Rigid sigmoidoscopy - Forum

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Old surgeon

Re: Rigid sigmoidoscopy - Ärzteforum

Post#21 »

Here is the clasic example of being blind to your own inconsistency--you
demonstrated the leak with betadine, so why in the world did you need to scope
to "see what the problem was"? News flash--the problem was a leak! And there
you were right at the operating table able to--and finally did--see the
anastomosis, and the problem, with your own eyes! What some people won't do
to justify an unnecessary procedure!


User avatar
Old surgeon

Re: Rigid sigmoidoscopy - Ärzteforum

Post#22 »

I assume the EEA is what we all use if stapling is done
second--you have seen soft tubes perforate the rectum and so prefer a RIGID
sigmoidoscope?
More power to you if you can get away with simply repairing--I would like to
see how many times this ultimately leads to a colostomy anyway down the road,
but I'm not aware anyone has looked at this Also--we should not take
nonchalantly the advice of another poster that we can simply do an ostomy
later if it leaks after closing--a postop leak is a lifethreatening event that
we should not subject a patient to if it can be helped--I guess I'm just not
as secure in feeling comfortable with your approach, but I can't argue with
your success

User avatar
Old surgeon

Re: Rigid sigmoidoscopy - Ärzteforum

Post#23 »

And this same thing can't be accomplished without the scope, using a small
soft catheter? Of course it can, as I do it routinely! Your analogy is
faulty--a block of hard feces does not flow thru a FRESH anastomosis, when the
suture line is at its weakest--this is when the leak occurs, not after full
tensile strength is reached.

User avatar
Loit

Re: Rigid sigmoidoscopy - Ärzteforum

Post#24 »

Of course I didn't need to scope in this situation , but in your usual
fashion you detracted... and never addressed... the "main point" in my post
which was your dogmatic approach to "leak=AUTOMATIC diversion" which to me
is a WRONG APPROACH. Why won't you address this instead of nitpicking about
the scope? What is the big deal about me wanting to look and see with my
own eyes "where and how" it was leaking...something that couldn't be done
with the bubbles and betadine in this very narrow male pelvis. It took all
of about 3 minutes and caused NO HARM.

User avatar
Treatment guru

Re: Rigid sigmoidoscopy - Ärzteforum

Post#25 »

1. If it leaks air it will leak s...; seeing it from the inside does not
help;
2. If it leaks air - either re-do or divert - both leaks I have had came
from the "...a little stitch here, a little stitch there..." school of
leak repair - stapled anastomoses down low heal in part because the ring
does not impair neovascular ingrowth and healing - but a suture or two
seems to create a problem.

forceps

Re: Rigid sigmoidoscopy - Ärzteforum

Post#26 »

> -you have seen soft tubes perforate the rectum and so prefer a RIGID
> sigmoidoscope?

The statement does not appear to make sense, does it? What I did not say clearly
enough was that even soft tubes can cause problems, and therefore, caution must be
exercised with whatever technique is employed.

> More power to you if you can get away with simply repairing

I really try to individualize each situation. I don't need a leak to do a
colostomy, nor does a leak mandate that I do a colostomy. Repair and/or colostomy
are tools to be used as needed, and the need is determined by the details of the
case.

> Also--we should not take
> nonchalantly the advice of another poster that we can simply do an ostomy
> later if it leaks after closing--a postop leak is a lifethreatening event that
> we should not subject a patient to if it can be helped

I couldn't agree with you more. On every one of the colectomies that I perform, I
receive permission to make an ostomy. I don't hesitate to do so, if I am at all
insecure about the integrity of the anastomsis.

> --I guess I'm just not
> as secure in feeling comfortable with your approach, but I can't argue with
> your success

I know that you've experienced this in practice over the years. What works in your
hands may not be effective in mine, and vice versa. I don't have a good
explanation for this observation, but it may have to do with how confidently a
certain technique is applied.

Wired

Re: Rigid sigmoidoscopy - Ärzteforum

Post#27 »

I also use a catheter and little air to check low anastamoses - but what
are we even so dogmatic about this when we don't check higher
anastamoses?

Poland

Re: Rigid sigmoidoscopy - Ärzteforum

Post#28 »

Looks like overdoing to me- fixing a small leak detected by the above measures
worked fine for me several times. One time the pt. did have a leak, detected
by the nearby drain- colostomy was made on POD 4 or 5, but overall course was
not complicated by sepsis or other catastrophes.

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