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Reddy SHS, Gupta V, Yadav TD, Singh G, Sahni D. Lengthening of left colon after rectal resection: What all is adequate? A prospective cohort study. Int J Surg 2016; 31:27-32. [PMID: 27233374 DOI: 10.1016/j.ijsu.2016.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 05/15/2016] [Accepted: 05/20/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Adequate mobilization of colon is essential to achieve tension free anastomosis after sphinchter saving surgeries. METHODS 26 patients undergoing of recto-sigmoid resection underwent low tie of inferior mesenteric artery (IMA), splenic flexure mobilization and descending branch of left colic artery (LCA) ligation in that order. One point at proximal 1/3rd of sigmoid colon (point of partial sigmoid resection) and another at descending-sigmoid colon junction (point of total sigmoid resection) were used for measurements and the distance was measured from pubic symphysis. Mobilization was considered adequate if colon could reach 2 cm beyond the upper border of pubic symphysis. RESULTS The length gained after each maneuver was 4.2 + 3.6 cm (low tie), 5.8 + 3.7 cm (splenic flexure mobilization) and 4.7 + 4.2 cm (descending branch of LCA ligation). Mobilization was adequate in 19% and 0% (low tie), 56% and 20% (low tie with splenic flexure mobilization) and 100% and 86% (all three manoeuvres) with partial and complete sigmoid resection respectively. In 13 patients undergoing low anterior resection, adequate mobilization for anastomosis was attainable in 15.3% and 0% (low tie), 50% and 0% (low tie with splenic flexure mobilization) and 100% and 83.3% (all three manoeuvres) with partial and complete sigmoid resection respectively. 15.3% had anastomotic leak, however none of the patients undergoing descending branch of LCA ligation had anastomotic insufficiency. CONCLUSIONS Low tie of IMA, with splenic flexure mobilization as required results in sufficient mobilization only in 50% patients with partial sigmoid resection. Ligation of descending branch of LCA is feasible, safe and enables a tension free anastomosis and is especially beneficial when sigmoid colon is resected completely.
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Affiliation(s)
- Shruthi H S Reddy
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Thakur D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Lu Z, Peng J, Li C, Wang F, Jiang W, Fan W, Lin J, Wu X, Wan D, Pan Z. Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients. Clinics (Sao Paulo) 2016; 71:264-70. [PMID: 27276395 PMCID: PMC4874270 DOI: 10.6061/clinics/2016(05)04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/17/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the safety and efficacy of a new nickel-titanium shape memory alloy compression anastomosis ring, NiTi CAR 27, in constructing an anastomosis for colorectal cancer resection compared with conventional staples. METHODS In total, 234 consecutive patients diagnosed with colorectal cancer receiving sigmoidectomy and anterior resection for end-to-end anastomosis from May 2010 to June 2012 were retrospectively analyzed. The postoperative clinical parameters, postoperative complications and 3-year overall survival in 77 patients using a NiTi CAR 27 compression ring (CAR group) and 157 patients with conventional circular staplers (STA group) were compared. RESULTS There were no statistically significant differences between the patients in the two groups in terms of general demographics and tumor features. A clinically apparent anastomotic leak occurred in 2 patients (2.6%) in the CAR group and in 5 patients (3.2%) in the STA group (p=0.804). These eight patients received a temporary diverting ileostomy. One patient (1.3%) in the CAR group was diagnosed with anastomotic stricture through an electronic colonoscopy after 3 months postoperatively. The incidence of postoperative intestinal obstruction was comparable between the two groups (p=0.192). With a median follow-up duration of 39.6 months, the 3-year overall survival rate was 83.1% in the CAR group and 89.0% in the STA group (p=0.152). CONCLUSIONS NiTi CAR 27 is safe and effective for colorectal end-to-end anastomosis. Its use is equivalent to that of the conventional circular staplers. This study suggests that NiTi CAR 27 may be a beneficial alternative in colorectal anastomosis in Chinese colorectal cancer patients.
