was lower than that of historic controls at the same centers (2.6 versus 5.8 percent), and the improvements were more significant for left-sided resections (2.6 percent with NIR versus 6.9 percent control) and low anterior resections (3 versus 10.7 percent) than for right-sided resections (2.8 percent with NIR versus 2.6 percent control).
If its efficacy in reducing anastomotic complication can be confirmed by randomized trials (at least one is under way [60]), ICG angiography using NIR imaging may become a useful tool for assessing perfusion before and after a bowel anastomosis. (https://www.isrctn.com/ISRCTN13334746? (Accessed on August 08, 2018).
Minor bleeding — Minor bleeding is defined as bleeding that does not require blood transfusion and/or intervention (endoscopic, angiographic, or surgical). It usually ceases within 24 hours. Minor anastomotic bleeding after hand-sewn or stapled anastomoses is common but rarely reported. It is usually manifested by the self-limited passage of dark blood with the patient's first few bowel movements. It is estimated that approximately 50 percent of patients who present initially with minor bleeding will progress to major bleeding and require a blood transfusion [10]. There are no high-quality data from prospective studies that have addressed this issue.
It is hypothesized that anastomotic bleeding occurs secondary to inadequate clearance of the mesentery prior to division and/or stapling of the bowel. The risk of bleeding is increased in patients with a bleeding diathesis. Proposed techniques to reduce minor bleeding include [11]:
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Careful inspection of the staple line, especially for side-to-side and functional end-to-end anastomoses.
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Inversion and inspection of the linear staple line prior to closure of the enterotomy through which a stapling instrument was passed has been advocated by some experts.
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Suture ligation, as opposed to electrocauterization, of significantly bleeding points.
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Utilization of the antimesenteric borders of each limb to construct the anastomosis, thereby avoiding inclusion of the mesentery into the staple line.
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Reinforcement of the anastomosis with an absorbable suture is an option used by some surgeons.
The management of an extraperitoneal dehiscence includes percutaneous drainage for a low pelvic abscess that is in continuity with anastomotic leak. For patients with a low pelvic abscess in continuity with the anastomotic leak that is not amenable to percutaneous drainage, an examination under anesthesia with transrectal or trans-anastomotic drainage should be performed. Consideration of proximal fecal diversion is warranted in symptomatic patients.
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Options for management of an intraperitoneal dehiscence include conservative management with broad-spectrum antibiotics and bowel rest, image-guided percutaneous drainage of abscesses, temporary fecal diversion and/or drainage, or resection of the anastomosis. Early operative intervention is warranted for patients with generalized peritonitis and sepsis or patients with a free intraperitoneal leak on radiographic imaging.