IAPP By Department of Surgery PDU Medical College

Jun 6, 2010 Dr.Jatin G. Bhatt 1

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Ileo-Anal Pouch Procedure (IPAA)Dr. Jatin G. Bhatt (M.S.)

Professor & Head

Dr. Yogesh K. Raichura (M.S.)

Dr. Ajay M. Rajyaguru (M.S.)

Dr. G. N. Vaghasiya (M.S.)

Asstt. ProfessorDepartment of SurgeryP.D.U. Medical CollegeRajkot.


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• Ulcerative Colitis• Familial Adenomatous Polyposis Coli


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• Removal of diseased caecum, colon & rectum• Ileal pouch: reservoir & storage of feces• Ileo-anal anastomosis: continence• Temporary Diverting Ileostomy/sos


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IPAA: Preoperative Counseling• Functional results are not perfect• Pt. selected properly : physically &

mentallyContraindications: Crohn’s disease

Malignancy Overweight males Fulminating colitis

Poor anal continence


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IPAA: Preoperative Counseling

If the patient is f i t , understands the less than perfect outcome,

and sti l l desires to have the procedure, i t should be

considered.


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Barium Enema


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Endoscopic View


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Operative Steps

• Colon & rectum mobilised• Terminal ileum transected flush with

cecum• Rectum transected just above levator

ani (5 cm from anus)• Root of small bowel mesentary

mobilised upto pancreas


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Mobilisation of Ileum:Dissection till root of SMV (pancreas)

ICV ligated, Serosal incisions


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Different Pouches

S Pouch J Pouch

W Pouch


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Operative Steps (J-Pouch)


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Linear Cutter 55


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Stapling Technique:


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J Pouch


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Rectal Transection5cm from anus


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Stapled Rectal Stump


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Technique of EEA


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Anvil placed at the apex of J pouch with purse string sutures


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Stapler introducer P/R


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Both ends are joined


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Stapler closed & fired


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AIM End Result


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Case-1 Case-2


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Case-1 Case-2


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IPAA: Without Loop Ileostomy

• Surgery proceeded smoothly without contamination

• Good hemostasis• No adverse features for anastomotic healing(high dose steroids, malnutrition, medical factors)

Covering stoma is safer in early learning phase


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IPAA: With Omentectomy

• Adheres to small bowel & abd. Wall.• Becomes fenestrated leads to intestinal

Obstruction.• If relaparotomy required causes difficulty in

dissection.

After colectomy omentum becomes abdominal “busybody” resulting in more harm than help.


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Postoperative Advises• Be aware of added Symptoms & risk factors

for dehydration (hot weather, exercise, air conditioning)

• Maintain adequate oral liquid intake• Avoid high solid fibre diet for 6 wks• Use bulk forming agent• Use Loperamide Hydrochloride• Anastomotic finger examination/dilatation

every 6wks


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Results

• Quality of life• Frequency: day and night• Perfect continence• Fecal spotting• Taking all food orally• Wt. gain


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IAPP By Department of Surgery PDU Medical College

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Transcript of IAPP By Department of Surgery PDU Medical College