The Functional Outcomes of Coloanal and Low Colorectal Anastomoses with Reservoirs after Low Rectal Cancer Resections

2014 ◽  
Vol 80 (12) ◽  
pp. 1222-1229 ◽  
Author(s):  
FranÇ Ois Rubin ◽  
Richard Douard ◽  
Philippe Wind
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Functional Outcomes ◽  
Functional Results ◽  
Functional Impairments ◽  
Level Of Evidence ◽  
Anastomotic Complications ◽  
Colorectal Anastomoses ◽  
Anterior Rectal Resection ◽  
Colonic Reservoir

Nearly half of patients undergoing low anterior rectal cancer resection have a functional sequelae after straight coloanal or low colorectal anastomoses (SA), including low anterior rectal resection syndrome, which combines stool fragmentation, urge incontinence, and incontinence. SA are responsible for anastomotic leakage rates of 0 to 29.2 per cent. Adding a colonic reservoir improves the functional results while reducing anastomotic complications. These colonic reservoir techniques include the colonic J pouch (CJP), transverse coloplasty (TC), and side-to-end anastomosis (STEA) procedures. The aim of this literature review was to compare the functional outcomes of these three techniques from a high level of evidence. CJP with a 4- to 6-cm reservoir is a good surgical option because it reduces functional impairments during the first year, and probably up to 5 years, but is not always feasible. TC appears to perform as well as CJP, is achievable in over 95 per cent of patients, but still with some doubts about a higher anastomotic leakage rate and worse functional outcomes. STEA appears equivalent to CJP in terms of morbidity and even better functional outcomes. STEA, with a terminal side segment size of 3 cm, is feasible in the majority of nonobese patients, combines good functional results, has low anastomotic leakage rates, and is easy to complete.

scholarly journals Prediction of anastomotic leakage after anterior rectal resection

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Shubang Cheng ◽  
Bolin He ◽  
Xueyi Zeng
Keyword(s):  
Rectal Cancer ◽  
Prediction Model ◽  
Anastomotic Leakage ◽  
Roc Curve ◽  
Rectal Resection ◽  
Preoperative Chemoradiotherapy ◽  
Tumor Differentiation ◽  
Intraoperative Bleeding ◽  
Anterior Rectal Resection ◽  
Validation Set

Objective: Anastomotic Leakage (AL) is one of the most common complications after resection of rectal cancer. Recognition of the incidence and risk factors related to AL is important. This study aimed develops a model that can predict anastomotic leakage after anterior rectal resection. Methods: Data from 188 patients undergoing anterior resection of rectal cancer were collected for retrospective analysis. Patients were randomly divided in the development set and validation set at a 1:1 ratio. We first included age, sex, preoperative chemoradiotherapy, tumor size, degree of tumor differentiation, stage, TNM stage, lymph vascular invasion, distance, anastomotic method, diabetes, intraoperative time, intraoperative bleeding and smoking as candidates for variable selection with a LASSO method. A ROC curve was constructed with the validation set to assess the accuracy of the prediction model. Results: AL occurred in 20 of 188 patients (10.6%). Preoperative chemoradiotherapy (p=0.04), medium degree of tumor differentiation (p=0.04), anastomotic method (p<0.01), intraoperative bleeding≥400ml (p<0.01), smoking (p<0.01), diabetes (p<0.01) were significantly related to AL. The area under the ROC curve of the prediction model is 0.952. Conclusions: This study developed a model that can predict anastomotic leakage after anterior rectal resection, which may aid the selection of preventive ileostomy and postoperative management. doi: https://doi.org/10.12669/pjms.35.3.252 How to cite this:Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection. Pak J Med Sci. 2019;35(3):830-835.  doi: https://doi.org/10.12669/pjms.35.3.252 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery

2021 ◽  
Vol 1 (5) ◽  
pp. 465-470
Author(s):  
HIROYA ENOMOTO ◽  
KATSUHITO SUWA ◽  
NANA TAKEUCHI ◽  
YOSHITO HANNYA ◽  
YUHEI TSUKAZAKI ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Rectal Resection ◽  
Univariate Analysis ◽  
Outlet Obstruction ◽  
Muscle Thickness ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Anterior Rectal Resection

