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Early detection and treatment of leakage ESO-ESSO Master Class in Colorectal Cancer Surgery 12 – 17 February 2011 Cascais, Portugal Torbjörn Holm MD PhD Section of Coloproctology Department of  Surgery Karolinska University Hospital  Stockholm, Sweden
Anastomotic leakage Outline ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anastomotic Leakage  a dangerous surgical complication ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage   Definition and Grading
Case 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 CRP development Primary surgery Reoperation
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anastomotic Leakage ,[object Object],[object Object],[object Object]
Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anastomotic Leakage Risk factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anastomotic Leakage Risk factors ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage Risk factors
[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage Risk factors
JWT. Dekker et al. Journal of Surgical Research Published on line
JWT. Dekker et al. Journal of Surgical Research Published on line
Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES 1999 – 2005 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object],[object Object]
RECTODES ,[object Object],[object Object],[object Object],[object Object]
Anastomotic Leakage Risk factors in Dutch TME Trial Peeters et al. BJS 2005; 92: 211–2
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage Detection
M. den Dulk et al. EJSO 35 (2009) 420-426
Median scores in patients with and without anastomotic leakage per postoperative day M. den Dulk et al. EJSO 35 (2009) 420-426
[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage Detection
[object Object],[object Object],[object Object],Anastomotic Leakage Treatment
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anastomotic Leakage Treatment
Damage Control Surgery in Generalised Peritonitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DCS
Damage Control Surgery in Generalised Peritonitis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Control leaking source ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Control leaking source ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rinse / clean abdomen ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Different methods to dress an open abdomen “ Bogota bag” Vac Pac system
Bukförslutning med polypropylennät Polypropylennät Plast med kompress eller inre Vac Pac svamp Fascia
 
Bukförslutning med polypropylennät Bukväggen dras gradvis samman
Bukförslutning med polypropylennät
Bukförslutning med polypropylennät Fascian sutureras när fasciekanterna har approximerats
Conclusion ,[object Object],[object Object],[object Object],[object Object],[object Object]

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MCC 2011 - Slide 19