Prevention of mechanical colorectal anastomosis leak in colostomy reversal after Hartmann procedure

2018 ◽  
Vol 24 (3) ◽  
pp. 21
Author(s):  
M. I. Sultanmuradov ◽  
V. S. Groshilin ◽  
P. V. Tsygankov ◽  
G. A. Mrykhin
Keyword(s):  
Colorectal Anastomosis ◽  
Hartmann Procedure ◽  
Colostomy Reversal ◽  
Anastomosis Leak

scholarly journals Reversión operación de Hartmann por vía laparoscópica

2021 ◽  
Author(s):  
Marcelo Viola Malet
Keyword(s):  
Multicenter Study ◽  
Open Surgery ◽  
Hartmann’S Procedure ◽  
Efficacy And Safety ◽  
Hartmann Procedure ◽  
Free Survival ◽  
Hartmann’S Reversal ◽  
Hartmann's Procedure ◽  
Colostomy Reversal ◽  
Hartmann's Reversal

Introducción. El procedimiento de Hartmann es una de las cirugías que se realizan con mayor frecuencia frente a una complicación oclusiva o perforativa de colon izquierdo; nos permite resolver el cuadro clínico de la complicación. El porcentaje de restitución del tránsito intestinal es muy bajo, promedialmente inferior al 50%. Ésto se debe a factores propios del paciente, la morbimortalidad de la cirugía, y a dificultades técnicas. El reestablecimiento del tránsito intestinal luego de un Hartmann puede llegar a ser una cirugía muy hostil. Tiene una morbilidadmortalidad propia no despreciable, independientemente de la vía de abordaje utilizada. La reversión por laparoscopía es uno de los procedimientos más complejos a realizar mediante este abordaje. Pero varios estudios han demostrado, que si bien requiere de una curva de aprendizaje más larga y un nivel de destreza técnica alto, tiene mejores resultados que el laparotómico.   Descripción. Presentamos el caso clínico de un hombre de 65 años, que consultó por una peritonitis purulenta diverticular un año atrás, al cual se le realizó una procedimiento de Hartmann. Se coordina para reconstrucción del tránsito intestinal por vía laparoscópica. Paciente en decúbito dorsal, Trendelemburg 30º y lateralizado a derecha. Neumoperitoneo hasta 12mmHg por técnica abierta en flanco derecho para un puerto de 12mm, inicialmente para la cámara, y luego para la mano izquierda del cirujano. Otro de 6mm en fosa ilíaca derecha para la mano derecha del cirujano, y  uno de 12mm supraumbilical para la cámara. Identificamos el muñón rectal en la pelvis. Liberamos el ostoma circunferencialmente, y confeccionamos una jareta con polipropileno 2-0. Colocacamos el anvil de la sutura mecánica 29mm, y reintroducimos el cabo colónico al abdomen. Se realiza cierre parietal en dos planos, y reinstalamos el neumoperitoneo. Colocacamos la sutura mecánica transrectal, engarzando la misma con el anvil a través de la cara anterior del muñón rectal, confeccionando la anastomosis colo-rectal término-lateral. La prueba hidroneumática fue negativa. El paciente tuvo un postoperatorio sin complicaciones, otorgándole el alta a las 72hs del procedimiento, tolerando vía oral, sin dolor, sin fiebre y habiendo movilizado el intestino.   Conclusiones. La cirugía de Hartmann sigue siendo uno de los procedimiento más realizados para tratar las complicaciones perforativas y oclusivas del colon izquierdo y recto. La restitución del tránsito intestinal luego de esta cirugía tiene un altísimo porcentaje de no concretarse por diferentes motivos. La cirugía miniinvasiva requiere de una larga curva de aprendizaje y destreza de alto nivel, pero hay varios trabajos que demuestran que la reversión de un Hartmann tiene mejores resultados por esta vía.   Bibliografía Hallam S, Mothe BS, Tirumulaju R. Hartmann's procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100(4):301-307. doi:10.1308/rcsann.2018.0006 Horesh N, Lessing Y, Rudnicki Y, et al. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis. 2017;32(11):1577-1582. doi:10.1007/s00384-017-2897-2 Melkonian E, Heine C, Contreras D, et al. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery. J Minim Access Surg. 2017;13(1):47-50. doi:10.4103/0972-9941.181329 Resio BJ, Jean R, Chiu AS, Pei KY. Association of Timing of Colostomy Reversal With Outcomes Following Hartmann Procedure for Diverticulitis. JAMA Surg. 2019;154(3):218-224. doi:10.1001/jamasurg.2018.4359 Park W, Park WC, Kim KY, Lee SY. Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal. Ann Coloproctol. 2018;34(6):306-311. doi:10.3393/ac.2018.09.07

