scholarly journals MECHANICAL SUTURE IN RECTAL CANCER

2017 ◽  
Vol 90 (3) ◽  
pp. 305-312
Author(s):  
Cornel Dragos Cheregi ◽  
Ioan Simon ◽  
Ovidiu Fabian ◽  
Adrian Maghiar
Keyword(s):  
Anal Sphincter ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Intestinal Function ◽  
Double Row ◽  
Intestinal Continuity ◽  
Manual Anastomosis ◽  
Mechanical Suture ◽  
End To End ◽  
Mechanical Anastomosis

Background and aims. Colorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves.Methods. In order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013-2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients).Results. Mechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001).Conclusion. The use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis is technically not possible, with the aim to preserve the anal sphincter, to restore intestinal function and maintain genitourinary function through preservation of hypogastric nerves.

scholarly journals Side-to-end vs. Colonic Pouch vs. End-to-end Anastomosis in Low Anterior Resection

2008 ◽  
Vol 20 (2) ◽  
pp. 61-68
Author(s):  
Akira TSUNODA ◽  
Goichi KAMIYAMA ◽  
Naoto SUZUKI ◽  
Makoto WATANABE ◽  
Kazuhiro NARITA ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colonic Pouch ◽  
End To End

scholarly journals Anorectal function after low anterior resection

2004 ◽  
Vol 51 (2) ◽  
pp. 95-97 ◽  
Author(s):  
K.E. Matzel ◽  
B. Bittorf ◽  
U. Stadelmaier
Keyword(s):  
Anterior Resection ◽  
Low Anterior Resection ◽  
Rectal Resection ◽  
Anorectal Function ◽  
Abdominoperineal Excision ◽  
Functional Deficits ◽  
Anterior Rectal Resection ◽  
Physiologic Function ◽  
Intestinal Continuity ◽  
Patients Experience

Most patients with rectal carcinoma can now be treated with sphincter-sparing procedures. The quality of life after sphincter-sparing procedures is better than after abdominoperineal excision. However, morphology and physiology of the neorectum/ sphincter complex are challenged and enthusians towards restorative surgery in rectal cancer was tempered by concerns over functional deficits: after low anterior resection a substantial portion of patients experience impaired anorectal function, in particular fecal leakage and urgency of defecation and report disturbed sexual function. The aim of our work was to investigate functional outcome and anorectal physiologic function as measured by manometry after the three most commonly used reconstructions of intestinal continuity: anterior rectal resection, low anterior rectal, and intersphincteric rectal resection.

325. Functional Results After Electrostimulation of Anal Sphincter After Low Anterior Resection

2012 ◽  
Vol 38 (9) ◽  
pp. 832
Author(s):  
Z. Mammadli ◽  
Y. Barsukov ◽  
A. Nikolaev ◽  
S. Pozdnyakov ◽  
V. Kulushev ◽  
...  
Keyword(s):  
Anal Sphincter ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Functional Results

Endosonographic evidence of injury to the internal anal sphincter after low anterior resection

1998 ◽  
Vol 41 (7) ◽  
pp. 888-891 ◽  
Author(s):  
Ridzuan Farouk ◽  
Graeme S. Duthie ◽  
Peter W. R. Lee ◽  
John R. T. Monson
Keyword(s):  
Anal Sphincter ◽  
Anterior Resection ◽  
Internal Anal Sphincter ◽  
Low Anterior Resection

Outcomes of Low Anterior Resection Anastomotic Leak after Preoperative Chemoradiation Therapy for Rectal Cancer

2010 ◽  
Vol 76 (7) ◽  
pp. 747-751 ◽  
Author(s):  
Lisa J. Harris ◽  
Benjamin R. Phillips ◽  
Pinckney J. Maxwell ◽  
Gerald A. Isenberg ◽  
Scott D. Goldstein
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Primary Anastomosis ◽  
Anal Verge ◽  
Lower Rectum ◽  
Institutional Review ◽  
Intestinal Continuity ◽  
Tumor Level