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Affiliation(s)
- Zhenhai Lu
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Jianhong Peng
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Cong Li
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Fulong Wang
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Wu Jiang
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Wenhua Fan
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Junzhong Lin
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Xiaojun Wu
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Desen Wan
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
| | - Zhizhong Pan
- Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery, Guangzhou, P.R., China
- E-mail:
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Anaf V, Gocevska S, Lemoine O, El Nakadi I, Buggenhout A, Zalcman M, Noël JC. The Problem of Anastomotic Stricture After Rectosigmoid Resection in Deep Infiltrating Endometriosis. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vincent Anaf
- Department of Gynecology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sashka Gocevska
- Department of Gynecology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Lemoine
- Department of Gastroenterology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Issam El Nakadi
- Department of Digestive Surgery, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexis Buggenhout
- Department of Digestive Surgery, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Zalcman
- Department of Radiology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Noël
- Department of Pathology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Rutegård M, Rutegård J. Anastomotic leakage in rectal cancer surgery: The role of blood perfusion. World J Gastrointest Surg 2015; 7:289-292. [PMID: 26649151 PMCID: PMC4663382 DOI: 10.4240/wjgs.v7.i11.289] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/12/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
Anastomotic leakage after anterior resection for rectal cancer remains a common and often devastating complication. Preoperative risk factors for anastomotic leakage have been studied extensively and are used for patient selection, especially whether to perform a diverting stoma or not. From the current literature, data suggest that perfusion in the rectal stump rather than in the colonic limb may be more important for the integrity of the colorectal anastomosis. Moreover, available research suggests that the mid and upper rectum is considerably more vascularized than the lower part, in which the posterior compartment seems most vulnerable. These data fit neatly with the observation that anastomotic leaks are far more frequent in patients undergoing total compared to partial mesorectal excision, and also that most leaks occur dorsally. Clinical judgment has been shown to ineffectively assess anastomotic viability, while promising methods to measure blood perfusion are evolving. Much interest has recently been turned to near-infrared light technology, enhanced with fluorescent agents, which enables intraoperative perfusion assessment. Preliminary data are promising, but large-scale controlled trials are lacking. With maturation of such technology, perfusion measurements may in the future inform the surgeon whether anastomoses are at risk. In high colorectal anastomoses, anastomotic revision might be feasible, while a diverting stoma could be fashioned selectively instead of routinely for low anastomoses.
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Caziuc A, Dindelegan GC, Mironiuc A. Operator-related risk factors of anastomotic leaks after colorectal surgery: an up-to-date. Med Pharm Rep 2015; 88:124-7. [PMID: 26528059 PMCID: PMC4576784 DOI: 10.15386/cjmed-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 03/26/2015] [Accepted: 04/02/2015] [Indexed: 11/23/2022] Open
Abstract
Digestive fistulas are a major complication after digestive surgery. Anastomotic leakage increases the hospitalization time, the prognosis and survival rate after colorectal surgical interventions. The factors involved are either systemic (determined by the patients’ co-morbidities), or local (vicious surgical technique or the injuries produced by the disease that requires the anastomosis). Although there are many studies regarding the risk factors of anastomotic leaks, there is no consensus for the role played by each one of them in the healing process of digestive sutures. Most authors sustain that the importance of systemic factors is secondary, the main role being played by the surgeon and the local conditions of the anastomosis. Knowledge of the risk factors can lead to new methods of reducing the incidence of anastomotic leaks by improving vascularization, limiting the tension and the duration of surgery, and by new surgical techniques used for digestive sutures.
