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Ghosh NK, Kumar A. Ultra-minimally invasive endoscopic techniques and colorectal diseases: Current status and its future. Artif Intell Gastrointest Endosc 2024; 5:91424. [DOI: 10.37126/aige.v5.i2.91424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 05/11/2024] Open
Abstract
Colorectal diseases are increasing due to altered lifestyle, genetic, and environmental factors. Colonoscopy plays an important role in diagnosis. Advances in colonoscope (ultrathin scope, magnetic scope, capsule) and technological gadgets (Balloon assisted scope, third eye retroscope, NaviAid G-EYE, dye-based chromoendoscopy, virtual chromoendoscopy, narrow band imaging, i-SCAN, etc.) have made colonoscopy more comfortable and efficient. Now in-vivo microscopy can be performed using confocal laser endomicroscopy, optical coherence tomography, spectroscopy, etc. Besides developments in diagnostic colonoscopy, therapeutic colonoscopy has improved to manage lower gastrointestinal tract bleeding, obstruction, perforations, resection polyps, and early colorectal cancers. The introduction of combined endo-laparoscopic surgery and robotic endoscopic surgery has made these interventions feasible. The role of artificial intelligence in the diagnosis and management of colorectal diseases is also increasing day by day. Hence, this article is to review cutting-edge developments in endoscopic principles for the management of colorectal diseases.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Zhang MM, Sha HC, Xue HR, Qin YF, Dong FF, Zhang L, Lyu Y, Yan XP. Treatment of anastomotic stricture after rectal cancer operation by magnetic compression technique: A case report. World J Gastrointest Surg 2024; 16:1443-1448. [PMID: 38817285 PMCID: PMC11135304 DOI: 10.4240/wjgs.v16.i5.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The treatment of postoperative anastomotic stenosis (AS) after resection of colorectal cancer is challenging. Endoscopic balloon dilation is used to treat stenosis in such cases, but some patients do not show improvement even after multiple balloon dilations. Magnetic compression technique (MCT) has been used for gastrointestinal anastomosis, but its use for the treatment of postoperative AS after colorectal cancer surgery has rarely been reported. CASE SUMMARY We report a 72-year-old man who underwent radical resection of colorectal cancer and ileostomy one year ago. An ileostomy closure was prepared six months ago, but colonoscopy revealed a narrowing of the rectal anastomosis. Endoscopic balloon dilation was performed three times, but colonoscopy showed no significant improvement in stenosis. The AS was successfully treated using MCT. CONCLUSION MCT is a minimally invasive method that can be used for the treatment of postoperative AS after colorectal cancer surgery.
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Affiliation(s)
- Miao-Miao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Huan-Chen Sha
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Hai-Rong Xue
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yuan-Fa Qin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Fang-Fang Dong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Li Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Xiao-Peng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Calleja R, Medina-Fernández FJ, Bergillos-Giménez M, Durán M, Torres-Tordera E, Díaz-López C, Briceño J. A comprehensive evaluation of 80 consecutive robotic low anterior resections: impact of not mobilizing the splenic flexure alongside low-tie vascular ligation as a standardized technique. J Robot Surg 2024; 18:156. [PMID: 38565813 DOI: 10.1007/s11701-024-01917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Rectal cancer surgery represents challenges due to its location. To overcome them and minimize the risk of anastomosis-related complications, some technical maneuvers or even a diverting ileostomy may be required. One of these technical steps is the mobilization of the splenic flexure (SFM), especially in medium/low rectal cancer. High-tie vascular ligation may be another one. However, the need of these maneuvers may be controversial, as especially SFM may be time-consuming and increase the risk of iatrogenic. The objective is to present the short- and long-term outcomes of a low-tie ligation combined with no SFM in robotic low anterior resection (LAR) for mid- and low rectal cancer as a standardized technique. A retrospective observational single-cohort study was carried out at Reina Sofia University Hospital, Cordoba, Spain. 221 robotic rectal resections between Jul-18th-2018 and Jan-12th-2023 were initially considered. After case selection, 80 consecutive robotic LAR performed by a single surgeon were included. STROBE checklist assessed the methodological quality. Histopathological, morbidity and oncological outcomes were assessed. Anastomotic stricture occurrence and distance to anal verge were evaluated after LAR by rectosigmoidoscopy. Variables related to the ileostomy closure such as time to closure, post-operative complications or hospital stay were also considered. The majority of patients (81.2%) presented a mid-rectal cancer and the rest, lower location (18.8%). All patients had adequate perfusion of the anastomotic stump assessed by indocyanine green. Complete total mesorectal excision was performed in 98.8% of the patients with a lymph node ratio < 0.2 in 91.3%. The anastomotic leakage rate was 5%. One patient (1.5%) presented local recurrence. Anastomosis stricture occurred in 7.5% of the patients. The limitations were small cohort and retrospective design. The non-mobilization of the splenic flexure with a low-tie ligation in robotic LAR is a feasible and safe procedure that does not affect oncological outcomes.
