1
|
Cheng Y, Tian Z, Gao S, Zhao S, Li R, Zhou J, Sun Q, Wang D. A nomogram of anastomotic stricture after rectal cancer: a retrospective cohort analysis. Surg Endosc 2024; 38:3661-3671. [PMID: 38777891 DOI: 10.1007/s00464-024-10885-w] [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: 03/02/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Anastomotic stricture significantly impacts patients' quality of life and long-term prognosis. However, current clinical practice lacks accurate tools for predicting anastomotic stricture. This study aimed to develop a nomogram to predict anastomotic stricture in patients with rectal cancer who have undergone anterior resection. METHODS A total of 1542 eligible patients were recruited for the study. Least absolute shrinkage selection operator (Lasso) analysis was used to preliminarily select predictors. A prediction model was constructed using multivariate logistic regression and presented as a nomogram. The performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration diagrams, and decision curve analysis (DCA). Internal validation was conducted by assessing the model's performance on a validation cohort. RESULTS 72 (4.7%) patients were diagnosed with anastomotic stricture. Participants were randomly divided into training (n = 1079) and validation (n = 463) sets. Predictors included in this nomogram were radiotherapy, diverting stoma, anastomotic leakage, and anastomotic distance. The area under the ROC curve (AUC) for the training set was 0.889 [95% confidence interval (CI) 0.840-0.937] and for the validation set, it was 0.930 (95%CI 0.879-0.981). The calibration curve demonstrated a strong correlation between predicted and observed outcomes. DCA results showed that the nomogram had clinical value in predicting anastomotic stricture in patients after anterior resection of rectal cancer. CONCLUSION We developed a predictive model for anastomotic stricture following anterior resection of rectal cancer. This nomogram could assist clinicians in predicting the risk of anastomotic stricture, thus improving patients' quality of life and long-term prognosis.
Collapse
Affiliation(s)
- Yifan Cheng
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Zhen Tian
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Shuyang Gao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Qiannan Sun
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
- Northern Jiangsu People's Hospital, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, 98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
| |
Collapse
|
2
|
Lin D, Liu W, Chen Z, He X, Zheng Z, Lan P, Hu J. Endoscopic Stricturotomy for Patients With Postoperative Benign Anastomotic Stricture for Colorectal Cancer. Dis Colon Rectum 2022; 65:590-598. [PMID: 34775404 DOI: 10.1097/dcr.0000000000001944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Postoperative benign anastomotic stricture is associated with colorectal anastomosis following surgery for colorectal cancer. Endoscopic stricturotomy is a novel technique that has been demonstrated to be safe and effective for the treatment of colorectal anastomotic stricture in several case reports and series. OBJECTIVE We designed this study to investigate the efficacy of endoscopic stricturotomy for postoperative benign anastomotic stricture in patients for colorectal cancer. The primary outcomes were stricture-recurrence-free survival and reoperation-free survival. DESIGN This is a retrospective study. SETTING This study presents a single-center experience. PATIENTS This retrospective study included patients with colorectal cancer who underwent surgical resection and developed anastomotic stricture between January 2014 and June 2019 and were treated with endoscopic stricturotomy. MAIN OUTCOME MEASURES Immediate technical success of endoscopic stricturotomy and the factors associated with success and recurrence were investigated. RESULTS Endoscopic stricturotomy was performed in 57 patients, and immediate technical success was achieved in 84% of the patients. The mean follow-up was 31.3 (15.8) months (range, 9-74 months). Postoperative benign anastomotic stricture recurred in 11 patients after initial successful endoscopic stricturotomy; 10 of the 11 recurrent patients accepted reoperation. Univariate and multivariate analysis indicated that length of stricture ≥1 cm was an independent risk factor for failure of the initial endoscopic stricturotomy (OR, 9.423; 95% CI, 1.729-51.350; p = 0.010) and the recurrence of postoperative benign anastomotic stricture after the initial endoscopic stricturotomy (OR, 13.521; 95% CI, 2.305-79.306; p = 0.004). LIMITATIONS The study was limited by its small sample size and retrospective design. CONCLUSIONS Endoscopic stricturotomy is a safe and effective technique for postoperative benign anastomotic stricture. However, if the length of the stricture is ≥1 cm, endoscopic stricturotomy may not be effective, and recurrence of postoperative benign anastomotic stricture is also likely. See Video