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Affiliation(s)
- Alexandra Caziuc
- 1 Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - George Calin Dindelegan
- 1 Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurel Mironiuc
- 1 Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Boström P, Haapamäki MM, Matthiessen P, Ljung R, Rutegård J, Rutegård M. High arterial ligation and risk of anastomotic leakage in anterior resection for rectal cancer in patients with increased cardiovascular risk. Colorectal Dis 2015; 17:1018-27. [PMID: 25851151 DOI: 10.1111/codi.12971] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/04/2015] [Indexed: 12/15/2022]
Abstract
AIM Controversy still exists as to whether division of the inferior mesenteric artery close to the aorta influences the risk of anastomotic leakage after anterior resection for rectal cancer. This population-based study was carried out to evaluate the independent association between high arterial ligation and anastomotic leakage in patients with increased cardiovascular risk. METHOD All 2673 cases of registered anterior resection for rectal cancer from 2007 to 2010 were identified from the Swedish Colorectal Cancer Registry and cross-referenced with the Prescribed Drugs Registry, rendering a cohort of all patients with increased cardiovascular risk. Operative charts and registered data were reviewed for 722 patients. The association between high tie and anastomotic leakage, as quantified by ORs and 95% CIs, was evaluated in a logistic regression model, with adjustment for confounding, including assessment of interaction. RESULTS Symptomatic anastomotic leakage occurred in 12.3% (41/334) of patients in the high tie group and in 10.6% (41/388) in the low tie group. The use of high tie was not independently associated with a higher risk of anastomotic leakage (OR = 1.05; 95% CI: 0.61-1.84). In a post-hoc analysis, patients with a history of manifest cardiovascular disease and American Society of Anesthesiologists (ASA) score III-IV seemed to be at greater risk (OR = 3.66; 95% CI: 1.04-12.85). CONCLUSION In the present population-based, observational setting, high tie was not independently associated with an increased risk of symptomatic anastomotic leakage after anterior resection for rectal cancer. However, this conclusion may not hold for patients with severe cardiovascular disease.
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Affiliation(s)
- P Boström
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - M M Haapamäki
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - P Matthiessen
- Department of Surgery, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - R Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Rutegård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - M Rutegård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Ostenfeld EB, Erichsen R, Baron JA, Thorlacius-Ussing O, Iversen LH, Riis AH, Sørensen HT. Preadmission glucocorticoid use and anastomotic leakage after colon and rectal cancer resections: a Danish cohort study. BMJ Open 2015; 5:e008045. [PMID: 26408282 PMCID: PMC4593143 DOI: 10.1136/bmjopen-2015-008045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine whether preadmission glucocorticoid use increases the risk of anastomotic leakage after colon and rectal cancer resections. DESIGN A population-based cohort study. SETTING Denmark (2001-2011). PARTICIPANTS We identified patients who had undergone a primary anastomosis after a colorectal cancer resection by linking medical registries. Participants who filled their most recent glucocorticoid prescription ≤90, 91-365 and >365 days before their surgery date were categorised as current, recent and former users, respectively. MAIN OUTCOME MEASURES We calculated 30-day absolute risk of anastomotic leakage and computed ORs using logistic regression models with adjustment for potential confounders. RESULTS Of the 18,190 patients with colon cancer, anastomotic leakage occurred in 1184 (6.5%). Glucocorticoid use overall was not associated with an increased risk of leakage (6.4% vs 6.9% among never-users; OR 1.05; 95% CI 0.89 to 1.23). Categories of oral, inhaled or intestinal-acting glucocorticoids did not greatly affect risk of leakage. Anastomotic leakage occurred in 695 (13.2%) of 5284 patients with rectal cancer. Glucocorticoid use overall slightly increased risk of leakage (14.6% vs 12.8% among never-users; OR 1.36, 95% CI 1.08 to 1.72). Results did not differ significantly within glucocorticoid categories. CONCLUSIONS Preadmission glucocorticoids modestly increased the risk of anastomotic leakage mainly after rectal cancer resection. However, absolute risk differences were small and the clinical impact of glucocorticoid use may therefore be limited.
