This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Rocco Ricciardi during the Postgraduate Course: Total Mesorectal Excision – Optimizing Surgery and Managing Challenges on April 11 2018
Keyword(s): abscess cavity, algorithm, anastomotic leak, antibiotics, anus, asymptomatic, bacterial load, bezoar, bladder, bowel rest, C-reactive protein, consensus standards, contrast enema, CRP, CT scan, defect, dentate line, diagnosis, diuresis, diversion, diverted, diverting, double rectum sign, drain, endo drain, endoluminal drain, endoscopic drain, extraluminal contrast, extraperitoneal anastomosis, extravasation, fever, flexible endoscope, fluid collection, free air, Hartmanns procedure, imaging, index of suspicion, innervation, International Study Group of Rectal Cancer, interventional radiology, IR, ischemia, laparotomy, loculated abscess, management, MGH, nausea, obstruction, pain, peri-anastomotic air, peri-anastomotic fluid, peritoneum, peritonitis, phlegmon, radiologists, sepsis, sinus cavity, staple line dehiscence, subclinical leaks, symptomatic, TME, total mesorectal excision, toxic, transanal approach, unstable patient, urethra, urinary retention, water soluble contrast exam, water soluble contrast study, WSCE, x-ray
Definitions–45 sec Br J Surg 1977
Subclinical leaks diverted after TME–1:24 J Gastrointest Surg 2014
Clinical leak classic signs & symptoms–2:25 Arch Surg 2009
Imaging modalities–3:18
Findings on CT imaging–4:27
Value of CRP–5:25 Br J Surg 2014
Index of suspicion–6:27
Definitions & grading–6:53 Surgery 2010
Management algorithm for extraperitoneal leak–7:37
Stable pt with leak: IR vs transanal vs endo drain–9:14
Management conundrums–10:13
Conclusion–11:08