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Bertucci Zoccali M, Fichera A. Anastomotic Techniques for Abdominal Crohn's Disease: Tricks and Tips. J Laparoendosc Adv Surg Tech A 2021; 31:861-866. [PMID: 34265213 DOI: 10.1089/lap.2020.1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
After surgical resection for Crohn's disease (CD) endoscopic recurrence is noted within few weeks and almost 80% of patients will have evidence of endoscopic recurrence at the anastomosis after ileocolic resection at 1 year. With time and if left untreated surgical recurrence will be detected at the preanastomotic segment or at the anastomosis in the vast majority of cases. It has become progressively apparent also based on these historical data that anastomotic configuration plays a major role in the subsequent recurrence of CD in surgically induced remission. In this article, we will review the evidence in the literature to support the different anastomotic configurations and we will discuss the principles of surgical prophylaxis of CD recurrence.
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Affiliation(s)
- Marco Bertucci Zoccali
- Division of Colon and Rectal Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
| | - Alessandro Fichera
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA
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Weledji EP, Mokake MD, Sinju M. Segmental resection with primary anastomosis is not always safe in splenic flexure perforation. BMC Res Notes 2016; 9:27. [PMID: 26774506 PMCID: PMC4715276 DOI: 10.1186/s13104-016-1841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 01/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Familial adenomatous polyposis (FAP) is caused by a rare mutation of the adenomatous polyposis coli gene on Chromosome 5q. The risk of colorectal cancer in patients with FAP is nearly 100% and intensive endoscopic surveillance or prophylactic colectomy are mandatory. If extensive endoscopic surveillance is chosen, there is a cumulative risk of perforation and bleeding especially after polypectomy. We discussed the problems and options in the management of the late diagnosis of an iatrogenic perforation of the splenic flexure complicating endoscopic surveillance in FAP. CASE PRESENTATION We present a 35-year-old black African man with FAP who sustained a splenic flexure perforation following a colonoscopic polypectomy of a suspicious lesion. He underwent a splenic flexure resection and primary anastomosis that dehisced and the patient benefited from an emergency definitive colectomy and ileorectal anastomosis. CONCLUSIONS Resection with primary anastomosis following iatrogenic perforation of the splenic flexure is not safe because of a high chance of anastomotic dehiscence. Following a late diagnosis in an unstable patient exteriorization of the perforation as a stoma is a better option prior to a definitive prophylactic colectomy.
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Affiliation(s)
- Elroy P Weledji
- Faculty of Health Sciences, University of Buea, P.O. Box 126, Limbe, S.W. Region, Buea, Cameroon. .,Regional Hospital Buea, S.W. Region, Buea, Cameroon.
| | - Martin D Mokake
- Faculty of Health Sciences, University of Buea, P.O. Box 126, Limbe, S.W. Region, Buea, Cameroon. .,Regional Hospital Buea, S.W. Region, Buea, Cameroon.
| | - Motaze Sinju
- Faculty of Health Sciences, University of Buea, P.O. Box 126, Limbe, S.W. Region, Buea, Cameroon.
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Snowdon KA, Smeak DD, Chiang S. Risk Factors for Dehiscence of Stapled Functional End-to-End Intestinal Anastomoses in Dogs: 53 Cases (2001-2012). Vet Surg 2015; 45:91-9. [PMID: 26565990 DOI: 10.1111/vsu.12413] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify risk factors for dehiscence in stapled functional end-to-end anastomoses (SFEEA) in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 53) requiring an enterectomy. METHODS Medical records from a single institution for all dogs undergoing an enterectomy (2001-2012) were reviewed. Surgeries were included when gastrointestinal (GIA) and thoracoabdominal (TA) stapling equipment was used to create a functional end-to-end anastomosis between segments of small intestine or small and large intestine in dogs. Information regarding preoperative, surgical, and postoperative factors was recorded. RESULTS Anastomotic dehiscence was noted in 6 of 53 cases (11%), with a mortality rate of 83%. The only preoperative factor significantly associated with dehiscence was the presence of inflammatory bowel disease (IBD). Surgical factors significantly associated with dehiscence included the presence, duration, and number of intraoperative hypotensive periods, and location of anastomosis, with greater odds of dehiscence in anastomoses involving the large intestine. CONCLUSION IBD, location of anastomosis, and intraoperative hypotension are risk factors for intestinal anastomotic dehiscence after SFEEA in dogs. Previously suggested risk factors (low serum albumin concentration, preoperative septic peritonitis, and intestinal foreign body) were not confirmed in this study.
