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Heiss MM, Lange J, Knievel J, Yohannes A, Hügle U, Dormann AJ, Eisenberger CF. Treatment of anastomotic leak in colorectal surgery by endoluminal vacuum therapy with the VACStent avoiding a stoma - a pilot study. Langenbecks Arch Surg 2024; 409:234. [PMID: 39083099 PMCID: PMC11291571 DOI: 10.1007/s00423-024-03426-5] [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: 04/10/2024] [Accepted: 07/22/2024] [Indexed: 08/03/2024]
Abstract
PURPOSE Anastomotic leak (AL) represents the most relevant and devastating complication in colorectal surgery. Endoscopic vacuum therapy (EVT) using the VACStent is regarded as a significant improvement in the treatment of upper gastrointestinal wall defects. The innovative concept of the VACStent was transferred to the lower GI tract, gaining initial experience by investigating safety and efficacy in 12 patients undergoing colorectal resections. METHODS The pilot study, as part of a German registry, began with 2 patients suffering from AL, who were treated with the VACStent after stoma placement. Subsequently, 6 patients with AL were treated with the VACStent omitting a stoma placement, with a focus on fecal passage and wound healing. Finally, the preemptive anastomotic coverage was investigated in 4 patients with high-risk anastomoses to avoid prophylactic stoma placement. RESULTS In total 26 VACStents were placed without problems. The conditioning and drainage function were maintained, and no clogging problems of the sponge cylinder were observed. No relevant clinical VACStent-associated complications were observed; however, in 2 patients, a dislodgement of a VACStent occurred. The 6 patients with AL but without stoma had a median treatment with 3 VACStents per case with a laytime of 17 days, leading to complete wound healing in all cases. The 4 prophylactic VACStent applications were without complications. CONCLUSION The clinical application of the VACStent in the lower GI tract shows that successful treatment of anastomotic colonic leaks and avoidance of creation of an anus praeter is possible. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT04884334, date of registration 2021-05-04, retrospectively registered.
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Affiliation(s)
- Markus M Heiss
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany.
| | - Jonas Lange
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Judith Knievel
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Alexander Yohannes
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - Ulrich Hügle
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - Arno J Dormann
- Department of Gastroenterology, Cologne-Holweide and Merheim Medical Center, Cologne, Germany
| | - Claus F Eisenberger
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
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Francesco C, Serafino V. Colorectal eversion technique combined with modified single-stapled double-purse-string low colorectal anastomosis. Colorectal Dis 2024; 26:772-775. [PMID: 38372032 DOI: 10.1111/codi.16907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/07/2023] [Accepted: 10/19/2023] [Indexed: 02/20/2024]
Abstract
AIM Total mesorectal excision with adequate free margins is the gold standard for rectal surgery. Applying a linear stapler in a narrow pelvis can be challenging and the proper distal margin difficult to assess. In selected cases the colorectal eversion technique combined with single-stapled double-purse-string anastomosis (SSDP) can be a practical solution. METHOD Eleven patients, six men and five women, mean body mass index 27 ± 1.3 kg/m2, underwent total mesorectal excision with the colorectal eversion technique combined with modified SSDP between September 2022 and January 2023. RESULTS The mean operative time was 190 min. The mean hospital stay was 4 days. There were no postoperative complications. The final histology showed complete mesorectal resection, circumferential resection margin negative, free distal resection margin, anastomotic doughnuts negative. At 7 ± 3 months follow-up there was no evidence of local recurrence or distant metastasis. CONCLUSION The colorectal eversion technique combined with modified SSDP is a reproducible and safe technique in selected patients. Prospective randomized trials with large patient series are needed to confirm our preliminary results.