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Affiliation(s)
- Rafael Calleja
- Liver Transplantation and Hepatobiliary Surgery Unit, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain
| | - Francisco Javier Medina-Fernández
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain.
- Unit of Coloproctology General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba, Spain.
| | - Manuel Bergillos-Giménez
- Unit of Coloproctology General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba, Spain
| | - Manuel Durán
- Liver Transplantation and Hepatobiliary Surgery Unit, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain
| | - Eva Torres-Tordera
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain
- Unit of Coloproctology General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba, Spain
| | - César Díaz-López
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain
- Unit of Coloproctology General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba, Spain
| | - Javier Briceño
- Liver Transplantation and Hepatobiliary Surgery Unit, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- Maimonides Biomedical Research Institute (IMIBIC), Avenida Menéndez Pidal s/n 14004, Córdoba, Spain
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Kim YI, Hong SW, Lim SB, Yang DH, Kim EB, Kim MH, Kim CW, Lee JL, Yoon YS, Park IJ, Yu CS. Risk factors for the failure of endoscopic balloon dilation to manage anastomotic stricture from colorectal surgery: retrospective cohort study. Surg Endosc 2024; 38:1775-1783. [PMID: 38278933 DOI: 10.1007/s00464-023-10661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND An anastomotic stricture after colorectal surgery is principally managed by endoscopic balloon dilation (EBD). Although this intervention is effective, however, subsequent procedures or surgical interventions are often required. This study aimed to assess the long-term outcomes of EBD for anastomotic stricture arising from colorectal cancer surgery. MATERIALS AND METHODS We analyzed 173 patients who received curative surgery for colorectal cancer at our hospital between January 2000 and December 2022 and had undergone EBD to manage anastomotic stricture. The medical records of these cases were retrospectively reviewed to assess the outcomes and risk factors for restenosis and permanent stoma. RESULTS Of the 173 study patients, 41 (23.7%) presented with restenosis with a median time to recurrence of 49 [37-150] days. The restenosis group was significantly younger (55.6 years versus 60.8 years), with a more prominent rectal location (80.5% versus 57.6%), a higher incidence of hand-sewn anastomosis (24.4% versus 5.3%), and a higher percentage of neoadjuvant radiotherapy (34.1% versus 5.3%, P < 0.001). Multivariable analysis indicated neoadjuvant radiotherapy (adjusted HR 2.48; 95% CI 1.03-5.95) and cerebral vascular disease (adjusted HR 6.97; 95% CI 2.15-22.54) as independent prognostic factors for restenosis. Fourteen patients (8.1%) required a permanent stoma due to treatment failure. All cases needing a permanent stoma were male (14 patients, 100%, P = 0.007) and this group had a higher rate of neoadjuvant radiotherapy, adjuvant chemotherapy, and hand-sewn anastomosis. CONCLUSION Patients receiving neoadjuvant radiotherapy are most prone to restenosis after an EBD intervention to manage an anastomotic stricture. Neoadjuvant radiotherapy is also a strong risk factor for requiring a permanent stomas due to treatment failure.
