Postoperative intraluminal/extraluminal bleeding management

PROGRAM 

    1. Postoperative intraluminal/extraluminal bleeding management - Dr. Carlo Cajucom

The main issue discussed in this webinar will be Postoperative Intraperitoneal Bleeding Management in Colorectal Surgery. One of the main surgical complications is postoperative bleeding because it can lead to major morbidity and mortality. Intraperitoneal bleeding is often caused by an injury to blood vessels or severe hemorrhage from major vascular structures.  

The most important is an early and timely diagnostic that can will reduce overall morbidity and mortality. In an ideal situation,  initial recovery through the peripheral líneas can it be sufficient but sometimes we will need intensive and critical care. We must ensure an accurate diagnosis and then a fast and efficient fluid and blood loss.  

The most common site of bleeding is the zone presacral. There are many creative approaches to providing a good tamponade of presacral hemorrhage. As conventional hemostatic measures often fail to control this type of bleeding, several alternative methods for definitive control have been described.

New techniques are being currently developed for colon cancer. The concept of Complete Mesocolic Excision provides a more meticulous D3 dissection after apical lymph nodes with central vascular ligation (CVL). This news techniques are thought to have oncologic advantages, but also a higher risk of vascular injuries.

In conclusion, postoperative intraperitoneal bleeding remains a feared complication. Management of this complication requires earlier recognition, assessment with appropriate instruments, and a well-organized team.

    2. Endovascular Treatment of gastrointestinal bleeding - Dr. Rodolfo J. Blandon

Like many complications, there are many options for treatment of gastrointestinal (GI) bleeding. Dr. Rodolfo Blandon goes over the characteristics of nuclear bleeding scan, computer tomography angiography, catheter angiography and ultrasound. Each one is best suited to a different case of GI bleeding. Furthermore, he reviews the characteristics of the 3 of the embolic agents currently used: gelfoam, coils and particle embolic. 

Not every case of bleeding is the same. We can differentiate between upper and lower GI bleeding. In each clinical case, the bleeding is different and so is the type of image used. Dr. Blandon uses visual aids to explain clinical cases, discussing the treatment used. 

To conclude, he gives some important take-home messages.

    3. Postoperative intraluminal bleeding - Dr. Mark Whiteford

Finding the source and reason for any kind of bleeding is crucial for optimal treatment. Moreover, preventive action can be taken even before the bleeding is detected in the postoperative period. Two examples are staple line reinforcement and anastomotic examination with flexible sigmoidoscopy,.

Once the bleeding has occurred, certain methods can end the hemorrhage, which have both pros and cons. Endoscopy is a very useful tool, which is the focus of all the explanations about preparation in the operation room and the instruments needed.

Dr Mike Whiteford discusses three videos that provide more visual information about the interventions for different kinds of situations, showing different patients and situations found on postoperative bleeding and how they were treated.

Finally, more data is given about the results of endoscopy treatment and the main points.