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Affiliation(s)
- Crafa Francesco
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Vanella Serafino
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
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Lee C, Park IJ. Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes. World J Mens Health 2024; 42:304-320. [PMID: 38449456 PMCID: PMC10949018 DOI: 10.5534/wjmh.230335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 03/08/2024] Open
Abstract
Anatomical and physiological differences exist between sex, leading to variations in how diseases, such as rectal cancer, are prevalence and treatment outcomes of diseases including rectal cancer. In particular, in the case of rectal cancer, anatomical differences may be associated with surgical challenges, and these factors are believed to be important contributors to potential disparities in postoperative recovery, associated complications, and oncological outcomes between male and female patients. However, there is still ongoing debate regarding this matter. Significantly, the male pelvic anatomy is distinguished by its narrower dimensions, which can present surgical challenges and impede visual access during operative procedures, rendering it more complex than surgical interventions in the female pelvis. As a result, this anatomical difference leads to a greater occurrence of postoperative complications, such as anastomotic leakage. Moreover, the pelvis houses nerves that are vital for urinary and genital functions, underscoring the need to assess the potential risks of sexual and urinary dysfunction in rectal cancer surgery. These postoperative complications can significantly impact the quality of life; therefore, it is imperative to perform surgery with an understanding of the structural differences between sexes. Therefore, to address the limitations imposed by anatomical structures, new approaches such as robotic surgery, trans-anal total mesorectal excision, and intraoperative neuromonitoring are being introduced. Furthermore, it is essential to conduct research into fundamental mechanisms that may give rise to differences in surgical outcomes and oncological results between sexes. By comprehending the disparities between males and females, we can advance toward personalized treatments. Consequently, this review outlines variations in surgical approaches, complications, and treatments for rectal cancer in male and female patients.
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Affiliation(s)
- Chungyeop Lee
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Francesco C, Serafino V, Caruso E, Hamada M, Ueno N. Solo surgery for low rectal cancer: trans-circular anal dilator low rectal dissection associated with laparoscopic total mesorectal excision-A Video Vignette. Colorectal Dis 2024; 26:805-809. [PMID: 38353474 DOI: 10.1111/codi.16878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 05/02/2024]
Affiliation(s)
- Crafa Francesco
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Vanella Serafino
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Emanuele Caruso
- Oncological, General and Robotic Surgery Unit, S. Giuseppe Moscati Hospital, Avellino, Italy
| | - Madoka Hamada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Nozomi Ueno
- Saiseikai Suita Hospital Hernia Center, Kobe University School of Medicine, Suita, Osaka, Japan
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Francesco C, Serafino V, Mario B, Antonio L. Colorectal eversion technique combined with modified DST (CET-M-DST) for low colorectal anastomosis after laparoscopic TME for colorectal cancer - Video correspondence. Colorectal Dis 2023; 25:2473-2474. [PMID: 37932880 DOI: 10.1111/codi.16802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Crafa Francesco
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Vanella Serafino
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Baiamonte Mario
- Oncological, General and Robotic Surgery Unit, S.Giuseppe Moscati Hospital, Avellino, Italy
| | - Longo Antonio
- European Center of Coloproctology and Pelvic Diseases, Multimedica Hospital, Milan, Italy
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Jung JM, Park IJ, Park EJ, Son GM. Fluorescence-guided colorectal surgery: applications, clinical results, and protocols. Ann Surg Treat Res 2023; 105:252-263. [PMID: 38023438 PMCID: PMC10648611 DOI: 10.4174/astr.2023.105.5.252] [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: 09/29/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750-800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG's role, advantages, disadvantages, and potential clinical impact in colorectal surgery.
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Affiliation(s)
- Jin-Min Jung
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jung Park
- Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Vanella S, Bottazzi EC, Farese G, Murano R, Noviello A, Palma T, Godas M, Crafa F. Minimally invasive colorectal surgery learning curve. World J Gastrointest Endosc 2022; 14:731-736. [PMID: 36438877 PMCID: PMC9693684 DOI: 10.4253/wjge.v14.i11.731] [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: 08/01/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 11/14/2022] Open
Abstract
The learning curve in minimally invasive colorectal surgery is a constant subject of discussion in the literature. Discordant data likely reflects the varying degrees of each surgeon’s experience in colorectal, laparoscopic or robotic surgery. Several factors are necessary for a successful minimally invasive colorectal surgery training program, including: Compliance with oncological outcomes; dissection along the embryological planes; constant presence of an expert tutor; periodic discussion of the morbidity and mortality rate; and creation of a dedicated, expert team.