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Affiliation(s)
- Eva Bjerre Ostenfeld
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - John A Baron
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Anders H Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
Stricture and fistula are common complications of Crohn's disease. Endoscopic balloon dilation and needle-knife stricturotomy has become a valid treatment option for Crohn's disease-associated strictures. Endoscopic therapy is also increasingly used in Crohn's disease-associated fistula. Preprocedural preparations, including routine laboratory testing, imaging examination, anticoagulant management, bowel cleansing and proper sedation, are essential to ensure a successful and safe endoscopic therapy. Adverse events, such as perforation and excessive bleeding, may occur during endoscopic intervention. The endoscopist should be well trained, always be cautious, anticipate for possible procedure-associated complications, be prepared for damage control during endoscopy, and have surgical backup ready. In this review, we discuss the principle, preparation, techniques of endoscopic therapy, as well as the prevention and management of endoscopic procedure-associated complications. We propose that inflammatory bowel disease endoscopy may be a part of training for "super" gastroenterology fellows, i.e., those seeking a career in advanced endoscopy or in inflammatory bowel disease.
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Compression anastomotic ring-locking procedure (CARP) is a safe and effective method for intestinal anastomoses following left-sided colonic resection. Int J Colorectal Dis 2015; 30:969-75. [PMID: 25989929 DOI: 10.1007/s00384-015-2257-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Compression anastomotic ring-locking procedure (CARP) is a novel procedure for creating colonic anastomoses. The surgical procedure allows perioperative quantification of the compression pressure between the intestinal ends within the anastomosis and postoperative monitoring of the anastomotic integrity. We have recently shown that CARP is a safe and effective method for colonic anastomoses in pigs, and the purpose of the present study was to evaluate CARP for colonic anastomoses in humans. MATERIALS AND METHODS This is a prospective study on 25 patients undergoing elective left-sided colonic resection. Time for evacuation of the anastomotic rings, perioperative compression pressure, and adverse effects were recorded. Postoperative blood samples were collected daily, and flexible sigmoidoscopy was performed 8-12 weeks after surgery to examine the anastomoses. RESULTS Fourteen out of 25 patients underwent CARP. CARP was not used in 11 patients due to advanced tumor disease (two cases) and size restrictions (nine cases). No case of anastomotic leakage, bowel obstruction, or stenosis formation was observed. No device-related perioperative adverse events were noted. The surgical device evacuated spontaneously in all patients by the natural route after a median of 10 days. Perioperative compression pressure ranged between 85 and 280 mBar (median 130 mBar). Flexible sigmoidoscopy revealed smooth anastomoses without signs of pathological inflammation or stenosis in all cases. CONCLUSION Our results indicate that the novel suture-less CARP is a safe and effective method for creating colonic anastomoses. Further studies are warranted in larger patient populations to compare CARP head-on-head with stapled and/or hand-sewn colonic anastomoses.