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Affiliation(s)
- Kyle A Snowdon
- College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Daniel D Smeak
- College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Sharon Chiang
- Department of Statistics, Rice University, Houston, Texas
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Kopelman D, Hatoum OA, Kimmel B, Monassevitch L, Nir Y, Lelcuk S, Rabau M, Szold A. Compression gastrointestinal anastomosis. Expert Rev Med Devices 2014; 4:821-8. [DOI: 10.1586/17434440.4.6.821] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sajid MS, Siddiqui MRS, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst Rev 2012; 1:CD005477. [PMID: 22258964 DOI: 10.1002/14651858.cd005477.pub4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gastrointestinal anastomosis (GIA) is an essential step to maintain the continuity of gastrointestinal tract following intestinal resection. GIA is still a source of significant controversy among surgeons due to the use of variety of approaches. Adequate apposition by single layer or double layer anastomosis may affect outcome after GIA OBJECTIVES: The objective of this review is to compare the effectiveness of single layer GIA (SGIA) versus double layer GIA (DGIA) being used in general surgery. The particular question we would attempt to answer will be; is single layer hand made GIA in surgical patients is as effective as double layer? SEARCH METHODS The CCCG (Colorectal Cancer Cochrane Group) Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 1, 2011), MEDLINE (until April 2011) , EMBASE ( The Intelligent Gateway to Biomedical & Pharmacological Information until April 2011), LILACS (The Latin American and Caribbean Health Sciences Library until April 2011 ) and Science Citation Index Expanded (SCI-E until April 2011) using the medical subject headings (MeSH) terms were searched without date, language or age restrictions. SELECTION CRITERIA Randomised, controlled trials comparing the effectiveness of SGIA versus DGIA DATA COLLECTION AND ANALYSIS: At least two review authors independently scrutinised search results, selected eligible studies and extracted data. MAIN RESULTS Seven randomised, controlled trials encompassing 842 patients undergoing SGIA versus DGIA were retrieved from the electronic databases. There were 408 patients in the SGIA group and 432 patients in the DGIA group. All included studies were small, with sample sizes ranging from 60 to 172. There was no heterogeneity among the included trials. Therefore, in the fixed effects model, incidence of anastomotic dehiscence, peri-operative complications and mortality was statistically equivalent between two techniques of GIA. Average hospital stay following SGIA and DGIA was also comparable. However, SGIA was superior in terms of shorter operative time. Sensitivity analysis of relatively good quality and poor quality trials supported same conclusion. AUTHORS' CONCLUSIONS SGIA can be performed quicker as compared to double layer GIA. SGIA is comparable to DGIA in terms of anastomotic leak, peri-operative complications, mortality and hospital stay. SGIA may routinely be used for GIA following bowel resection. However, since this conclusion is derived from smaller number of patients recruited in relatively moderate quality trials, further trials should be aimed to reduce the limitations of this review.
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Abstract
AIM The aim of the retrospective study was to evaluate complications and outcome of children in whom an intestinal anastomosis had been performed at age younger than 1 year. PATIENTS AND METHODS Data were collected both retrospectively and by interviewing the parents. For the retrospective analysis, the underlying disease, biometric data, technical information about the anastomoses, associated illnesses, and complications were evaluated. In the parent interviews, the present quality of life and the state of health of the children were evaluated. RESULTS From 1997 to 2007, intestinal anatomoses had been performed in 131 children for various reasons. There were no complications in 81.7% of the patients; 17 children received reoperation. In only 5 cases were anastomotic complications the reasons for the reoperation. Only 7.3% of the 77 interviewed families believe that their child has severe or relevant restrictions in daily life. CONCLUSIONS Among 131 children in whom an intestinal bowel anastomosis procedure was performed at age younger than 1 year, only 5 (3.2%) experienced complications associated with the anastomosis. The children are in good physical condition and have an excellent quality of life.