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Affiliation(s)
- Serafino Vanella
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Enrico Coppola Bottazzi
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Giancarlo Farese
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Rosa Murano
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Adele Noviello
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Tommaso Palma
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Maria Godas
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
| | - Francesco Crafa
- Department of General and Oncology Surgery, A.O.R.N. San Giuseppe Moscati, Avellino 83100, Italy
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Crafa F, Vanella S. Laparoscopic TME and hepatic resection after total neoadjuvant chemotherapy plus short course radiotherapy for low rectal cancer with single synchronous liver metastases - A video vignette. Colorectal Dis 2022; 24:1264-1265. [PMID: 35583093 DOI: 10.1111/codi.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Francesco Crafa
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
| | - Serafino Vanella
- General and Oncological Surgery Unit, Hospital of National Relevance and High Specialty "St. Giuseppe Moscati", Avellino, Italy
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Crafa F, Vanella S, Noviello A, Longo G, Longo F. Laparoscopic PME with colorectal anstomosis with transanal control - A video vignette. Colorectal Dis 2022; 24:887-888. [PMID: 35254719 DOI: 10.1111/codi.16107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/01/2022] [Accepted: 02/27/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Francesco Crafa
- Oncological and General Surgery Unit, S.G. Moscati Hospital, Avellino, Italy
| | - Serafino Vanella
- Oncological and General Surgery Unit, S.G. Moscati Hospital, Avellino, Italy
| | - Adele Noviello
- Oncological and General Surgery Unit, S.G. Moscati Hospital, Avellino, Italy
| | - Giuseppe Longo
- Oncological and General Surgery Unit, S.G. Moscati Hospital, Avellino, Italy
| | - Francesco Longo
- Oncological and General Surgery Unit, S.G. Moscati Hospital, Avellino, Italy
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Valdes-Hernandez J, Cintas-Catena J, Del Rio-Lafuente FJ, Cano-Matias A, Torres-Arcos C, Perez-Sanchez A, Capitan-Morales L, Oliva-Mompean F, Gomez-Rosado JC. Initial experience with intraoperative testing and repair of colorectal anastomosis using a TAMIS approach after a positive leak test. Tech Coloproctol 2022; 26:901-904. [PMID: 35727427 DOI: 10.1007/s10151-022-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
Anastomotic leak is one of the most feared complications of colorectal anastomosis. Different techniques have been described for intraoperative testing of anastomotic integrity. These include air insufflation, methylene blue and endoscopic visualisation. If an anastomotic leak is identified intraoperatively, there are various management options. Redo anastomosis is a possibility, but may be difficult in some cases. Defunctioning is another option, but there is an associated morbidity and signficant detrimental effect on quality of life. Direct transanal repair is only possible when a low anastomosis has been performed. When the anastomotic leak occurs high in the rectum or a partial mesorectal excision is performed a transanal approach is technically very challenging. We present our experience with transanal minimally invasive surgery (TAMIS) approach for anastomotic assessment and repair in four patients. In all cases, a colorectal anastomosis was performed and the air insufflation test was positive. We assessed the anastomosis with TAMIS. In three cases, a defect was found and subsequently sutured. In one case, a scar in the rectal mucosa was found and reinforced with a suture. A protective ileostomy was performed in two cases, while in the other two cases, no stoma was added. All four patients were discharged with no further complications. Both protective ileostomies were taken down after radiological and endoscopic confirmation of anastomotic integrity and all 4 anastomoses remain intact after follow-up. TAMIS intraoperative assessment and repair of anastomotic leak is a safe and feasible technique whcih may avoid the need for a defunctioning stoma.
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Affiliation(s)
- J Valdes-Hernandez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain.
| | - J Cintas-Catena
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - F J Del Rio-Lafuente
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - A Cano-Matias
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - C Torres-Arcos
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - A Perez-Sanchez
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - L Capitan-Morales
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - F Oliva-Mompean
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
| | - J C Gomez-Rosado
- Colorectal Surgery Unit, General and Digestive Surgery Unit, Virgen Macarena University Hospital, Dr Fedriani s/n 41003, Seville, Spain
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