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Kotzampassi K, Stavrou G, Damoraki G, Georgitsi M, Basdanis G, Tsaousi G, Giamarellos-Bourboulis EJ. A Four-Probiotics Regimen Reduces Postoperative Complications After Colorectal Surgery: A Randomized, Double-Blind, Placebo-Controlled Study. World J Surg 2015; 39:2776-83. [DOI: 10.1007/s00268-015-3071-z] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Marshall JK, Lindner P, Tait N, Maddocks T, Riepsamen A, van der Linden J. Intra-operative tissue oxygen tension is increased by local insufflation of humidified-warm CO2 during open abdominal surgery in a rat model. PLoS One 2015; 10:e0122838. [PMID: 25835954 PMCID: PMC4383325 DOI: 10.1371/journal.pone.0122838] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/20/2015] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Maintenance of high tissue oxygenation (PtO2) is recommended during surgery because PtO2 is highly predictive of surgical site infection and colonic anastomotic leakage. However, surgical site perfusion is often sub-optimal, creating an obstructive hurdle for traditional, systemically applied therapies to maintain or increase surgical site PtO2. This research tested the hypothesis that insufflation of humidified-warm CO2 into the abdominal cavity would increase sub-peritoneal PtO2 during open abdominal surgery. MATERIALS AND METHODS 15 Wistar rats underwent laparotomy under general anesthesia. Three sets of randomized cross-over experiments were conducted in which the abdominal cavity was subjected to alternating exposure to 1) humidified-warm CO2 & ambient air; 2) humidified-warm CO2 & dry-cold CO2; and 3) dry-cold CO2 & ambient air. Sub-peritoneal PtO2 and tissue temperature were measured with a polarographic oxygen probe. RESULTS Upon insufflation of humidified-warm CO2, PtO2 increased by 29.8 mmHg (SD 13.3; p<0.001), or 96.6% (SD 51.9), and tissue temperature by 3.0°C (SD 1.7 p<0.001), in comparison with exposure to ambient air. Smaller, but significant, increases in PtO2 were seen in experiments 2 and 3. Tissue temperature decreased upon exposure to dry-cold CO2 compared with ambient air (-1.4°C, SD 0.5, p = 0.001). CONCLUSIONS In a rat model, insufflation of humidified-warm CO2 into the abdominal cavity during open abdominal surgery causes an immediate and potentially clinically significant increase in PtO2. The effect is an additive result of the delivery of CO2 and avoidance of evaporative cooling via the delivery of the CO2 gas humidified at body temperature.
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Affiliation(s)
- Jean K. Marshall
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia
- * E-mail:
| | - Pernilla Lindner
- Karolinska Institute, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
| | - Noel Tait
- Moruya District Hospital, Moruya, Australia
| | - Tracy Maddocks
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Angelique Riepsamen
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
| | - Jan van der Linden
- Karolinska Institute, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
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Vilhjalmsson D, Olofsson P, Syk I, Thorlacius H, Grönberg A. The compression anastomotic ring-locking procedure: a novel technique for creating a sutureless colonic anastomosis. Eur Surg Res 2014; 54:139-47. [PMID: 25531546 DOI: 10.1159/000368354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Compression anastomoses might represent an improvement over traditional hand-sewn or stapled techniques. Herein, we describe a novel concept of sutureless colonic anastomosis named compression anastomotic ring-locking procedure (CARP). MATERIALS AND METHODS The surgical device consists of two anastomotic rings and their associated helping tools, facilitating the placement of the rings into the intestinal ends. Furthermore, four catheters are connected to the surgical device, allowing the evaluation of the anastomosis during and after surgery. A total of 31 pigs underwent a low colocolic anastomosis using the anastomotic rings. The compression pressure was measured perioperatively and up to 96 h after surgery. Anastomotic integrity and morphology were analyzed by use of radiology and histology, respectively. A long-term follow-up was conducted in a subgroup of pigs up to 108 days after surgery when the bursting pressure and stricture formation were examined. RESULTS All animals recovered uneventfully, and macroscopic examination revealed intact anastomoses without signs of pathological inflammation or adhesions. The perioperative compression pressure was inversely proportional to the gap size between the anastomotic rings. For example, an anastomotic gap of 1.5 mm created a colonic anastomosis with a perioperative compression pressure of 91 mbar, which remained constant for up to 48 h and resulted in a markedly increased compression pressure. Contrast infusion via the catheters effectively visualized the anastomoses, and no leakage was detected within the study. The surgical device was spontaneously evacuated from the intestines within 6 days after surgery. Histology showed collagen bridging of the anastomoses already 72 h after surgery. Long-term follow-up (54-108 days) revealed no stricture formation in the anastomoses, and the bursting pressure ranged from 120 to 235 mbar. The majority of bursts (10/12) occurred distant from the anastomoses. CONCLUSION We conclude that the surgical device associated to CARP is safe and efficient for creating colonic anastomoses. Further studies in patients undergoing colorectal surgery are warranted.