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Affiliation(s)
- Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eon Bin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min Hyun Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Symer MM, Zheng X, Pua BB, Sedrakyan A, Milsom JW. Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York. Surg Innov 2024:15533506241240580. [PMID: 38498843 DOI: 10.1177/15533506241240580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined. STUDY DESIGN A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and 'other' procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared. RESULTS 58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07). CONCLUSION Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.
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Affiliation(s)
- Matthew M Symer
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey W Milsom
- Department of Surgery, Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Aboelezz AF, Othman MO. Endoscopic Management of Colonic Obstruction. Gastrointest Endosc Clin N Am 2024; 34:141-153. [PMID: 37973225 DOI: 10.1016/j.giec.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Large bowel obstruction is a serious event that occurs in approximately 25% of all intestinal obstructions. It is attributed to either benign, malignant, functional (pseudo-obstruction), or mechanical conditions. Benign etiologies of colonic obstructions include colon volvulus, anastomotic strictures, radiation injury, ischemia, inflammatory processes such as Crohn's disease, diverticulitis, bezoars, and intussusception.
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Affiliation(s)
- Ahmad F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Faculty of Medicine, Tanta University, El Bahr Street, Tanta Qism 2, Tanta 1, Gharbia Governorate 31111, Egypt
| | - Mohamed O Othman
- Department of Internal Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Gastroenterology Section at Baylor St Luke's Medical Center, 7200 Cambridge Street. Suite 8A, Houston, TX 77030, USA.
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Lee KY, Lee J, Park YY, Kim HJ, Oh ST. The effect of circular stapler size on anastomotic stricture formation in colorectal surgery: A propensity score matched study. PLoS One 2023; 18:e0287595. [PMID: 37903104 PMCID: PMC10615279 DOI: 10.1371/journal.pone.0287595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/08/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Small circular staplers possess the advantage of being relatively easy to use when compared to larger circular staplers. However, there is some contention as to whether the use of small circular staples in colorectal surgery increases the incidence of anastomotic strictures. This study aimed to determine whether the frequency of anastomosis site stricture formation differs depending on stapler size when performing anastomosis in colorectal surgery. METHODS Patients who underwent surgery for colon or rectal disease between June 1, 2009, and December 31, 2021, and who had circular staplers used for the formation of intestinal anastomoses post colectomy were included in our study. Propensity score matching with a 1:1 ratio using logistic regression was performed. The primary outcome was the anastomotic stricture rate, and the secondary outcome was total anastomotic complications. RESULTS A total of 875 patients who were operated on by surgeons using 28/29-mm and 25-mm circular staplers were included. After propensity score matching, 106 patients were assigned to each group. Anastomotic strictures occurred in two cases (1.9%) from the 25-mm group and in four cases (3.8%) from the 28/29-mm group. There were no statistically significant differences between the two groups (p = 0.683). Anastomotic complications were observed in two cases (1.9%) from the 25-mm group and in six cases (5.7%) from the 28/29-mm group; no statistically significant differences were found (p = 0.280). CONCLUSION Circular stapler size does not influence anastomotic stricture formation in colorectal surgery.