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Santos CL, Abílio EJ, Oliveira ALDA, Mariano CMA, Nunes AT, Cravalho ECQD. Estudo comparativo entre as técnicas de sutura total e serosubmucosa em anastomoses colônicas na presença de um protetor intraluminar em cães. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a cicatrização comparando as técnicas de sutura total e parcial em anastomoses colônicas término-terminais na presença de um protetor intraluminar confeccionado a partir de um dreno de Penrose. MÉTODOS: Foram realizadas anastomoses colônicas em 10 cães nos quais foi suturado a mucosa / submucosa um protetor intraluminar por meio da eversão do segmento intestinal proximal em 10 cm. Os animais foram distribuidos em dois grupos experimentais: Grupo 1 - sutura total e Grupo 2 - sutura serosubmucosa. Os animais foram reoperados com sete dias de pós-operatório para coleta de material e subseqüente análise histopatológica. RESULTADOS: Observamos no exame histopatológico das anastomoses realizadas com sutura serosubmucosa (Grupo 2) uma melhor cicatrização caracterizada por um menor infiltrado inflamatório e por uma maior integridade das camadas intestinais quando comparadas com o Grupo 1. CONCLUSÃO: O uso da técnica de sutura parcial mostrou-se superior a de sutura total nas anastomoses colônicas na presença de protetor intraluminar.
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Stumpf M, Klinge U, Mertens PR. [Anastomotic leakage in the gastrointestinal tract-repair and prognosis]. Chirurg 2005; 75:1056-62. [PMID: 15580329 DOI: 10.1007/s00104-004-0956-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Anastomotic leakage is still a serious complication in surgery, resulting in increased morbidity and mortality. The reasons for its onset are various and due to two main reasons: general risk factors of the individual patient and technical surgical factors influencing the outcome after gastrointestinal anastomoses. Changes in the extracellular matrices, particularly due to collagen metabolism, and related disturbances are assumed to be important factors influencing wound healing processes. The technique chosen and the surgical skill are important with regard to inflammation and tissue necroses at the anastomotic line. Analysis of data obtained by clinical studies that concern clinical risk factors for anastomotic leakage reveal an inhomogeneous picture. Attempts to develop risk profiles or scores based on these results have failed until now. Problems encompass the complexity of wound healing processes, and it is questionable whether our current knowledge about them is complete. Therefore, profound understanding of anastomotic leakage requires in-depth analysis of the interaction of extracellular matrix components. Preliminary results indicate the presence of a risk population with collagen metabolism disturbances that have a major effect on wound healing after gastrointestinal anastomosis.
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Affiliation(s)
- M Stumpf
- Chirurgische Klinik, Universitätsklinikum der RWTH Aachen.
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Abstract
BACKGROUND The single-layer appositional serosubmucosal anastomosis is a well established technique and appears to have a favourable record. Over a 15-year period the senior author of this paper has performed or directly supervised 553 anastomoses using this technique. This report describes the results of these operations, the results of stapled anastomoses carried out during the same period and discusses the utility of the handsewn technique. METHODS From August 1986 to July 2001, 553 intestinal anastomoses in 550 patients were fashioned using single-layer, interrupted serosubmucosal 3/0 braided polyamide and 131 anastomoses in 131 patients were performed using a circular anastomosing stapler. RESULTS One anastomotic leakage occurred in the group of patients whose anastomosis was handsewn (0.2%) and 11 leaks occurred in those who had a stapled anastomoses (8.4%). The mortality rate in each group was similar (2% and 2.3%, respectively). There were no deaths attributable to anastomotic dehiscence in either group. CONCLUSION In this prospectively audited series of 553 handsewn anastomoses the leakage rate was 0.2%. These results compare favourably with other published series and continue to support a single layer of interrupted serosubmucosal sutures as the gold standard for anastomoses involving the large or small bowel.