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Affiliation(s)
- Dadi Vilhjalmsson
- Section of Surgery, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Endoscopy in the early postoperative setting after primary gastrointestinal anastomosis. J Gastrointest Surg 2014; 18:1911-6. [PMID: 25118643 DOI: 10.1007/s11605-014-2625-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/04/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Gastrointestinal anastomoses may require early evaluation and treatment via flexible endoscopic techniques when complications arise. There is reticence, however, to perform endoscopy given the applied mechanical forces. We aimed to identify the incidence of gastrointestinal anastomotic perforation or disruption resulting from endoscopy performed ≤6 weeks of anastomoses. METHODS Review of patients from 2002 to 2013 who underwent flexible endoscopy within 6 weeks of creation of gastrointestinal anastomosis. Exclusion criteria included intraoperative endoscopy, anastomotic perforation prior to endoscopy, and endoscopy remote from the anastomotic site. Data are presented as median (interquartile range; IQR) or percentages as appropriate. RESULTS Twenty-four patients met our criteria (age 69 years [IQR 54-77], 54% men]). Endoscopy was performed at a median postoperative time of 18 days (IQR 8-30). Indications for endoscopy included bleeding (66%), obstruction (13%), pain (13%), concern for pancreatic duct leak (4%), and concern for ischemia (4%). Six patients underwent therapeutic endoscopic procedures including coagulation (8%), balloon dilation (8%), tube decompression (8%), and stent placement (4%). There were no anastomotic perforations or disruptions as a result of endoscopy. CONCLUSION Despite theoretical risks of adverse events of flexible endoscopy in the early postoperative period, no endoscopic perforations or disruptions occurred in recently created surgical anastomoses.
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Perry T, Borowiec A, Dicken B, Fedorak R, Madsen K. Murine ileocolic bowel resection with primary anastomosis. J Vis Exp 2014:e52106. [PMID: 25406841 DOI: 10.3791/52106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn's disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.
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Affiliation(s)
- Troy Perry
- Department of Surgery, University of Alberta;
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Liu Z, Wang G, Yang M, Chen Y, Miao D, Muhammad S, Wang X. Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? World J Surg Oncol 2014; 12:306. [PMID: 25287418 PMCID: PMC4198793 DOI: 10.1186/1477-7819-12-306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/01/2014] [Indexed: 02/07/2023] Open
Abstract
Background The purpose of this study was to compare short-term clinical outcomes of ileocolonic functional end-to-end anastomosis (FEEA) and end-to-side anastomosis (ESA) following resection of the right colon for cancer. Methods We enrolled 379 patients who underwent ileocolonic anastomosis following resection of the right colon for cancer by a single surgeon, from January 2009 through June 2012. Patient characteristics, operative results, and postoperative complications were analyzed. Results A total of 164 patients received ESA and 215 patients received FEEA. The FEEA group had a lower incidence of anastomotic error (0.9% versus 4.3%; P = 0.04) and a shorter operating time (140.4 ± 14.9 min versus 150.5 ± 20.1 min; P = 0.001). The length of hospital stay (10.9 ± 3.5 days versus 11.3 ± 4.0 days; P = 0.36) and anastomotic leakage (1.8% versus 0.5%; P = 0.20) were similar in both groups. No relevant differences between FEEA and ESA were observed for blood loss, retrieved lymph nodes, first flatus and postoperative complications. Conclusion An FEEA after right hemicolectomy for colon cancer is a safe and reliable anastomotic technique, resulting in a favorable outcome in selected patients with the right colon cancer.
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Affiliation(s)
| | | | | | | | | | | | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, 150081 Harbin, China.