Background: The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient’s quality of life and prolongs hospitalization. Patients and Methods: A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer. Results: Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO. Conclusion: When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.

scholarly journals Outcomes Following Treatment of the Infected Achilles Tendon

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984694
Author(s):  
Mark W. Bowers ◽  
Norman S. Turner ◽  
Daniel B. Ryssman ◽  
Steven L. Moran
Keyword(s):  
Achilles Tendon ◽  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Therapy Program ◽  
Tendon Surgery ◽  
Secondary Closure

Background: Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat and often leads to poor outcomes. A number of treatments have been described, but there is little information concerning outcomes of these treatments. Our purpose was to evaluate the clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon after acute and chronic midsubstance repair. Methods: We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range, 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture-specific intravenous (IV) antibiotics for 3 to 6 weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale. Results: All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. Fourteen patients participated in the FAAM ADL survey. There were 6 patients lost to follow-up. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal.” Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture-specific IV antibiotics. Level of Evidence: Level IV, retrospective case series.

Meta-Analysis on the Efficacy of Indocyanine Green Fluorescence Angiography for Reduction of Anastomotic Leakage After Rectal Cancer Surgery

2020 ◽  
pp. 000313482098284
Author(s):  
Zonglin Li ◽  
Yejiang Zhou ◽  
Gang Tian ◽  
Yi Liu ◽  
Yifan Jiang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Indocyanine Green ◽  
Anastomotic Leakage ◽  
Operation Time ◽  
Pooled Analysis ◽  
Fluorescence Angiography ◽  
Cochrane Library ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Colorectal Anastomoses

Background Indocyanine green (ICG) fluorescence angiography is a new technique that help surgeons to assess the blood perfusion of the anastomotic intestine. The aim of this study is to evaluate whether ICG fluorescence angiography can reduce the anastomotic leakage (AL) rate after colorectal anastomoses for rectal cancer (RC) patients. Methods Studies comparing AL rates between use and nonuse of ICG fluorescence angiography up to April 2020 were systematically searched from PubMed, Embase, Web of Science, Cochrane Library, and China National Knowledge Infrastructure. A pooled analysis was performed for the available data regarding the baseline features, AL rate, and other surgical outcomes. ReMan 5.3 software was used to perform the statistical analysis. Quality evaluation and publication bias were also conducted. Results Thirteen studies with a total of 2593 patients (1121 in the ICG group and 1472 in the control group) undergoing colorectal anastomoses after RC surgery were included. In the pooled analysis, the baseline data, operation time, and intraoperative blood loss in 2 groups were all comparable and without significant heterogeneity. However, the AL rate in the ICG group was significantly lower (OR .31; 95% CI .22-.44; P < .00001) than that in the control group. Additionally, ICG fluorescence angiography was associated with a decreased overall complication rate (OR .60; 95% CI .47-.76; P < .0001) in patients who undergo RC surgery. Conclusions The present study revealed that ICG fluorescence angiography reduced AL rate after colorectal anastomoses for RC patients. However, more high-quality randomized controlled trials are needed to confirm this benefit.

Endoscopic Flexor Hallucis Longus Transfer for Achilles Noninsertional Tendinopathy: Description of Surgical Technique and Functional Outcomes

2020 ◽  
pp. 193864001989591
Author(s):  
Juan Bernardo Gerstner G ◽  
Ian Winson ◽  
Jimmy Campo ◽  
Michael Swords ◽  
Juan Camilo Medina ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Case Series ◽  
Functional Results ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Flexor Hallucis Longus Transfer ◽  
The Mean ◽  
American Orthopaedic