Anastomotic leak remains a major cause of morbidity and mortality after colorectal surgery, especially with low anastomoses. The aim of this study was to assess outcomes of patients who developed an anastomotic leak after low anterior resection of the rectum for rectal cancer. An Institutional Review Board-approved retrospective review of 89 consecutive patients undergoing open low anterior resection with primary anastomosis for cancer of the mid/lower rectum at a single institution between January 2001 and December 2008 was performed. All patients received neoadjuvant chemotherapy and radiation therapy. Proximal diversion was performed in all patients. Perioperative data were collected and analyzed with attention to management and outcomes after development of anastomotic leak. Nine patients (10.1%) developed anastomotic leak. Mean age was 62 years. Mean tumor level was 4.8 cm above the anal verge. Symptomatic anastomotic leak developed in seven (78%) patients. Percutaneous drainage was performed in five (55.6%) patients with an average of 4.4 procedures required for management of anastomotic leak. Five (55.6%) patients required reoperation. Only two procedures (25%) involved laparotomy. No operative procedures were performed emergently. There were no mortalities. Excluding one patient who received completion proctectomy for local recurrence, restoration of intestinal continuity was achieved in five (63%) of eight patients. Mean time to stoma closure was 289 days. The potentially lethal complication of anastomotic leak after low anterior resection for rectal cancer can be managed expectantly and electively in patients who are proximally diverted with the expectation of stoma reversal in the long term.

scholarly journals Rectal Reconstruction after Total Mesorectumectomy: Functional Outcomes and Quality of Life

2021 ◽  
Vol 11 (3) ◽  
pp. 195-202
Author(s):  
A. O. Rasulov ◽  
A. B. Baychorov ◽  
A. M. Merzlyakova ◽  
A. I. Ovchinnikova ◽  
A. V. Semyanikhina
Keyword(s):  
Quality Of Life ◽  
Anterior Resection ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Post Surgery ◽  
J Pouch ◽  
End To End

Background. The study aims to compare the functional outcomes and quality of life in patients having variant rectal reconstruction procedures after low anterior resection for cancer.Materials and methods. A prospective randomised controlled trial enrolled 90 patients who underwent total mesorectumectomy with formation of J-pouch (J-P), side-to-end (STE) or end-to-end (ETE) anastomoses.Results and discussion. We analysed 22 J-P, 30 STE and 38 ETE patients. For technical reasons, 26.6 % J-Ps were remodelled to other anastomoses. The neorectal sensory threshold, first and permanent defecation urges and maximal tolerated volume were higher in J-P at months 3–6–12 postoperatively.Severe low anterior resection syndrome events at post-surgery month 6 were significantly more frequent in the ETE vs. J-P and STE cohorts (21, 0 and 3.3 %, respectively, p < 0.05). Stool frequency was significantly lower in J-P vs. STE and ETE at months 3–6–12. Wexner score was 3, 5, 6 at month 6 (p < 0.05) and 0, 1, 1 at month 12 for J-P, STE and ETE, respectively (p > 0.05). Evacuatory dysfunction was present at month 6 in 59.1 J-P, 33.3 STE and 21.1 % ETE.Quality of life (FIQL) in J-P and STE was significantly higher vs. ETE anastomoses in the Lifestyle (3.21, 3.22 and 3.03, respectively, p < 0.05) and Coping (3.29, 3.21 and 2.95, respectively, p < 0.05) scales to month 12 postoperatively.Conclusion. The J-pouch formation after low anterior resection ameliorates anal continence at months 3–6 post-surgery, reduces low anterior resection syndrome and improves quality of life (FIQL). The ease of implementation and irrelevance of evacuatory dysfunction in side-to-end anastomosis make it a superior choice over end-to-end surgery.

Sign in / Sign up

Export Citation Format

Share Document