Sleeve Advancement



Sleeve Advancement


David J. Maron






Preoperative Planning

Careful patient selection is critical to success and important to reduce the risk of a nonhealing wound and worsening perianal disease. Patients with concomitant perianal sepsis need to undergo drainage of any abscess, with the judicious use of draining setons to prevent further sepsis. The author prefers to leave draining setons in place for a minimum of 3 months to allow for resolution of underlying inflammation. In patients with ongoing sepsis despite the use of draining setons, a diverting stoma may be used.

In patients with Crohn’s disease, sleeve advancement should be avoided in the setting of active proctitis. It is recommended that patients undergo an endoscopic evaluation of the colon and potentially a barium small bowel series to evaluate for Crohn’s disease elsewhere in the intestine, as optimal control of proximal Crohn’s disease may improve the success of the sleeve advancement flap. Assessment should also be made of the mobility and pliability of the rectal wall; this may require an examination under anesthesia in the operating room.


Surgery


Positioning

Preoperatively, the patient undergoes a standard mechanical bowel preparation. Oral antibiotics are not generally given, however the patient receives broad-spectrum intravenous antibiotics prior to incision. Either general or regional (spinal) anesthetic can be used, depending on the patient and surgeon preference. The procedure can be performed in either the lithotomy or prone jackknife position. The author prefers the prone jackknife position under general anesthesia.

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Jun 12, 2016 | Posted by in GENERAL | Comments Off on Sleeve Advancement
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