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Affiliation(s)
- A Leslie
- Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK.
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Saad SS, Matos D. Estudo clínico comparativo entre anastomose colocólica com anel anastomótico biofragmentável e com sutura manual não absorvível. Rev Col Bras Cir 2000. [DOI: 10.1590/s0100-69912000000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A anastomose com sutura é método consagrado, apresentando desvantagens teóricas representadas pelo trauma tecidual, edema e alteração da microcirculação. Além disso, o fio de sutura, sendo corpo estranho, determina reação inflamatória, propiciando a aderência e a proliferação de bactérias, assim como de células neoplásicas que seriam evitadas ao se usar método de anastomose sem sutura. A procura por método de anastomose em que não se utilizasse fio de sutura vem sendo realizada desde o início deste século. Com o advento das novas aquisições tecnológicas foi desenvolvido método de anastomose sem sutura através do anel biofragmentável. Esse anel sofre desintegração por hidrólise, sendo eliminado com a evacuação, não permanecendo corpo estranho na anastomose. Esse instrumento permite a realização de anastomose sem sutura, por meio da compressão das paredes intestinais justapostas. O objetivo desse estudo prospectivo e casualizado, foi o de comparar os resultados clínicos e endoscópicos de anastomoses colocólicas, eletivas e de baixo risco, realizadas com anel biofragmentável e com fio de sutura não absorvível. CASUÍSTICA E MÉTODOS: A casuística foi composta por 36 doentes, divididos em dois grupos de 18, que foram denominados Grupo I (anel biofragmentável ) e Grupo II (sutura com fio não absorvível ), constituídos de doentes comparáveis. RESULTADOS: Os parâmetros de avaliação do período intra-operatório, revelaram que a anastomose com anel biofragmentável despende menor tempo para sua realização. Não se detectou diferença estatisticamente significante entre os dois grupos com relação à incidência de complicações pós-operatórias, mortalidade e avaliação clínica ambulatorial. A incidência de deiscência anastomótica só ocorreu no Grupo I. A análise endoscópica da anastomose no período pós-operatório não demonstrou diferença quanto à perviedade, contratilidade, elasticidade e grau de epitelização. O Grupo II apresentou maior incidência de fio de sutura na anastomose em relação ao Grupo I sendo esta diferença estatística significante. CONCLUSÕES: O anel biofragmentável permite a realização de anastomose de colo mais rápida do que aquela realizada com fio de sutura. Este método de anastomose determinou, na análise global da complicações clínicas, resultados semelhantes ao uso de fio de sutura. O método de anastomose sem sutura apresentou o inconveniente de determinar maior incidência de deiscência anastomótica e como vantagem estabeleceu presença de corpo estranho na anastomose em menor porcentagem.
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11
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Abstract
Leakage is a problem largely confined to anastomoses within 6 cm of the anal verge when optimal surgical technique is exercised. At such low levels, most surgeons now use a combination of linear and circular staplers. The Moran Triple Stapling Technique is our chosen method. Most recently, the simultaneous use of two linear staplers to seal the specimen and wash the distal stump is a rapid technique for anastomosis onto the dentate line within the external sphincter. Proximal defunctioning and the short colon pouch with side-to-end colo-anal anastomosis are currently considered optimal. A trial is under way to assess a silastic transanal stent as an alternative. Ultra-low anastomosis, however, remains potentially hazardous and still should be undertaken only by specialists.
