Dr. Mark Whiteford

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.

With Johnson & Johnson MedTech

U.S Experience with the introduction of transanal TME

There are several particularities in the evolution of surgical approaches for the treatment of rectal cancer in the USA. It seems that the adoption of minimally invasive surgery has not been as fast as in other regions such as Europe. Another particular fact is that several surgeons have moved from the open to the robotic approach, skipping laparoscopy. Back in 2007 data regarding the feasibility of the transanal approach in human cadavers was published by Mark Whiteford and Lee Swanstrom (Gastrointestinal and Minimally Invasive Surgery Division, Legacy Portland Hospitals, Portland, Oregon, USA), attracting the attention of several surgeons around the world. Patricia Sylla is one of the leading surgeons involved in the development and research into the transanal approach for rectal cancer. In this lecture she discusses the U.S experience with the introduction of transanal TME.