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Affiliation(s)
- Kil-yong Lee
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaeim Lee
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Young Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyung-Jin Kim
- Department of Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University Hospital, Seoul, Korea
| | - Seong Taek Oh
- Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Wang H, Wang X, Wang P, Lv K, He H, Yuan W, Fu M, Chen J, Yang H. Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study. Langenbecks Arch Surg 2023; 408:384. [PMID: 37770772 DOI: 10.1007/s00423-023-03118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND In cases of rectal cancer surgery, patients at high risk of anastomotic leakage often receive a defunctioning stoma (DS). However, its role in postoperative anastomotic strictures (AS) remains unclear. This study aimed to investigate the correlation between DS and AS and outcomes of transanal endoscopic microsurgery (TEM) in treating rectal AS. METHODS This retrospective study was conducted from January 2019 to September 2021 and included patients who underwent rectal cancer surgery. A 1:1 ratio was used for propensity score matching (PSM). Univariate analyses were performed to identify statistically significant variables, and multivariate analyses were conducted to determine the factors affecting AS. RESULTS This study included 383 patients. The results of the univariate analysis suggested that surgery time (HR 4.597, 95% CI 1.563-13.525, P=0.006), postoperative anastomotic leakage (HR 11.830, 95% CI 3.773-37.094, P<0.001), and DS (HR 15.475, 95% CI 6.042-39.641, P<0.001) were significantly associated with AS. In the multivariate analysis, postoperative anastomotic leakage (HR 7.596, 95% CI 1.987-29.044, P= 0.003) and DS (HR 11.252, 95% CI 4.113-30.779, P<0.001) were identified as significant risk factors for AS. After matching, the univariate analysis revealed that postoperative anastomotic leakage (HR 8.333, 95% CI 1.541-45.052, P= 0.014) and DS (HR 9.965, 95% CI 2.200-45.142, P= 0.003) were associated with AS. The multivariate analysis indicated that postoperative anastomotic leakage (HR 14.549, 95% CI 1.765-119.913, P= 0.013) and DS (HR 12.450, 95% CI 2.418-64.108, P= 0.003) were significant risk factors for AS. CONCLUSIONS This study provides evidence that DS is independently associated with AS, and postoperative anastomotic leakage increases the risk of AS. Furthermore, this study suggests that TEM could be a valuable treatment option for AS.
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Affiliation(s)
- Haoran Wang
- Department of General Surgery, School of Clinical Medicine, Weifang Medical University, Weifang, 261053, Shandong, China
| | - Xiao Wang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, No.16766 Jingshi Road, Jinan, 250000, Shandong, China
| | - Peng Wang
- The Fifth People's Hospital of Jinan, Jinan, 250117, China
| | - Kai Lv
- Department of General Surgery, School of Clinical Medicine, Weifang Medical University, Weifang, 261053, Shandong, China
| | - Haoqing He
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, No.16766 Jingshi Road, Jinan, 250000, Shandong, China
| | - Wenguang Yuan
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, No.16766 Jingshi Road, Jinan, 250000, Shandong, China
| | - Mofan Fu
- Department of General Surgery, School of Clinical Medicine, Weifang Medical University, Weifang, 261053, Shandong, China
| | - Jingbo Chen
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, No.16766 Jingshi Road, Jinan, 250000, Shandong, China.
| | - Hui Yang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, No.16766 Jingshi Road, Jinan, 250000, Shandong, China.
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Mathew J, Kazi M, Sukumar V, Thakur S, Desouza A, Saklani A. Factors predicting successful resolution and long-term outcomes of benign anastomotic strictures following rectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1307-1313. [PMID: 36918333 DOI: 10.1016/j.ejso.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/25/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
AIM Although advances in treatment have improved sphincter-preservation rates in rectal cancer, the incidence of benign anastomotic strictures has also increased. This retrospective single-institution study sought to determine the incidence of benign anastomotic strictures and the factors associated with their successful resolution following treatment. METHODOLOGY From January 2010 to December 2019, consecutive patients undergoing endoscopic dilatation and/or surgery for benign anastomotic strictures developing after radical sphincter-sparing resections for rectal cancer were evaluated. To model the relationship between outcomes and potential independent variables, sequential univariate and multivariate analyses were performed using binary logistic regression. RESULTS Of 2069 rectal cancer patients undergoing sphincter-preserving surgery, benign anastomotic strictures were identified in 110 (5.3%). Mean age was 48.2 ± 13.98 years; 73.6% were male. Distal tumor-extent was within 6 cm of the anal verge in 60%; 80.9% patients received neoadjuvant radiotherapy. Surgical approach in 71.8% was open, 74.5% being anterior or low anterior resections and 70.9% of anastomoses stapled. Covering stoma was performed in 91.8%. On follow-up, strictures of median length 4 cm were identified at median 3 cm from the anal verge. Endoscopic dilatation was offered in 89.1%, whereas 9.1% required redo-surgery. Overall, 49.1% experienced sustained stricture-resolution with dilatation and 45.4% required re-intervention. At last follow-up, 72.7% were stoma-free. On multivariate analysis, good performance status, absence of anastomotic leak, and short-segment strictures predicted successful stricture-resolution. CONCLUSION Endoscopic dilatation is an effective first-line therapy, with redo anastomosis used to salvage those failing conservative measures. Adverse performance status, anastomotic leak and greater stricture length may predict detrimental outcomes in terms of stricture resolution.