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Gandini M, Giusto G, Iotti B, Valazza A, Sammartano F. In vitro description of a new technique for stapled side-to-side jejunocecal anastomosis in horses and CT scan anatomical comparison with other techniques. BMC Vet Res 2014; 10 Suppl 1:S9. [PMID: 25238113 PMCID: PMC4122904 DOI: 10.1186/1746-6148-10-s1-s9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Stapled jejunocecal anastomoses are commonly performed in equine abdominal surgery. They carry higher complication rates compared to handsewn techniques. In human surgery various causes likely to lead to failure of stapled techniques have been evaluated, including staple line failure. Recently Freeman proposed a technique to perform a stapled jejunocecal anastomosis in horses while avoiding blind pouch formation. The aim of this study is to describe a method for stapled side-to-side jejunocecal anastomosis in horses and to compare it with other techniques with computed tomography to assess stomal area, shape and blind pouch size. Methods Intestinal specimens comprising the cecum, ileum and jejunum from 18 horses were collected and were divided into three groups. In Group S a standard stapled side-to-side jejunocecal anastomosis was performed. In Group F the anastomosis was performed using a modified technique proposed by Freeman. In Group G the anastomosis was performed with a modified technique proposed by the authors. Inflated bowel segments were CT scanned to obtain a MultiPlanar Reconstruction of the stoma and afferent small intestine before calculating the cross-sectional area of each of these regions. The ratio of the measured areas was compared between the three techniques. The volume of the blind-end pouch was measured and its ratio with the intestinal area compared between techniques. The cecum was opened and the length of the stoma measured with a caliper and compared to the intended initial length. Results The stomal/intestinal area ratio was not significantly different between techniques. No statistically significant difference was found in the stomal ideal/real perimeter ratio. There was no statistically significant difference in the intended/real stomal length ratio, and all techniques featured an increase in stomal length ranging from 2 to 12 %. Blind pouch formation was a consistent finding in Group S and was virtually absent in Groups F and G. Conclusions Both the Freeman and the new (G) technique were comparable to the standard technique in terms of stomal area, stomal shape and difference in stomal elongation. They consistently produced a smaller blind pouch and allowed easier placement of the staplers.
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Audett MC, Paquette IM. Intraoperative and postoperative diagnosis of anastomotic leak following colorectal resection. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sneider EB, Davids JS. Effect of chemotherapy, radiation, or immunosuppression on the integrity of the intestinal anastomosis. SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Ostenfeld EB, Erichsen R, Thorlacius-Ussing O, Riis AH, Sørensen HT. Pre-admission use of glucocorticoids and 30-day mortality following colorectal cancer surgery: a population-based Danish cohort study. Aliment Pharmacol Ther 2014; 39:843-53. [PMID: 24611938 DOI: 10.1111/apt.12667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous studies indicate that pre-admission glucocorticoids increase the risk of perioperative complications. AIM To examine whether pre-admission use of glucocorticoids affects 30-day mortality after colorectal cancer (CRC) surgery. METHODS We conducted a nationwide population-based cohort study by linking Danish medical registries. All residents in Denmark who underwent CRC surgery from 2001 to 2011 were included. We characterised subjects who filled their most recent glucocorticoid prescription ≤90, 91-365 and >365 days before their surgery date as prevalent, recent and former users, respectively. Prevalent users were subgrouped into new (first-ever prescription ≤90 days before surgery date) and continuing users. We estimated 30-day cumulative mortality by the Kaplan-Meier method and corresponding mortality rate ratios (MRRs) using Cox proportional hazard regression, adjusting for potential confounders. RESULTS Of the 34 641 CRC patients included, 3966 (11.5%) had filled one or more prescriptions of glucocorticoids within the year before the surgery date. Thirty-day mortality among prevalent users of oral glucocorticoids was 15.0% vs. 7.3% among non-users [MRR = 1.28; 95% confidence interval (CI): 1.03, 1.58]. Among new users, the 30-day mortality was 17.8% (MRR = 1.92; 95% CI: 1.30, 2.83) while it was 14.2% among continuing users (MRR = 1.13; 95% CI: 0.88, 1.44). No associations were found for recent or former use of oral glucocorticoids nor for use of inhaled, intestinal-acting, and mixed glucocorticoids. CONCLUSIONS Prevalent use, particulary new use, of oral glucocorticoids was associated with markedly increased 30-day mortality after colorectal cancer surgery compared to patients not exposed to any glucocorticoids.