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Affiliation(s)
- B Moran
- North Hampshire Hospitals Trust, The North Hampshire Hospital, Basingstoke, Hampshire, United Kingdom
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Benoist S, Panis Y, Alves A, Valleur P. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 2000; 179:275-81. [PMID: 10875985 DOI: 10.1016/s0002-9610(00)00337-8] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the impact of obesity on surgical outcomes after colorectal resection is not well known, this study was designed to compare the results of colorectal resection in obese and nonobese patients. METHODS From 1990 to 1997, 584 consecutive patients underwent elective colorectal resection in our department. Of these, 158 (27%) were obese (body mass index >27). Obese and nonobese patients were well matched for demographic data and surgical procedures. RESULTS After right or left colectomy, no difference was noted between obese and nonobese patients for overall mortality, morbidity, or leakage rates. However, after left colectomy, postoperative intra-abdominal collections requiring treatment were significantly more frequent in obese than in nonobese patients (10% versus 2%; P <0.05). After proctectomy, the mortality rate was 5% (3 of 61) among obese patients and 0.5% (1 of 185) among nonobese patients (P <0.02). The anastomotic leakage rate was 16% (5 of 58) for obese patients and 6% (11 of 169) for nonobese patients (P <0. 05), and the corresponding proportions of transfused patients were 43% and 19%, respectively (P <0.02). After proctectomy, multivariate analysis showed that for obese patients, diabetes mellitus (P <0.05) and American Society of Anesthesiologists (ASA) status >2 (P <0.05) were significant risk factors for anastomotic leakage; age >60 years (P <0.01) and ASA status >2 (P <0.05) were significant risk factors for perioperative blood transfusions. CONCLUSIONS Our study suggested that, for obese patients, (1) right colectomy can be performed in the same manner as for nonobese patients; (2) after left colectomy, abdominal drainage may be indicated, and (3) after proctectomy, a defunctioning stoma should be recommended when diabetes mellitus or ASA status >2 is present, and an autologous blood transfusion could be discussed for patients >60 years old or with ASA status >2.
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Affiliation(s)
- S Benoist
- Department of Surgery, Lariboisière Hospital, Paris, France
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Pickleman J, Watson W, Cunningham J, Fisher SG, Gamelli R. The failed gastrointestinal anastomosis: an inevitable catastrophe? J Am Coll Surg 1999; 188:473-82. [PMID: 10235574 DOI: 10.1016/s1072-7515(99)00028-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is a great deal of conflicting data regarding risk factors for anastomotic leakage, with most studies being small and looking only at anastomoses performed at one level of the gastrointestinal (GI) tract. Surgeons have looked at patient and technical variables with inconsistent findings. The purpose of this study was to evaluate the incidence, possible predictive factors, and results of treatment of anastomotic dehiscence in patients undergoing operations at all levels of the GI tract. STUDY DESIGN We evaluated the records of 2,842 patients undergoing esophagogastrectomy, total or partial gastrectomy, enterectomy, and partial or subtotal colectomy over a 12-year period. Complete demographic data, comorbidity, and details regarding anastomotic technique were collected on all patients sustaining leaks along with diagnostic methods used, treatment modalities, and outcomes data. Using age and gender-matched case control methodology, we compared patients sustaining an anastomotic leak to those undergoing successful anastomoses. RESULTS Fifty-one of 2,842 patients (1.8%), ranging from 1.1% of enterectomy patients to 4.8% of total gastrectomy patients, sustained an anastomotic dehiscence. Foregut procedures were accompanied by a significantly increased rate of leakage, and depending on location, diagnosis was made between the 6th and 9th postoperative day. For each procedure, deaths from factors other than leakage far exceeded deaths from leaks. Standard risk stratifiers did not predict occurrence of leakage. Overall, 24% of patients sustaining a leak died, and this complication necessitated multiple reoperations and significantly increased length of hospital stay. CONCLUSIONS In view of these findings, standard preoperative strategies to prepare these patients for operation may prove unsuccessful, because minimizing the incidence of anastomotic leaks will have little overall impact on survival. In addition, efforts to accomplish early hospital discharge may prove hazardous, because many of these patients manifest their leaks later in the postoperative period than is generally assumed. Improved management of GI tract disruption, including aggressive attempts at diagnosis, ICU care, antibiotics, and nutritional support may further increase survival in these patients.