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Affiliation(s)
- Joseph Mathew
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | - Mufaddal Kazi
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | - Vivek Sukumar
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | - Swarnim Thakur
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | - Ashwin Desouza
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | - Avanish Saklani
- Division of Colorectal Oncology, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
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10
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Matsuo K, Urakawa S, Symer M, Sedrakyan A, Pua B, Milsom J. Iterative evaluation of novel access techniques for small bowel obstruction: combining image guided, percutaneous, and endoscopic methods. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000150. [PMID: 37223824 PMCID: PMC10201263 DOI: 10.1136/bmjsit-2022-000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To avoid the need for extensive adhesiolysis in patients with small bowel obstruction (SBO). We evaluated the feasibility of using advanced imaging, percutaneous access, and endoscopy as alternative therapies for SBO. Design Retrospective case series (IDEAL [Idea, Development, Exploration, Assessment, and Long-term Study Collaborative] stages 1 and 2a). Setting Single tertiary referral center. Participants Twelve adults with chronic SBO resulting from inflammatory bowel disease, disseminated cancer, radiation, and/or adhesive disease. Participants were included if they underwent one of three novel access procedures. There were no exclusion criteria. The median age of participants was 67.5 years (range 42-81); two-thirds were women; and median American Society of Anesthesiology class was 3. Interventions All participants underwent one of three novel access methods, followed by wire-guided balloon dilation of a narrowed area of small bowel. These methods combined endoscopic, fluoroscopic, and surgical techniques. The techniques were (1) a purely endoscopic approach aided by an over-the-scope double-balloon device, (2) a combined endoscopic and percutaneous approach, and (3) a cut-down approach. Main outcome measures Procedural success (defined as successful access to the small bowel and successful balloon dilation of the stenotic area). Secondary outcomes included major complications, recurrence, length of stay, and procedure time. Results Procedural success was achieved in 10 of 12 patients (83%). At the time of median follow-up of 10 months, recurrence of SBO was observed in two patients. In only one patient, the novel method did not change the treatment plan. No major complications occurred. Conventional operative intervention was avoided in all patients who achieved technical success with one of the novel approaches. The median postprocedure length of hospital stay was 4 days. Median procedure time was 135 min. Conclusions Novel minimally invasive approaches to SBO represent feasible alternatives to surgical procedures in select patients. Further study should compare these approaches to standard ones as new methods are refined.
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Affiliation(s)
- Kentaro Matsuo
- Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
- Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Matthew Symer
- Surgery, NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Art Sedrakyan
- Healthcare Polcy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Bradley Pua
- Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey Milsom
- Department of Surgery, Weill Cornell Medical College, New York, New York, USA
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Xu W, Qin Y, Yang F, Qian J, Dong Y, Tu S, Yao J. Application of transurethral prostate resection instrumentation for treating rectal anastomotic stenosis: Case series. Medicine (Baltimore) 2023; 102:e33799. [PMID: 37171313 PMCID: PMC10174415 DOI: 10.1097/md.0000000000033799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Anastomotic stenosis is a common complication of colorectal surgery with anastomosis. To explore a minimally invasive novel approach surgical method for the treatment of rectal anastomotic strictures using transurethral prostate resection instrumentation. METHODS From 2012 to 2022, 18 patients for the treatment of rectal anastomotic strictures using transurethral prostate resection instrumentation. The transurethral prostate resection instrumentation enters the rectum through the anus to incise the narrow anastomotic orifice in a 4-point radial manner under the resectoscope. RESULTS The surgery was successfully completed in 18 patients, and there were no postoperative complications. Postoperatively, 12 patients achieved satisfactory improvement in defecation after 1 incision, and 4 patients underwent another incision 3 months later. Two patients underwent incisions thrice, and the ease of defecation improved in a short period; however, they later underwent permanent colostomy due to repeated stenosis and pain. CONCLUSION The transanal 4-point radial incision of the prostate using transurethral prostate resection instrumentation is a minimally invasive, safe, effective, and simple surgical method for the treatment of rectal anastomotic stenosis supplemented by postoperative dilatation, and is worthy of clinical application.