Abstract at http://links.lww.com/DCR/B739. ESTRICTUROTOMA ENDOSCPICA PARA PACIENTES CON ESTRICCIN ANASTOMTICA BENIGNA POSTOPERATORIA PARA EL CNCER COLORRECTAL ANTECEDENTES:La estenosis anastomótica benigna postoperatoria se asocia con anastomosis colorrectal después de la cirugía para el cáncer colorrectal. La estricturotomia endoscópica es una técnica novedosa que se ha demostrado que es segura y efectiva para el tratamiento de la estenosis anastomótica colorrectal en varios informes de casos o series.OBJETIVO:Diseñamos este estudio para investigar la eficacia de la estricturotomia endoscópica para la estenosis anastomótica benigna postoperatoria en pacientes con cáncer colorrectal. El resultado primario fue la supervivencia libre de restricción estricta y la supervivencia libre de reoperación.DISEÑO:Este es un estudio retrospectivo.CONFIGURACIÓN:Este estudio presenta una experiencia de un solo centro.PACIENTES:Este estudio retrospectivo incluyó pacientes con cáncer colorrectal que se sometieron a resección quirúrgica y desarrollaron estenosis anastomótica entre enero de 2014 y junio de 2019 y tratados con estricturotomia endoscópica.MEDIDAS PRINCIPALES DE RESULTADO:Éxito técnico inmediato y estenosurotomía endoscópica, los factores asociados con el éxito y la recurrencia.RESULTADOS:Se realizó estricturotomia endoscópica en 57 pacientes, y se logró un éxito técnico inmediato en el 84% de los pacientes. El seguimiento medio fue de 31,3 (15,8) meses (rango, 9 a 74 meses), el POBAS se repitió en 11 pacientes después del éxito inicial de ESt. 10 de los 11 pacientes recurrentes aceptaron la reoperación. El análisis univariado y multivariado indicó que la longitud de la estenosis ≥1 cm era un factor de riesgo independiente para el fracaso de la estricturotomia endoscópica inicial (odds ratio = 9,423; IC del 95% = 1.729-51.350; p = 0.010) y la recurrencia de estenosis anastomótica benigna postoperatoria después de la estricturotomia endoscópica inicial (odds ratio = 13,521; IC del 95% = 2,305-79,306; p = 0.004).LIMITACIONES:El estudio estuvo limitado por su pequeño tamaño de muestra y diseño retrospectivo.CONCLUSIONES:La estricturotomia endoscópica es una técnica segura y efectiva para la estructura anastomótica benigna postoperatoria. Sin embargo, si la longitud de la estenosis es ≥1 cm, la estricturotomia endoscópica puede no ser efectiva y también es probable que se repita la estenosis anastomótica benigna postoperatoria. Consulte Video Resumen en http://links.lww.com/DCR/B739.
Collapse
Affiliation(s)
- Dezheng Lin
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Liu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zexian Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaowen He
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zheyu Zheng
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiancong Hu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
3
|
Lam D, Jones O. Changes to gastrointestinal function after surgery for colorectal cancer. Best Pract Res Clin Gastroenterol 2020; 48-49:101705. [PMID: 33317788 DOI: 10.1016/j.bpg.2020.101705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 01/31/2023]
Abstract
Bowel function is increasingly considered as an important outcome for patients undergoing surgery for colorectal cancer. Increasing technical skills and technological advances have meant fewer patients require a long-term stoma but this comes at the cost, often, of poor function. With a larger range of treatment options available for a given cancer, both function and oncology should be considered in parallel when counselling patients before surgery. In the perioperative phase, bowel function can be improved with minimally invasive surgery and enhanced recovery after surgery protocols, with limited evidence for targeted medical therapies. Early detection and sound management of surgical complications such as anastomotic leak and stricture can mitigate their adverse effects on bowel function. Long-term gastrointestinal dysfunction manifests as diarrhoea and low anterior resection syndrome for colon and rectal cancer respectively. Multi-modal strategies for low anterior resection syndrome are emerging to improve significantly quality of life after restorative rectal cancer surgery.
Collapse
Affiliation(s)
- David Lam
- Senior Clinical Fellow in Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Department of Colorectal Surgery, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - Oliver Jones
- Consultant Colorectal Surgeon and Clinical Director of Surgery, Oxford University Hospitals NHS Foundation Trust, Department of Colorectal Surgery, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.
| |
Collapse
|
4
|
Kwak JY, Yang KM, Seo HI. Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation. Ann Coloproctol 2020; 36:353-356. [PMID: 32674554 PMCID: PMC7714376 DOI: 10.3393/ac.2020.02.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/27/2020] [Indexed: 12/03/2022] Open
Abstract
An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.
