1 / 19

Incidence of Leakage

Incidence of Leakage. Fielding 1980 Multi-centre prospective audit of 1466 colorectal anastomoses Leak Rate Intraperitoneal 10.8% Pelvic 18.7% Overall 13%. Trent/Wales and Wessex Audits. Incidence of Leakage. Incidence of Leakage. ACPGBI Guidelines: 2001

ifeoma-head
Download Presentation

Incidence of Leakage

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Incidence of Leakage Fielding 1980 Multi-centre prospective audit of 1466 colorectal anastomoses Leak Rate Intraperitoneal 10.8% Pelvic 18.7% Overall 13%

  2. Trent/Wales and Wessex Audits Incidence of Leakage

  3. Incidence of Leakage ACPGBI Guidelines: 2001 “Surgeons should carefully audit their leak rates for colorectal surgery and should expect to achieve an overall leak rate of below 8% for anterior resection and 4% for other colonic anastomoses.”

  4. Incidence of Leakage Why has the incidence of leakage gone down? Widespread use of stapling guns. Increased sub-specialisation. ?Better patient selection. Widespread use of audit

  5. Cause of Leaks Technical - Construction - Vascularity Failure to Heal - Hypoxia - Hypo-perfusion - Co-morbidity

  6. Vascularity of Left Colonic Pedicle JD Griffiths: Arris & Gale lecture 1956 “A truly critical point exists at the splenic flexure where the marginal artery is often small --- the terminal branches of the left colonic artery form a secondary marginal artery at this point.”

  7. Co-morbidity & Anastomotic Leak • Ischaemic heart disease • Acute and chronic respiratory disease • Diabetes • Old age • Co-existing sepsis • Previous radiotherapy • Smoking.

  8. What do I do? Anastomotic Levels High Low Ultra low

  9. What do I do? Options • Anastomosis alone • Anastomosis with proximal stoma • End colostomy with closed rectal stump (Hartmann’s procedure) • End colostomy with full ano-rectal excision (abdomino-perineal excision)

  10. What does a proximal stoma achieve? It does: - reduce the number of clinical leaks. - reduce the need for further surgery in the event of a leak. It does not: - prevent breakdown of a poorly constructed or poorly perfused anastomosis. - provide a guarantee against major sepsis.

  11. Complications of Ileostomy Formation and Closure

  12. What do I do? No Anastomosis • Dubious blood supply to left colonic pedicle • Major co-morbidity • Pre-existing pelvic sepsis • Residual pelvic tumour

  13. What do I do? High Rectal Anastomosis

  14. What do I do? Low Rectal Anastomosis

  15. What do I do? Ultra L ow Anastomosis

More Related