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Affiliation(s)
- Wenshan Xu
- Department of General Surgery II, Hexi University Affiliated Zhangye People's Hospital, Zhangye Gansu, China
| | - Yujie Qin
- Department of Endoscopy Center, Hexi University Affiliated Zhangye People's Hospital, Zhangye Gansu, China
| | - Faying Yang
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Gansu, China
- Institute of Urology, Hexi University, Zhangye Gansu, China
| | - Jun Qian
- Institute of Urology, Hexi University, Zhangye Gansu, China
| | - Yanbo Dong
- Lanzhou University Second College of Clinical Medicine, Gansu, China
| | - Song Tu
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Gansu, China
- Institute of Urology, Hexi University, Zhangye Gansu, China
| | - Jiaxi Yao
- Department of Urology, Hexi University Affiliated Zhangye People's Hospital, Gansu, China
- Institute of Urology, Hexi University, Zhangye Gansu, China
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12
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Surek A, Donmez T, Gemici E, Dural AC, Akarsu C, Kaya A, Ferahman S, Bozkurt MA, Karabulut M, Alis H. Risk factors affecting benign anastomotic stricture in anterior and low anterior resections for colorectal cancer: a single-center retrospective cohort study. Surg Endosc 2023:10.1007/s00464-023-10002-3. [PMID: 36964291 DOI: 10.1007/s00464-023-10002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Although not as life-threatening as anastomotic leakage, anastomotic stricture reduces the quality of life. The risk factors for such an important life complication have not been revealed. This article examines the risk factors affecting anastomotic strictures due to colorectal cancers. METHODS Patients who underwent anterior and low anterior resection for colorectal cancer under elective conditions between 2015 and 2021 were included in the study. The patients were divided into two groups, those who developed anastomotic stricture and those who did not. The parameters determined between the two groups were compared, and multivariate analysis of statistically significant parameters was performed. RESULTS A total of 375 patients were included in the study. The anastomotic stricture was detected in 36 (9.6%) patients. In the multivariate analysis, non-mobilization of the splenic flexure and a proximal clean surgical margin of < 10 cm and a distal surgical margin of < 2 cm were identified as risk factors affecting anastomotic stricture. The risk factor with the highest odds ratio in the development of anastomotic stricture is the non-mobilization of the splenic flexure (p = 0.001, OR 11.375). CONCLUSION It is recommended that the mobilization of the splenic flexure to reduce the development of strictures. In addition, a clean surgical margin of 10 cm proximally and 2 cm distally and high ligation of the inferior mesenteric artery may reduce the development of stricture.
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Affiliation(s)
- Ahmet Surek
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey.