Collapse
Affiliation(s)
- Jae Young Kwak
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kwan Mo Yang
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyun Il Seo
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| |
Collapse
|
5
|
Braund S, Hennetier C, Klapczynski C, Scattarelli A, Coget J, Bridoux V, Tuech JJ, Roman H. Risk of Postoperative Stenosis after Segmental Resection versus Disk Excision for Deep Endometriosis Infiltrating the Rectosigmoid: A Retrospective Study. J Minim Invasive Gynecol 2020; 28:50-56. [PMID: 32360656 DOI: 10.1016/j.jmig.2020.04.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVE To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR). DESIGN Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database. SETTING University tertiary referral center. PATIENTS Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study. INTERVENTIONS Laparoscopic SR or DE. MEASUREMENTS AND MAIN RESULTS One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR. CONCLUSION Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.
Collapse
Affiliation(s)
- Sophia Braund
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Clotilde Hennetier
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Clemence Klapczynski
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Antoine Scattarelli
- Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis (Drs. Braund, Hennetier, Klapczynski, and Scattarelli)
| | - Julien Coget
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Valérie Bridoux
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Jean Jacques Tuech
- Department of Surgery (Drs. Coget, Bridoux, and Tuech), Rouen University Hospital, Rouen
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux (Dr. Roman), France; Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark (Dr. Roman)..
| |
Collapse
|
6
|
Kawak S, Turaihi H, Bjordahl P. Transanal stricturoplasty: a minimally-invasive approach to a challenging problem. J Surg Case Rep 2019; 2019:rjz087. [PMID: 30949337 PMCID: PMC6439508 DOI: 10.1093/jscr/rjz087] [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: 02/20/2019] [Accepted: 03/02/2019] [Indexed: 11/14/2022] Open
Abstract
Despite the advances in the surgical techniques and technology in colorectal surgery, the development of rectal anastomotic stricture is a common problem. In some case series, the incidence is estimated to be as high as 30%. Some of the known risk factors for developing a stricture include anastomotic leak and ischemia. Treatment options range from frequent dilations using digital rectal examinations and dilators if the stricture is low or endoscopic balloon dilations for higher strictures. Unfortunately, multiple sessions are typically required to achieve adequate results. We present a case report of a benign anastomotic stricture and describe a novel approach, transanal stricturoplasty, for this challenging problem.
Collapse
Affiliation(s)
- Samer Kawak
- Department of Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Hassan Turaihi
- Department of Colon and Rectal Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Paul Bjordahl
- Department of Surgery, University of South Dakota, Sioux Falls, SD, USA
| |
Collapse
|
7
|
de'Angelis N, Di Saverio S, Chiara O, Sartelli M, Martínez-Pérez A, Patrizi F, Weber DG, Ansaloni L, Biffl W, Ben-Ishay O, Bala M, Brunetti F, Gaiani F, Abdalla S, Amiot A, Bahouth H, Bianchi G, Casanova D, Coccolini F, Coimbra R, de'Angelis GL, De Simone B, Fraga GP, Genova P, Ivatury R, Kashuk JL, Kirkpatrick AW, Le Baleur Y, Machado F, Machain GM, Maier RV, Chichom-Mefire A, Memeo R, Mesquita C, Salamea Molina JC, Mutignani M, Manzano-Núñez R, Ordoñez C, Peitzman AB, Pereira BM, Picetti E, Pisano M, Puyana JC, Rizoli S, Siddiqui M, Sobhani I, Ten Broek RP, Zorcolo L, Carra MC, Kluger Y, Catena F. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 2018; 13:5. [PMID: 29416554 PMCID: PMC5784542 DOI: 10.1186/s13017-018-0162-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022] Open
Abstract
Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic approach must vary based on the setting of the diagnosis (intra- or post-colonoscopy), the type of ICP, the characteristics and general status of the patient, the operator’s level of experience, and surgical device availability. Although ICPs have been the focus of numerous publications, no guidelines have been created to standardize the management of ICPs. The aim of this article is to present the World Society of Emergency Surgery (WSES) guidelines for the management of ICP, which are intended to be used as a tool to promote global standards of care in case of ICP. These guidelines are not meant to substitute providers’ clinical judgment for individual patients, and they may need to be modified based on the medical team’s level of experience and the availability of local resources.
