Attualità in tema di cancro del retto How I do: anastomosi coloanale

Presentazione sul tema: "Attualità in tema di cancro del retto How I do: anastomosi coloanale"— Transcript della presentazione:

1 Attualità in tema di cancro del retto How I do: anastomosi coloanale
Dr. Alberto Vannelli Struttura Complessa Chirurgia Colon-retto Istituto Nazionale Tumori di Milano XIX CONGRESSO NAZIONALE SPIGC Bologna giugno 2006

2 ABDOMINAL SURGICAL TIME
CLOUSURE OF THE IMA LYMPHOADENECTOMY HIPOGATRIC NERVE SPARING TOTAL MESORECTAL EXCISION

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4 RATIONALE AND SURGICAL DETAILS: EXTENT OF LYMPHOADENECTOMY

5 N3 LN3 N2 N1 LN2

6 RATIONALE AND SURGICAL DETAILS: NERVE SPARING TECHNIQUE
PRESERVING WHY?: ERECTION EIACULATION BLADDER FUNCTION

7 POUCH

8 PERINEAL SURGICAL TIME
MUCOSECTOMY POUCH FIXING POUCH OPENING COLO-ENDOANAL ANASTOMOSIS DRAINAGE SETTING

9 1° SURGICAL STEP: MUCOSECTOMY

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11 RATIONALE AND SURGICAL DETAILS
TOTAL REMOVAL OF MUCOSA HISTOLOGICAL EXAMINATION OF DISTAL MUCOSA IMPROVED FUNCTIONAL RESULTS EASIER MANUAL ANASTOMOSIS

12 2° SURGICAL STEP: POUCH FIXING

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14 RATIONALE AND SURGICAL DETAILS
TO AVOID ANASTOMOSIS DISLOCATION TO FIX THE POUCH TO THE PELVIC FLOOR TO IMPROVE LONG TERM FUNCTIONAL RESULTS

15 3° SURGICAL STEP: POUCH OPENING

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17 RATIONALE AND SURGICAL DETAILS
OPENING NOT GREATER THAN 2 cm CONTROL OF LOCAL VASCULAR FLOW

18 4° SURGICAL STEP: COLO ENDOANAL ANASTOMOSIS

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20 RATIONALE AND SURGICAL DETAILS
SUTURE WITH REABSORBABLE 3-0 STITCHES ANASTOMOSIS OF PECTINATE LINE MUCOSA WITH THE ENTIRE WALL OF THE POUCH

21 5° SURGICAL STEP: DRAINAGE SETTING

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23 RATIONALE AND SURGICAL DETAILS
TO MAINTAIN ADEQUATE ANASTOMOSIS CALIBER TO DREIN POUCH SECRETIONS AND BLOOD

24 VII International Symposium Sphincter Saving Surgery for Rectal Cancer
ARECO Associazione per la Ricerca Europea in Chirurgia Oncologica VII International Symposium Sphincter Saving Surgery for Rectal Cancer Milano, Novembre 2006 Informazioni:

25 MASTER IN CHIRURGIA COLORETTALE
A.R.E.C.O. Associazione per la Ricerca Europea in Chirurgia Oncologica MASTER IN CHIRURGIA COLORETTALE Maggio-Giugno 2006 Ai precedenti Master sono stati attribuiti 50 CREDITI ECM