| | - Turgut Donmez
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey
| | - Eyup Gemici
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey
| | - Ahmet Cem Dural
- Department of General Surgery, LIV Hospital Ulus and Vadistanbul, Istanbul, Turkey
- Department of General Surgery, Faculty of Medicine, Istinye University, Zeytinburnu, Istanbul, Turkey
| | - Cevher Akarsu
- Department of General Surgery, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Arif Kaya
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey
| | - Sina Ferahman
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey
| | - Mehmet Abdussamet Bozkurt
- Department of General Surgery, Faculty of Medicine, İstinye University, Bahçeşehir LIV Hospital, Istanbul, Turkey
| | - Mehmet Karabulut
- Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey
| | - Halil Alis
- Department of General Surgery, Istanbul Aydin University, Istanbul, Turkey
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13
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Zhang D, Tang H, Li T, Li P, Pan X, Jia Q, Wang L, Zhao Y. Application of rectal balloon ice water stimulation for the rehabilitation of stroke patients with neurogenic bowel dysfunction. NeuroRehabilitation 2023; 53:83-90. [PMID: 37424483 DOI: 10.3233/nre-230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Neurogenic bowel dysfunction (NBD) is a common complication in stroke patients. OBJECTIVE To investigate the effect of rectal balloon ice water stimulation on the rehabilitation of patients with NBD after a cerebral stroke. METHODS Forty stroke patients with NBD were selected between March and August 2022 and randomly divided into a study group (n = 20) and a control group (n = 20). Based on routine rehabilitation training, rectal balloon ice water stimulation or finger rectal stimulation were performed on the study or control group, respectively. After two weeks, the changes in the NBD, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores were compared between the two groups. RESULTS Before the intervention, there were no significant differences in age, sex ratio, and NBD, SDS and SAS scores between the two groups (p > 0.05). The NBD, SDS and SAS scores of both groups were significantly decreased following intervention (p < 0.05). After 2 weeks of intervention, the NBD score of the study group was significantly lower than that of the control group (5.50±1.28 vs 6.45±1.05; p = 0.014). The SDS score of the study group was lower than that of the control group, and the difference was statistically significant (32.30±2.81 vs 44.05±2.19; p = 0.014). The study group also had significantly lower SAS scores than the control group (p = 0.024). In addition, the incidence of dizziness, headaches, nausea, vomiting and abdominal pain and distension in the study group was significantly lower than in the control group (p < 0.05). CONCLUSION Rectal balloon ice water stimulation can significantly improve stroke patients with NBD's intestinal function and psychological status.
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Affiliation(s)
- Di Zhang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Hong Tang
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Ting Li
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Ping Li
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Xiangying Pan
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Qin Jia
- Department of Nursing, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, China
| | - Lu Wang
- Department of Geriatric Rehabilitation, Wuxi Central Rehabilitation Hospital, Wuxi, China
| | - Yanjun Zhao
- Jiangnan University Medical Center, Wuxi, China
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Miao X, Liu L, Wang X, Fan Z, Miao L, Wang J. Clinical efficacy of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery. Medicine (Baltimore) 2022; 101:e30036. [PMID: 35984174 PMCID: PMC9387986 DOI: 10.1097/md.0000000000030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Benign anastomotic stricture is a frequent complication after rectal surgery. This study investigated the feasibility of endoscopic dilation combined with bleomycin injection for benign anastomotic stricture after rectal surgery. 31 patients who diagnosed with benign anastomotic stricture after rectal surgery were included in this study. 15 patients received simple endoscopic dilation (dilation group) and 16 patients received endoscopic dilation combined with bleomycin injection (bleomycin group). The clinical effect and adverse events were compared in the 2 groups. The strictures were managed successfully and the obstruction symptoms were relieved immediately. There were 2 minor complications in dilation group and 3 minor complications in bleomycin group. The difference was not significant between the 2 groups (P > .05). During the follow-up, the mean reintervention interval was 4.97 ± 1.00 months in dilation group and 7.60 ± 1.36 months in bleomycin group. The median treatment times was 4 (range 3-5) in dilation group and 2 (range 2-3) in bleomycin group. The differences in the 2 groups were significant (P < .05). Compared with endoscopic dilation, endoscopic dilation combined with bleomycin injection may reduce the treatment times and prolong the reintervention interval, which is a safe and effective endoscopic management for benign anastomotic stricture after rectal surgery.