Collapse
Affiliation(s)
- Nicola de'Angelis
- 1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, and University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | | | - Osvaldo Chiara
- 3General Surgery and Trauma Team, Niguarda Hospital, Milan, Italy
| | | | - Aleix Martínez-Pérez
- 5Department of General and Digestive Surgery, University Hospital Dr Peset, Valencia, Spain
| | - Franca Patrizi
- 6Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy
| | - Dieter G Weber
- 7Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Luca Ansaloni
- 8General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Walter Biffl
- 9Acute Care Surgery at The Queen's Medical Center, John A. Burns School of Medicine, University of Hawaii, Honolulu, USA
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Miklosh Bala
- 11Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Francesco Brunetti
- 1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, and University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Federica Gaiani
- 12Gastroenterology and Endoscopy Unit, University Hospital of Parma, Parma, Italy
| | - Solafah Abdalla
- 1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, and University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Aurelien Amiot
- 13Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, and University of Paris Est, UPEC, Creteil, France
| | - Hany Bahouth
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Giorgio Bianchi
- 1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, and University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Daniel Casanova
- Unit of Digestive Surgery and Liver Transplantation, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | | | - Raul Coimbra
- 15Department of Surgery, UC San Diego Health System, San Diego, CA USA
| | | | | | - Gustavo P Fraga
- 17Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Pietro Genova
- Department of General and Oncological Surgery, University Hospital Paolo Giaccone, Palermo, Italy
| | - Rao Ivatury
- 19Virginia Commonwealth University, Richmond, VA USA
| | - Jeffry L Kashuk
- 20Assia Medical Group, Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew W Kirkpatrick
- 21Department of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical Center, Calgari, AB Canada
| | - Yann Le Baleur
- 13Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, and University of Paris Est, UPEC, Creteil, France
| | - Fernando Machado
- 22Department of Emergency Surgery, Hospital de Clínicas, School of Medicine, UDELAR, Montevideo, Uruguay
| | - Gustavo M Machain
- 23Il Cátedra de Clínica Quirúgica, Hospital de Clínicas, Facultad de Ciencias Medicas, Universidad National de Asuncion, Asuncion, Paraguay
| | - Ronald V Maier
- 24Department of Surgery, University of Washington, Seattle, WA USA
| | - Alain Chichom-Mefire
- Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
| | - Riccardo Memeo
- Unit of General Surgery and Liver Transplantation, Policlinico di Bari "M. Rubino", Bari, Italy
| | - Carlos Mesquita
- 27Unit of General and Emergency Surgery, Trauma Center, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Juan Carlos Salamea Molina
- Department of Trauma and Emergency Center, Vicente Corral Moscoso Hospital, University of Azuay, Cuenca, Ecuador
| | - Massimiliano Mutignani
- 29Digestive and Interventional Endoscopy Unit, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Ramiro Manzano-Núñez
- 30Department of Surgery and Critical Care, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Carlos Ordoñez
- 30Department of Surgery and Critical Care, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Andrew B Peitzman
- Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Bruno M Pereira
- 17Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP Brazil
| | - Edoardo Picetti
- 32Department of Anesthesiology and Intensive Care, University Hospital of Parma, Parma, Italy
| | - Michele Pisano
- 8General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Juan Carlos Puyana
- 33Critical Care Medicine, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Sandro Rizoli
- 34Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON Canada
| | - Mohammed Siddiqui
- 1Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, AP-HP, and University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Iradj Sobhani
- 13Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, and University of Paris Est, UPEC, Creteil, France
| | - Richard P Ten Broek
- 35Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luigi Zorcolo
- 36Department of Surgery, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | | | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Fausto Catena
- 38Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| |
Collapse
|
8
|
Meister FA, Amygdalos I, Neumann UP, Lurje G. Rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. Ann R Coll Surg Engl 2017; 99:e191-e192. [PMID: 28660835 DOI: 10.1308/rcsann.2017.0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rectal foreign body insertion is a common condition in emergency surgery, which often requires surgical intervention. Here we report a clinical case of rectal foreign body insertion as a rare cause of persistent lumbosacral plexus injury. A 72-year-old man presented to the emergency department complaining of acute bilateral paraplegia with loss of sensation in both legs, as well as total urinary retention. The patient underwent abdominal computed tomography, which showed a rectal foreign body measuring 13 × 11.5 × 10 cm in the lower abdomen and pelvis. Extraluminal assistance through a median laparotomy was required after unsuccessful attempts at transanal recovery alone. After removal of the foreign body, the rectal wall and anorectal sphincter were massively dilated, with severe bruising of the rectal mucosa on proctoscopy. A protective loop-ileostomy was performed. The sacral plexus is located posteriorly in the pelvis. Physiologically, the nerves are well protected by surrounding anatomical structures. Post-traumatic lumbosacral plexus injuries with paraplegia, urinary retention and anorectal sphincter insufficiency occur quite frequently after heavy traffic accidents. Lumbosacral plexus injury as a result of rectal foreign body insertion is rare. Severe neurological deficits through rectal foreign body insertion are rare but known medical conditions. To the best of our knowledge, this is the first reported case of severe and persistent post-traumatic lumbosacral plexus injury through a rectal foreign body.