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Affiliation(s)
- J Pickleman
- Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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Edwards DP, Warren BF, Galbraith KA, Watkins PE. Comparison of two closure techniques for the repair of experimental colonic perforations. Br J Surg 1999; 86:514-7. [PMID: 10215827 DOI: 10.1046/j.1365-2168.1999.01070.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary repair of penetrating wounds of the colon is gaining increasing acceptance in surgical practice. This study compared two techniques for the repair of experimental colonic perforations in the presence of peritonitis. METHODS Multiple colonic perforations were created in the colon of 24 pigs. Following a 6-h delay the perforations were closed either by local excision and suture or by skin staples applied to the seromuscular layers of the colon. The repairs were assessed biomechanically and histologically for up to 14 days after surgery. RESULTS All animals had diffuse peritonitis at the time of colonic repair. Stapled repairs were completed significantly faster than sutured repairs (mean(s.d.) 4.8(1.6) versus 30.7(4.0) min, P < 0.001). Bio- mechanical evaluation of repairs revealed no significant differences between the two techniques. Histological examination of repairs closed by staples demonstrated more advanced healing compared with suture closure, on the basis of tissue apposition and inflammatory changes. CONCLUSION Experimental colonic injuries may be treated successfully by primary repair in the presence of peritonitis. The use of skin staples for repair does not appear to prejudice colonic wound healing.
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Affiliation(s)
- D P Edwards
- Biomedical Sciences, CBD Porton Down, Salisbury, UK
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Lima SV, Araujo LA, Vilar FO, Kummer CL, Lima EC. How to perform enterocystoplasty without opening the intestine. Urology 1996; 47:269-71; discussion 271-2. [PMID: 8607252 DOI: 10.1016/s0090-4295(99)80434-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To introduce a new technique for intestinal anastomosis when performing demucosalized enterocystoplasty. METHODS In 8 dogs, a vascularized seromuscular patch of sigmoid colon was harvested without opening the bowel lumen. The bowel mucosa was invaginated into the intestinal lumen and the sigmoid musculature was reapproximated. Twelve patients underwent a nonsecretory sigmoid cystoplasty following the same principle. RESULTS No complications occurred in the experimental animals. The animals were fed normally starting on the first postoperative day. Prolapse of the excess mucosa occurred in 3 cases and disappeared spontaneously. In the clinical group, the postoperative course was normal. Oral intake was resumed on the first day after the operation. The hospital stay was shorter than that of patients in whom the bowel lumen was opened. CONCLUSIONS The use of demucosalized intestinal patches without opening the intestinal lumen appears to be feasible and is expected to reduce perioperative morbidity. Extensive bowel preparation can be reduced, as can the prophylactic use of antibiotics.
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Affiliation(s)
- S V Lima
- Department of Surgery, Federal University of Pernambuco and Hospital Infantil Manoel Almeida, Recife, Brazil
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Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81:1224-6. [PMID: 7953369 DOI: 10.1002/bjs.1800810850] [Citation(s) in RCA: 412] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11.0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6.4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6 cm (P = 0.08). The abdominoperineal excision rate was 9.1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0.03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0.002), and three died (P = 0.02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0.05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors include: a clean dry pelvic cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.
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Affiliation(s)
- N D Karanjia
- Colorectal Research Unit, Basingstoke District Hospital, UK
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Steele RJ. Continuous single-layer serosubmucosal anastomosis in the upper gastrointestinal tract. Br J Surg 1993; 80:1416-7. [PMID: 8043055 DOI: 10.1002/bjs.1800801120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a 4-year period, 100 anastomoses in the upper gastrointestinal tract were fashioned using a single serosubmucosal layer of continuous polydioxanone. One patient required revisional surgery because of anastomotic stricture after partial gastrectomy, but there was no other complication related to the anastomosis. This technique is simple, safe, and quick to perform.
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Affiliation(s)
- R J Steele
- Department of Surgery, University of Nottingham, UK
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