| Bowel Preparation | Intestinal Anastomsis | Segments for Urinary Diversion | Complications | Miscellaneous |
|---|---|---|---|---|
|
Mechanical reduces the amount of feces/total # of bacteria, antibiotic preparation reduces concentration
What are the two categories of bowel prep and what is do they do to help with infection?
|
Exposure, Blood supply, prevent enteric spillage, serosa to serosa, prevent strangulation, realign mesentary of bowel segments
Name 3 out 6 surgical principles listed in campbells that should guide your technique for proper intestinal anastomosis?
|
Ileum
Which segment of bowel is is associated with the fewest interoperative and postoperative complications?
|
Ischemia, urine leak, radiation, or infection.
What can lead to stricture formation at the ureterointestinal anastomosis?
|
Last 2 inches of the terminal ileum (which is often fixed in the pelvis by ligamentous attachments), 5 feet of small bowel beginning approximately 6 feet from the ligament of Treitz (the mesentery of which is the longest of the entire small bowel)
Which 2 portions of the small bowel may lie within the confines of the pelvis and, as such, may be exposed to pelvic irradiation and pelvic disease?
|
|
Neomycin and Metronidazole
The addition of these two oral antibiotics to mechanical bowel prep decreased the SSI rate from 27% to 8%?
|
False
True or False: There is a difference in complication rate for leaks and fistulas when compared sutured and stapled anastomoses for intestinal segments.
|
Transverse Colon
What is the preferred bowel segment to be used in individuals who have gotten significant pelvic irradiation?
|
Antirefluxing anastomoses
What type of anastomosis is associated with a higher incidence of stricture?
|
Belly of the Rectus
Which abdominal layer does a stoma need to be pulled through to decrease risk of parastomal hernia?
|
|
Peri-op antibiotics
What is the most effective way of preventing infective complications from intestinal diversion surgery?
|
Radiation
What previous treatment modality significant increases the risk of serious bowel anastomsis complications after radical cystectomy?
|
Hyperkalemic, Hyponatremic metabolic acidosis
Which metabolic disorder is jejunum associated with?
|
18-20%. Death rate from renal failure is 6%
What percent of patients with an ileal conduit have long term renal deterioration?
|
Wallace Technique
What type of ureter to small bowel anastomsis has the lowest complication rate?
|
|
Stomach
What segment of the entire bowel has the lowest bacterial count?
|
Absorbable, prevent stone formation
What type of suture should be used for intestingal segments exposed to urine. Why?
|
Short bowel syndrome, Inflammatory bowel disease, radiation
Name two reasons when you should consider alternative bowel segments other than ileum?
|
Placement of stent (almost 0% from 5-10%)
What can be done intraoperatively to decrease your risk of stricture formation?
|
Hypochloremic, hypokalemic metabolic alkalosis
What metabolic abnormality is seen if stomach is used?
|
|
Diarrhea and Pseudomembranous Colitis
What are the two complications from bowel preparation?
|
Better blood supply to healing margin, decreased tissue manipulation, minimal edema, wider lumen constructed, decreased operative time and ease, decrease post-op ileus
Name three theoretical advantages of using a stapled anastomosis for the bowel instead of suture?
|
Hypograstric arteries have been ligated and rectum is in situ
also dont use if disease of this segment, Radiation,
The severing of this artery makes the use of sigmoid colon an absolute contraindication?
|
left side where the ureter cross the aorta
Ureteral strictures occurring after an ileal conduit not associated with ureteral intestinal anastomosis most frequently occur here.
|
8 cm but experimentally up to 15 cm
In general, however, how much length on the small bowel is recommended to assume will survive away from a straight vessel
|
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