Collapse
Affiliation(s)
- F A Meister
- Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany
| | - I Amygdalos
- Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany
| | - U P Neumann
- Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany
| | - G Lurje
- Department of Surgery and Transplantation, University Hospital RWTH-Aachen , Aachen , Germany
| |
Collapse
|
9
|
Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer. Surg Endosc 2017; 32:660-666. [PMID: 28726144 DOI: 10.1007/s00464-017-5718-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR). METHODS We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated. RESULTS Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247-7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961-19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (n = 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma. CONCLUSION ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected.
Collapse
|
10
|
Li YF, Wang XF, Li HS. Diagnosis and treatment of iatrogenic anorectal stenosis. Shijie Huaren Xiaohua Zazhi 2016; 24:1632-1638. [DOI: 10.11569/wcjd.v24.i11.1632] [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] [Indexed: 02/07/2023] Open
Abstract
Iatrogenic anorectal stenosis is one of serious complications after anorectal surgery, and it is often caused by improper operation in surgical resection of hemorrhoids and anal fistula, procedure for prolapse and hemorrhoids (PPH), internal hemorrhoid agent injection and saving anal sphincter in low rectal cancer. Because of the difficulty of defecation, severe anal pain may occur. Stenotic ring can be directly touched in anal and low rectal stenosis. The degree and extent of the stenosis can be observed by colonoscopy in upper rectal stenosis. Mild stenosis can be temporarily treated with conservative therapy. If the degree of stenosis does not relieve or stenosis is more severe, we can choose different types of surgery according to the position, scope and the reasons of stenosis, which include scar closed procedure, longitudinal incision and transverse suture procedure, thread-drawing procedure, reconstruction of the anus by skin flap transposition or colostomy. Although only one procedure was adopted in the majority of cases, two or more procedures can be combined. This article reviews the diagnosis and treatment of anorectal stenosis.
Collapse
|
11
|
van Vledder MG, Doornebosch PG, de Graaf EJR. Transanal endoscopic surgery for complications of prior rectal surgery. Surg Endosc 2016; 30:5356-5363. [PMID: 27059974 DOI: 10.1007/s00464-016-4888-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/23/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Long-term complications of previous rectal surgery (e.g., enterovisceral fistula, anastomotic stricture, rectal stenosis) can be challenging problems for which transabdominal or transperineal surgery with or without definitive fecal diversion is often required. Transanal endoscopic surgery (TES) might allow for local treatment of these complications, thereby saving patients from otherwise major surgery. PATIENTS AND METHODS All patients undergoing TES in the IJsselland Hospital (NL) since 1996 were recorded in a prospective database, of which twenty patients were treated for complications after previous rectal surgery. Data on prior treatment, surgical techniques, outcomes, and need for additional surgery were collected. RESULTS Twenty patients were identified from the database (rectourinary fistula n = 3, rectovaginal fistula n = 5, anastomotic stricture n = 8, and rectal stenosis n = 4). One of the three (33 %) rectourinary fistulas and two of five (40 %) rectovaginal fistulas were successfully treated with TES. Anastomotic strictures were successfully treated in 5/8 (63 %) patients. Strictures after local excision of rectal tumors were successfully treated in 3/4 (75 %) patients. No minor complication and one major complication occurred (rectovaginal fistula after stenoplasty eventually requiring Hartmann's procedure). CONCLUSIONS Transanal treatment of anastomotic strictures, rectal stenosis, and fistula after prior rectal surgery is safe and effective in a large proportion of patients. TES should be considered as a first step in all patients presenting with these late complications after rectal surgery.
