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Posted in Lectures on 16 May 2019

Jordi Farguell Piulachs
General Surgery resident.
Hospital Clinic (Barcelona, Spain)

Dr. Bemelman introduced the course talking about the importance of anastomotic leakage and the implications of its appearance in colorectal surgeries, specially when creating a low anastomosis.

In the first part of the presentation, they talked about how they dealt with leaks. Strategies on how to lower leak rates and early management were discussed.

Dr. Bemelman explained a management diagram flow that is used at the Academic Medical Center involving analytical markers, diagnostic techniques and treatment options.

Then some surgical cases were presented, explaining the surgical technique and their postoperative evolution.

Dr. Bemelman made special emphasis on early diagnosis for leak treatment success.

“In treating leaks, it is very important that you make the diagnosis early”

Then came Dr. Lacy’s turn. He explained the TaTME procedure using the Cecil approach for rectal cancer, based on two teams working at the same time.

As the video and the explanation went on, Dr. Lacy gave some technical tricks for surgeons, such as hand positions, plane identification for the dissection, how to combine the abdominal pressure and the rectal pressure when difficult cases are being performed, and many others.

Dr. Lacy placed special emphasis on using ICG when making the decision on the anastomotic site, as, in his experience, it changes in 20% of cases after performing this test. This has large implications to avoid anastomotic leakage, as it makes it possible to create a better vascularized anastomosis.

Dr. Lacy explained the importance of teamwork, as in this technique two teams are working at the same time.

Dr. Frasson said “The worst nightmare of surgeons when we think about rectal and colorectal resection is anastomotic leak”.

As surgery evolves, we try to create riskier anastomoses, facing new complications that lead to higher anastomosis leakage. Dr. Frasson explained how endo-Sponge can help us to deal with this type of complications.

Dr. Frasson showed a basic setup video, explaining some tricks for introduction, vacuum connection, and extraction.

“The combination of endo-Sponge therapy and transanal defect closure probably is the best solution” said Dr. Frasson.

Dr. Frasson explained that in diverted patients, endoscopic controls are performed before discharging, explaining its implications for avoiding anastomotic leakage.

Dr. Bemelman and Dr. Frasson answered questions that Dr. Lacy was receiving through the AIS Channel platform.

Different topics were discussed, such as washout protocols, economical aspects, LARS, chronic sinus, outpatient management, and reoperation, among others.