Background. The transfer of the flexor hallucis longus (FHL) tendon is an established treatment for replacing a dysfunctional Achilles tendon. Objectives. (1) Describe a new technique for endoscopic FHL transfer for noninsertional Achilles tendinopathy and (2) describe the functional outcomes and complications after endoscopic and open FHL transfer. Materials and Method. Retrospective study of patients who underwent open or endoscopic FHL transfer between 2014 and 2016. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot scale was used preoperatively and postoperatively to measure the functional results. Results. We included 18 endoscopic FHL transfers and 24 open FHL transfers. The mean age of endoscopic and open procedures was 47.5 years (range 25-77 years) and 61.2 years (range 43-72 years), respectively. An improvement on the average AOFAS of 52.8% (31.9 points) was observed in the endoscopy group during the follow-up from the baseline. The mean improvement in AOFAS score for the open group was 41.4% (24.5 points). Four and 7 cases reported complications in the endoscopy and open FHL transfer groups, respectively. Conclusion. While both procedures were effective in treating noninsertional Achilles tendinopathy, the described arthroscopic treatment led to a greater improvement in the AOFAS score and is slightly less prone to lasting complications. Level of Evidence: Level IV: Case series

scholarly journals Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038930
Author(s):  
Felix J Hüttner ◽  
Pascal Probst ◽  
André Mihaljevic ◽  
Pietro Contin ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Pilot Trial ◽  
Ileostomy Closure ◽  
Ghost Ileostomy ◽  
Anterior Rectal Resection ◽  
Randomised Controlled

IntroductionAnastomotic leakage is the most important complication in colorectal surgery occurring in up to 20% after low anterior rectal resection. Therefore, a diverting ileostomy is usually created during low anterior resection to protect the anastomosis or rather to diminish the consequences in case of anastomotic leakage. The so-called virtual or ghost ileostomy is a pre-stage ostomy that can be easily exteriorised, if anastomotic leakage is suspected, in order to avoid the severe consequences of anastomotic leakage. On the other hand, an actual ileostomy can be avoided in patients, who do not develop anastomotic leakage.Methods and analysisThe GHOST trial is a randomised controlled pilot trial comparing ghost ileostomy with conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision for rectal cancer. After screening for eligibility and obtaining informed consent, a total of 60 adult patients are included in the trial. Patients are intraoperatively randomised to the trial groups in a 1:1 ratio after assuring that none of the intraoperative exclusion criteria are present. The main outcome parameter is the comprehensive complication index as a measure of safety. Further outcomes include specific complications, stoma-related complications, complications of ileostomy closure, frequency of transformation of ghost ileostomy into conventional ileostomy, frequency of terminal ostomy creation, proportion of patients with an ostomy at 6 months after index surgery, anorectal function (Wexner score) and quality of life assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Follow-up for each individual patient will be 6 months.Ethics and disseminationThe GHOST trial has been approved by the Medical Ethics Committee of Heidelberg University (reference number S-694/2017). If the intervention proves to be safe, loop ileostomy could be spared in a large proportion of patients, thus also avoiding stoma-related complications and a second operation (ileostomy closure) with its inherent complications in these patients.Trial registration numberGerman Clinical Trials Registry (DRKS00013997); Universal Trial Number: U1111-1208-9742.

scholarly journals SIDE-TO-END ANASTOMOSIS IN LOW ANTERIOR RECTAL RESECTION

2015 ◽  
Vol 174 (2) ◽  
pp. 42-46
Author(s):  
Yu. A. Shelygin ◽  
A. S. Budtuev ◽  
D. Yu. Pikunov ◽  
E. G. Rybakov ◽  
O. Yu. Fomenko ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Period ◽  
Rectal Resection ◽  
Randomized Study ◽  
Functional Results ◽  
Main Group ◽  
Stool Frequency ◽  
Prospective Randomized Study ◽  
Control Group ◽  
Anterior Rectal Resection

The authors have launched a prospective randomized study aimed to make a comparison of functional results of formation of straight coloanal (control group) and side-to end (main group) anastomosis in case of low anterior rectal resection since 2012. Each group consisted of 40 patients undergoing operation concerning uncomplicated rectal cancer of medium-ampullar section of rectum. It was noted that patients of the main group had lower stool frequency in postoperative period. A function of the interior sphincter was less damaged and the rate of compliance of rectum was high.

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