Vishal Garg, MS

The main 8 types of Pancreaticojejunal anastomoses after pancreatoduodenectomy: step by step! 1. Direct end-to-side anastomosis (the Cattell–Warren technique) 2. End-to-side duct-to-mucosa anastomosis 3. End-to-side anastomosis with invagination (“Dunking”) 4. Intubated anastomosis with an internalized pancreatic drain 5. Intubated anastomosis with an externalized pancreatic drain 6. Anastomosis with transfixing suture (Blumgart technique) 7. Anastomosis with intussusception (Peng technique) 8. Pancreatic anastomosis to a Roux-en-Y jejunal limb

"𝗧𝗬𝗣𝗘𝗦 𝗢𝗙 𝗔𝗡𝗧𝗘𝗥𝗜𝗢𝗥 𝗥𝗘𝗦𝗘𝗖𝗧𝗜𝗢𝗡"     Anterior resection is the general term used to describe resection of the rectum from an abdominal approach to the pelvis with no need for a perineal, sacral incisions. 𝗧𝘆𝗽𝗲𝘀; 𝗜-High Anterior Resection: It's resection of the distal sigmoid colon and upper rectum and is the appropriate operation for benign lesions and disease at rectosigmoid junction such as diverticulitis. Upper rectum is mobilized, but the pelvic peritoneum is not divided and the rectum is not mobilized fully from the concavity of the sacrum.  𝗜𝗜- Low Anterior Resection: It used to remove lesions in the upper and mid rectum. The rectosigmoid is mobilized, the pelvic peritoneum is opened, and the inferior. Rectum is mobilized from the sacrum by sharp dissection (TME) under direct view within the endopelvic fascial plane. The dissection may be performed distally to the anorectal ring, extending posteriorly through the rectosacral fascia ...

Lets discuss most commonly used solution in surgery " Povidone iodine (Betadine) "- It is available in 5% & 10% solution, 7/5% W/V ointment and also as mouth wash Iodine is a good germicidal and is effective against Virus, bacteria, protozoa, Fungi and yeast but it is irritant, insoluble and instable. To overcome all these problems it is mixed with Polyvinyl Pyrrolidone, thus it becomes Povidone iodine. Now it has bactericidal properties and water soluble yet nontoxic. • The povidone carrier releases its iodine slowly. • Iodophors are highly effective but their anti-microbial action declines rapidly upon drying, ( does not have a residual effect ). • Iodine is in-activated by organic material so should be applied only to clean skin • Loss of colour of solution denotes loss of bactericidal properties.