Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection

Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark). Materials and Methods: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between October 2018 and December 2019. The Obsidian ASG® Matrix was applied to the rectal stump, and after closure with the circular stapling device, at the circumference of anastomosis in every single case. Anastomoses were supplemented with intra- and extra-anastomotic application (IAA—intra-anastomotic application developed by Rivolution GmbH, Rosenheim, Germany) of Obsidian ASG® Matrix. The primary endpoints were incidence of perioperative complications and anastomotic leak rate. Results: Two-hundred-sixty-one (138 female) patients underwent left-sided colonic (n=177) or rectal resection (n=84). In 253 (96.9%) cases, a laparoscopic or robotic-assisted approach was used. There were no complications attributable to the intraoperative application of the Obsidian ASG® Matrix. All intraoperative leak tests were negative. Overall, anastomotic leak rate accounted for 2.3% (6/261). AL following colonic and rectal resection was seen in 2.3% (4/177) and 2.4% (2/84), respectively. Complication and leak rate was similar in the two participating centers. Postoperative fever and elevated CRP levels were significantly correlated to AL. There was no significant risk factor for AL on multivariate analysis. Conclusion: Application of an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®) at anastomotic site following colorectal resection is safe and associated with a low rate of anastomotic leakage.

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A Case of IgG4 Related Disease Mimiking Disseminated Recurrence of Rectal Cancer after Laparoscopic Rectal Resection

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.81.1151 ◽

2020 ◽

Vol 81 (6) ◽

pp. 1151-1155

Author(s):

Masashi HATTORI ◽

Hitoshi TERAMOTO ◽

Masahiro SASAHARA ◽

Naoya TAKEDA ◽

Hirotaka MARUYAMA ◽

...

Keyword(s):

Rectal Cancer ◽

Rectal Resection ◽

Related Disease ◽

Igg4 Related Disease ◽

Laparoscopic Rectal Resection ◽

Recurrence Of Rectal Cancer

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Preoperative Endoscopic Tattoo Marking Improves Lymph Node Retrieval in Laparoscopic Rectal Resection: A Retrospective Cohort Study

Annals of Coloproctology ◽

10.3393/ac.2021.00458.0065 ◽

2021 ◽

Author(s):

Kouki Imaoka ◽

Takuya Yano ◽

Masanori Yoshimitsu ◽

Sotaro Fukuhara ◽

Ko Oshita ◽

...

Keyword(s):

Cohort Study ◽

Lymph Node ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Rectal Resection ◽

Lymph Node Retrieval ◽

Laparoscopic Rectal Resection

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Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma

10.21203/rs.2.18766/v3 ◽

2020 ◽

Author(s):

Daichi Kitaguchi ◽

Tsuyoshi Enomoto ◽

Yusuke Ohara ◽

Yohei Owada ◽

Katsuji Hisakura ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Anastomotic Leakage ◽

Rectal Resection ◽

False Negative ◽

Water Soluble ◽

Stapled Anastomosis ◽

Stoma Closure ◽

Radiological Result ◽

Diverting Stoma

Abstract Background When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. Methods This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7 Results The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Conclusions Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

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