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Affiliation(s)
- E B Ostenfeld
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
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Elasticity and geometry: a computational model of the Heineke–Mikulicz strictureplasty. Biomech Model Mechanobiol 2014; 13:1185-98. [DOI: 10.1007/s10237-014-0565-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/21/2014] [Indexed: 12/25/2022]
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Rolph R, Duffy JMN, Alagaratnam S, Ng P, Novell R. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev 2004; 2004:CD002100. [PMID: 15495028 PMCID: PMC8437749 DOI: 10.1002/14651858.cd002100.pub2] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is little agreement on prophylactic use of drains in anastomoses in elective colorectal surgery despite many randomized clinical trials. Results of these trials are contradictory, quality and statistical power of these individual studies have been questioned. Once anastomotic leakage has occurred it is generally agreed that drains should be used for therapeutic purposes. However, on prophylactic use no such agreement exists. OBJECTIVES Comparison of safety and effectiveness of routine drainage and non-drainage regimes after colorectal surgery. The following hypothesis was tested: The use of prophylactic anastomotic drainage after elective colorectal surgery does not prevent development of complications. SEARCH STRATEGY The studies were identified from CINAHL, EMBASE, LILACS, MEDLINE, Controlled Clinical Trials Database, Trials Register of the Cochrane Colorectal Cancer Group, reference lists. SELECTION CRITERIA Randomized controlled trials comparing drainage with non-drainage regimes after anastomoses in elective colorectal surgery were reviewed. Outcome measures were: 1. mortality; 2. clinical anastomotic dehiscence; 3. radiological anastomotic dehiscence; 4. wound infection; 5. reoperation; 6. extra-abdominal complications. DATA COLLECTION AND ANALYSIS Data were independently extracted and cross-checked by the two reviewers. The methodological quality of each trial was assessed. Details of the randomization (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The RCTs were stratified based on experimental group, according to clinical homogeneity (external validity). MAIN RESULTS Of the 1140 patients enrolled (6 RCTs), 573 were allocated for drainage and 567 for no drainage. The patients assigned to the drainage group compared with the ones assigned to non-drainage group showed: a) Mortality: 3% (18 of 573 patients) compared with 4% (25 of 567 patients); b) Clinical anastomotic dehiscence: 2% (11 of 522 patients) compared with 1% (7 of 519 patients); c) Radiological anastomotic dehiscence: 3% (16 of 522 patients) compared with 4% (19 of 519 patients); d) Wound infection: 5% (29 of 573 patients) compared with 5% (28 of 567 patients); e) Reintervention: 6% (34 of 542 patients) compared with 5% (28 of 539 patients); f) Extra abdominal complications: 7% (34 of 522 patients) compared with 6% (32 of 519 patients). REVIEWERS' CONCLUSIONS There is insufficient evidence showing that routine drainage after colorectal anastomoses prevents anastomotic and other complications.
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Affiliation(s)
- Rachel Rolph
- Guys and St Thomas' NHS Foundation TrustDepartment of Plastic and Reconstructive SurgeryWestminster Bridge RoadLondonUKSE1 7EH
| | - James MN Duffy
- Balliol College, University of OxfordiHOPE: International Collaboration to Harmonise Outcomes for Pre‐eclampsiaOxfordOxfordshireUKOX2 6NW
| | - Swethan Alagaratnam
- Royal Free HospitalDepartment of Colorectal SurgeryPond StreetLondonUKNW3 2QG
| | - Paul Ng
- St Thomas' HospitalDepartment of Colorectal SurgeryLondonUK
| | - Richard Novell
- Royal Free HospitalUniversity Department of Colorectal SurgeryPond StreetLondonUK
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