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Affiliation(s)
- Xin Miao
- Gastroenterology Department, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Li Liu
- Digestive Endoscopy Department & General Surgery Department, the First Affiliated Hospital with Nanjing Medical University & Jiangsu Province Hospital, Nanjing, China
| | - Xiang Wang
- Digestive Endoscopy Department & General Surgery Department, the First Affiliated Hospital with Nanjing Medical University & Jiangsu Province Hospital, Nanjing, China
| | - Zhining Fan
- Digestive Endoscopy Department & General Surgery Department, the First Affiliated Hospital with Nanjing Medical University & Jiangsu Province Hospital, Nanjing, China
| | - Lin Miao
- Gastroenterology Department, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiankun Wang
- Digestive Endoscopy Department & General Surgery Department, the First Affiliated Hospital with Nanjing Medical University & Jiangsu Province Hospital, Nanjing, China
- *Correspondence: Jiankun Wang, Digestive Endoscopy Department & General Surgery Department, the First Affiliated Hospital with Nanjing Medical University & Jiangsu Province Hospital, 300 Guangzhou Road, 210029, Nanjing, Jiangsu Province, China (e-mail: )
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Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery. Dis Colon Rectum 2022; 65:1062-1068. [PMID: 35421009 DOI: 10.1097/dcr.0000000000002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anastomotic stenosis is a common complication of colorectal cancer surgery with anastomosis. Transanal minimally invasive surgery is a novel approach to the treatment of anastomotic stenosis. OBJECTIVE This study aimed to evaluate the efficacy and safety of transanal minimally invasive surgery for anastomotic stenosis treatment. DESIGN This was a retrospective study. SETTINGS This study was conducted at a comprehensive cancer center. PATIENTS This study included patients with rectal anastomotic stenosis who after undergoing colorectal surgery were admitted to the Sir Run Run Shaw Hospital between September 2017 and June 2019. MAIN OUTCOME MEASURES The primary outcome was the operative success rate. The secondary outcomes were intraoperative variables, postoperative complications, stoma closure conditions, and stenosis recurrence risks. RESULTS Nine patients, aged 52 to 80 years, with a history of colorectal cancer with end-to-end anastomosis underwent transanal minimally invasive surgery for anastomotic stenosis. The distance between the stenosis and the anal verge ranged from 5 to 12 cm. The mean stenosis diameter was 0.3 cm. Four patients had completely obstructed rectal lumens. Eight of 9 patients successfully underwent transanal minimally invasive surgery radial incision and cutting. The average operation time was 50 minutes. After the procedure, 1 patient had symptomatic procedure-associated perforations but recovered with conservative treatment. No perioperative mortality occurred. One patient underwent transverse colostomy 1 month after transanal minimally invasive surgery because of proximal colon ischemia induced by primary rectal surgery. Eight patients underwent protective loop ileostomy. After transanal minimally invasive surgery, stoma closure was performed in 88% of patients with no stenosis recurrence or obstruction at follow-up (21-42 mo). LIMITATIONS This study was limited by its small sample size and single-center design. CONCLUSIONS Transanal minimally invasive surgery provides an excellent operative field, good maneuverability, and versatile instrumentation and is a safe and effective treatment for rectal anastomotic stenosis, especially for severe fibrotic stenosis or complete obstruction. See Dynamic Article Video at http://links.lww.com/DCR/B965 .
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Takada J, Arao M, Kubota M, Ibuka T, Shimizu M. Endoscopic fenestration for benign complete anastomotic obstruction following rectal surgery. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 7:193-195. [PMID: 35585897 PMCID: PMC9108115 DOI: 10.1016/j.vgie.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Video 1Endoscopic fenestration for benign complete anastomotic obstruction after rectal surgery.
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Affiliation(s)
- Jun Takada
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masamichi Arao
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masaya Kubota
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
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Ismail MS, Charabaty A. Management of Crohn's stricture: medical, endoscopic and surgical therapies. Frontline Gastroenterol 2022; 13:524-530. [PMID: 36250181 PMCID: PMC9555137 DOI: 10.1136/flgastro-2021-101827] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with Crohn's disease are at high risk of presenting with or developing a bowel stricture during the course of their disease. The available therapeutic options to manage a symptomatic Crohn's stricture include medical therapy (mainly biologics), surgical resection and endoscopic interventions. The choice of therapeutic modality depends on the clinical presentation of the stricture, the nature of the stricture (inflammatory vs fibrotic, primary vs anastomotic) and its anatomical characteristics on endoscopy and imaging (length, number, location of strictures and severity of obstruction). The aim herein is to provide an overview of the comprehensive assessment of a Crohn's stricture and to review the indications of the different therapeutic modalities, their success rates and their limitations to help clinicians properly evaluate and manage Crohn's strictures.
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Affiliation(s)
- Mohamed Saleh Ismail
- Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aline Charabaty
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Sibley Memorial Hospital, Washington, District of Columbia, USA
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