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    Surgical Management of Ibd by 39

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    Surgical Management of Ibd by 39

    Uploaded by

    JH
    4 views19 pages

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    Download as pptx, pdf, or txt
    4 views19 pages

    Surgical Management of Ibd by 39

    Uploaded by

    JH

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    Surgical Management

    of
    Inflammatory Bowel Disease

    By
    Hanushiya J.
    Final year MBBS
    Indications for surgery in Crohn's disease
    1. Intractable disease
    2.Fulminant disease
    3. Toxic megacolon
    4. Colonic perforation
    5. Extracolonic disease
    6. Colonic obstruction
    7. Colon cancer
    Surgery for crohn's
    • surgery for CD is tecnically demanding as involved
    mucosa is edematous and healing maybe impaired

    • surgery is not the cure for CD, recrudescence is common.


    The various Manifestations of CD:
    • Ileocolitis
    • Stricture formation
    • Hollow viscus fistulae
    • Anorectal disease
    For Ileocolitis: ileocaecal/colonic resection

    • Resection of diseased segments with primary


    anastamosis between the free ends of ileum and
    colon.
    • Can be done Laproscopically or through Laprotomy
    For strictures: strictureplasty or segmental resection may be
    done
    Heineke- Mikulicz strictureplasty

    1. strictured length of intestine is incised along


    its length
    2. bowel is opened, its walls retracted
    3. bowels resutred transversely to widen the
    narrow segment.
    Colectomy and ileorectal anastamosis:

    • All parts of colon removed


    • ileum anastamosed with rectum
    • Done only when rectum is not
    involved
    Anal disese to be treated conservatively by drainage of
    abscess and use of setons through fistulae to avoid
    sphincter injury.
    • A seton is a piece of surgical thread that's left in the
    fistula for several weeks to keep it open.This
    allows it to drain and helps it heal
    • fistulotomy is avoided in CD as healing takes place
    very slowly or not at all
    Proctectomy and Proctocolectomy:
    • proctectomy= surgical removal of the rectum
    • for those with severe anal disease failing to respond to medical treatment.
    • permanent ileostomy done
    Indications for surgery in Ulcerative Colitis:
    1. Small intestine
    • stricture and obstruction
    • unresponsiveness to medical therapy
    • massive hemorrhage
    • refractory fistula

    2. Colon and rectum


    • Intractable disease
    • Fulminant disease: > 10 bowel movements daily, continous
    bleeding,progressive colonic dilatation (toxic megacolon)
    • cancer prophylaxis: high incidence of neoplastic changes in UC than
    CD
    surgery for Ulcerative colitis

    Emergency: Fulminant disease


    subtotal colectomy and end
    ileostomy
    • sigmoid colon left behind
    Elective surgery indications:
    • failure of medical therapy/ steroid dependence
    • growth retardation in the young
    • extraintestinal disease
    • malignant change
    Elective surgeries done:
    • subtotal colectomy and end ileostomy
    • proctocolectomy and end ileostomy
    • restrorative proctocolectomy and ileoanal pouch
    • subtotal colectomy and ileorectal anastamosis
    Restorative proctocolectomy with ileoanal pouch:

    • Removes the entire colon and rectum while preserving


    the anal sphincter and, hence, normal bowel function and
    fecal continence
    • mucosectomy of upper anal canal may be done.
    alternatively upper anal mucosa preserved and the pouch
    is double stapled to the anal canal.
    Ileoanal pouch
    Ileum is folded, sewn or stapled to form a substitute rectum.
    this is then sutured or stapled to the anal canal at the level of the dentate line.
    complications of restorative proctocolectomy with ilioanal pouch:

    • pouchitis
    • pelvic infections
    • reduced fertility and vaginal dryness in women:
    denervation of secretory glands of vaginal mucosa.
    References
    • Harrison's principle of internal medicine
    • Bailey and Love's short practice of surgery
    • Manipal manual of surgery
    • https://www.researchgate.net
    Thank you

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