Collapse
Affiliation(s)
- Mark G van Vledder
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, PO 690, 2900 AR, Capelle Ad IJssel, The Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, PO 690, 2900 AR, Capelle Ad IJssel, The Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Prins Constantijnweg 2, PO 690, 2900 AR, Capelle Ad IJssel, The Netherlands.
| |
Collapse
|
12
|
Reibetanz J, Kim M, Germer CT, Schlegel N. [Late complications and functional disorders after rectal resection : Prevention, detection and therapy]. Chirurg 2016; 86:326-31. [PMID: 25673116 DOI: 10.1007/s00104-014-2851-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The prognosis of patients with rectal carcinoma has been improved with the implementation of multimodal therapy and improvement of the surgical technique. Therefore, late complications and functional consequences that determine the quality of life following oncological rectal resection are increasingly being recognized. In general both the surgical trauma and side effects of the multimodal therapy play a critical role in the manifestation of various problems in the long-term course after treatment of rectal carcinoma. In this context the low anterior resection syndrome (LARS) has been described which is influenced by different factors and can be worsened by neoadjuvant radiation. Disorders of the urinary bladder and sexual dysfunction as well as benign anastomotic stenoses are problems independent of LARS. Therapeutic approaches for these late complications and functional disorders have either been insufficiently evaluated or are not available. Treatment of functional disorders can be attempted by pelvic floor training, biofeedback and sacral nerve stimulation. Interventional and surgical procedures are available to treat anastomotic stenosis. It must be emphasized that an adequate surgical technique is indispensable to avoid most of these late complications and functional disorders.
Collapse
Affiliation(s)
- J Reibetanz
- Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland,
| | | | | | | |
Collapse
|
13
|
Complications during colonoscopy: prevention, diagnosis, and management. Tech Coloproctol 2015; 19:505-13. [PMID: 26162284 DOI: 10.1007/s10151-015-1344-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/07/2015] [Indexed: 02/08/2023]
Abstract
Colonoscopy is largely performed in daily clinical practice for both diagnostic and therapeutic purposes. Although infrequent, different complications may occur during the examination, mostly related to the operative procedures. These complications range from asymptomatic and self-limiting to serious, requiring a prompt medical, endoscopic or surgical intervention. In this review, the complications that may occur during colonoscopy are discussed, with a particular focus on prevention, diagnosis, and therapeutic approaches.
Collapse
|
14
|
Osera S, Ikematsu H, Odagaki T, Oono Y, Yano T, Kobayashi A, Ito M, Saito N, Kaneko K. Efficacy and safety of endoscopic radial incision and cutting for benign severe anastomotic stricture after surgery for lower rectal cancer (with video). Gastrointest Endosc 2015; 81:770-3. [PMID: 25708767 DOI: 10.1016/j.gie.2014.11.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/05/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Shozo Osera
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomoyuki Odagaki
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasuhiro Oono
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomonori Yano
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akihiro Kobayashi
- Department of Surgical Oncology, Colorectal and Pelvic Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masaaki Ito
- Department of Surgical Oncology, Colorectal and Pelvic Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Norio Saito
- Department of Surgical Oncology, Colorectal and Pelvic Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
15
|
Comparable short- and long-term outcomes of colonoscopic balloon dilation of Crohn's Disease and benign non-Crohn's Disease strictures. Inflamm Bowel Dis 2014; 20:1739-46. [PMID: 25153504 DOI: 10.1097/mib.0000000000000145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The response of Crohn's disease (CD) stricture to endoscopic therapy compared with non-CD stricture is unknown. Our aim was to compare the short- and long-term outcomes of endoscopic management of those strictures. METHODS All eligible patients with benign non-CD strictures who underwent the endoscopic balloon dilation between January 2002 and September 2013 were included. Patients with CD strictures were randomly selected with a ratio (CD versus non-CD strictures) of 2:1. RESULTS A total of 90 patients were included, including 30 (33.3%) with non-CD strictures and 60 (66.7%) with CD strictures. Patients with CD strictures were younger than those with non-CD strictures at the time of disease diagnosis (25.8 ± 11.1 versus 50.5 ± 17.5; P < 0.001) and at the time of the first dilation (43.9 ± 12.4 versus 55.8 ± 13.9; P < 0.001). There were no significant differences in characteristics of strictures and their endoscopic treatments between the CD and non-CD groups, except for the percentage of patients who were ever treated with intralesional corticosteroid injection (25.0% versus 6.7%, P = 0.046). Patients in the 2 groups had similar technical success rates (94.0% versus 93.9%, P = 1.00). Few patients in CD stricture group required emergency room visits due to obstructive symptoms from recurrence of disease (1.7% versus 16.7%, P = 0.02). There were on procedure-related complications in either of the 2 groups. CONCLUSIONS The efficacy and safety of endoscopic balloon dilation in the treatment of CD and non-CD strictures seemed to be comparable.
Collapse
|