Colorectal anastomotic leakage is a serious complication after colorectal surgery leading to high morbidity and mortality rates. In this surgical procedure, the C seal, a bio fragmental drain is stapled to the colorectal anastomosis to protect the anastomosis from leakage. First, the C seal is attached to the anvil of the Circular stapler.
Next, the anvil with The attached C seal is inserted into the proximal bowel loop. The circular stapler is then fired to attach the C seal to the bowel anastomosis, and the stapler is removed from the rectum. By removing the stapler, the C seal is withdrawn from the anus.
Finally, the C seal is cut four centimeters from the anal verge and the C seal is left protruding from the anus. The main advantage of using the C seal over existing methods is that the CIL protects against extra of feces outside the bowel lumen in case of colorectal anastomotic dsn. Well, the sea seal looks like the concept used in the 1980s by they invented the color shield.
But the big difference between the CIL and the color shield is that the sea seal is attached together with the stapling machine and the color shield is attached in the bowel proximal to the anastomotic side. So you have to do an an extra handling to attach the color shield inside the bowel, and that takes a lot of time, extra surgical time, and the CSO is attached together with a surgical stapler to the anastomotic site, and thereby no extra delays introduced in the surgical procedure, Dilute the polymer to a suitable concentration for spray coating and spray the polyurethane solution On a rotating mold to a certain thickness, the concentration of the spray solution is 4%The wall thickness of the C seal is 70 micrometers after 30 minutes, release the C seal by placing the mold in a room. Temperature water bath once released, the C seal is dried by freeze drying in a minus 18 degrees Celsius freezer for two hours.
The C seal is packaged in a Tyvek pouch and sterilized using ethylene oxide gas prior to use. The C seal can be stored for 12 months at or below Four degrees Celsius. The C seal can be applied in anastomosis within 15 centimeters, distance from the anal verge.
Often this is a low interior resection. The patient in the video is suffering from diverticular disease and has a stenotic colon. Therefore, a more extensive resection of the sigmoid colon was necessary.
This protocol starts at the moment that the well vascularized afferent bowel loop can be tension-free anastos with the rectum stump, Using A fresh pair of sterile surgical gloves. Unpack the pre sterilized C seal and a sterilized 12 millimeter stainless steel marble onto a clean, sterile surface. Next, open the C seal.
Insert the marble, and then insert the anvil with the connecting pin. First, using two strips of adhesive tape, attach the C seal to the anvil firmly. Press the adhesive strips Of the C seal onto the stapler head.
Advance the Anvil into the C seal so that the connection pin punctures the open pointed end of the C seal. Then gently unfold the C seal completely and make sure that the marble ends up inside the C seal away from the anvil. If you do not completely unfold the C seal, it can become double stapled and can get stuck at the anastomotic site.
Insert the anvil together with the C seal in the proximal bowel loop by first advancing the tail of the CIL with the help of the marble. If needed, use blunt forceps to facilitate this. Ensure the tail of the C seal is placed upwards in the bowel, and make sure the tail of the C seal is stretched.
The tail orientation is important because you do not want the tail to be stapled together with the anastomosis. When creating a side to end anastomosis, penetrate the bow wall with the anvil's pin staple off the stenotic colon. Check the position of the marble, which should be at least six centimeters away from the anvil.
We advise to create a purse string suture around the pin for extra support, gently dilate the anus and Insert the stapler in the rectum. Connect the anvil with the stapler. Fire the circular stapler.
At this point, the bowel is reconnected and the C seal is attached to the staples. Gently pull out the stapler through the anus. After opening the stapler, according to the corresponding protocol, the stapler should not be turned more than 180 degrees when pulling out the stapler.
Otherwise, the C seal may twist as the stapler is removed from the anus. The C seal is pulled through the anus, cut the C seal approximately four centimeters from the anus. When the C seal is applied correctly, it covers the anastomosis.
Remove the marble from the rectum. Often the marble comes out together with the C seal. If not gently, manually remove the marble, which is situated between the C seal and the intestinal wall.
Optionally, an air test is done to verify the anastomosis. This is done by filling the pelvis with saline solution and simultaneously injecting air into the anal canal within the C seal, and between the C seal and the bowel. Absence of bubbles confirms a complete anastomosis.
If a nce forms at the anastomotic site or below the anastomotic site, the cyl covers that gap. So in case of that de essence, the feces is not able to flow outside the bowel lumen. Since the C seal covers the defect and the C seal directs actually the fecal stream outside the bowel lumen through the anus, the C seal can cause some hygienic discomfort due to soiling as long as the sea seal crosses the anal swinger, and therefore, we advise to rinse the sea with water after the ation.
When the sea seal is applied correctly on the Anil, it should look like this. Ensure the tail of the sea seal is stretched before firing the stapler. Therefore, check the position of the marble, which should be at least six centimeters away from the anvil.
When pulling the stapler out of the anus, the C seal comes out together with the stapler. After cutting the C seal at approximately four centimeters from the anal verge, the C seal is left protruding from the anus. When the patient is recovered and no anastomotic complications are suspected, the CCL can be cut off at the level of the anus.
The remainder of the CCL will degrade over time and the patient will expel it with normal stool production. After watching this video, you should have a good understanding of the rationale and the application of the CIL and patient's undergoing colorectal resection with the creation of a colorectal anastomosis.