scholarly journals Bronchoperitoneal and Enterocutaneous Fistula Development Following a Colorectal Anastomosis Leak

Cureus ◽  
2019 ◽  
Author(s):  
Peter A Ebeling ◽  
Jacob Malmquist ◽  
Katherine Beale ◽  
Deborah L Mueller ◽  
Jason Kempenich
Keyword(s):  
Enterocutaneous Fistula ◽  
Colorectal Anastomosis ◽  
Anastomosis Leak

scholarly journals Colorectal Anastomosis Leak: Rate , Risk Factors and Outcome in a Tertiary Teaching Hospital, Addis Ababa Ethiopia, a Five Year Retrospective Study

1970 ◽  
Vol 29 (6) ◽  
Author(s):  
Gutema Wako ◽  
Henok Teshome ◽  
Engida Abebe
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Retrospective Study ◽  
Colorectal Surgery ◽  
Logistic Regression Model ◽  
Addis Ababa ◽  
Colorectal Anastomosis ◽  
Multivariate Logistic Regression Model ◽  
Multivariate Logistic Regression ◽  
Anastomosis Leak

BACKGROUND: Anastomotic leakage is a morbid and potentially fatal complication of colorectal surgery. Determination of perioperative risk factors for colorectal anastomosis leak helps to identify patients requiring increased postoperative surveillance.METHODS: Institution based retrospective study was done to determine colorectal anastomosis leak rate and risk factors associated with it at a teaching hospital in Addis Ababa Ethiopia. Patients operated from January 2013 to December 2017 G.C were included. Univariate analysis followed by a multivariate logistic regression model was used to determine the influence of patient factors and operative events on postoperative anastomotic leakage.RESULTS: Inclusion criteria were met by 221 patients. Mean age of patients was 46.44(SD=19.1) with range of 1 to 85 years. Male accounted to 166 (74.8%) of the patients. Anastomotic leakage occurred in 12 (5.2%) of the patients. Mean time to diagnosis was 9.55 days (95% CI, 7.2-11.8) after surgery. Univariate analyses showed high preoperative level of creatinine, ASA score III and IV, emergency operation, operative time more than three hours, and malignant diseases were associated with colorectal anastomosisleak. Multivariate logistic regression model failed to show an association. Colorectal anastomosis leak increased the inpatient mortality rate by 50%. Median length of hospitalization in colorectal anastomosis leak group was 27.5 days, versus 7 days in patients without leak.CONCLUSION: Colorectal anastomosis leak remains common problem after colorectal surgery resulting significant post-operative mortality and morbidity. 

scholarly journals Post-resectional pelvic recurrences of rectal cancer

2021 ◽  
Vol 16 (2) ◽  
pp. 202-206
Author(s):  
Adnan Al ALOUL ◽  
◽  
Dan Florin UNGUREANU ◽  
Nicolae BACALBASA ◽  
◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Recurrence Rate ◽  
Abdominoperineal Resection ◽  
Anterior Resection ◽  
Locally Advanced ◽  
Colorectal Anastomosis ◽  
Rare Event ◽  
Pelvic Recurrence ◽  
Hartmann Procedure

Introduction. Pelvic recurrence is not a rare event after resection with curative intent for rectal cancer originating from different segments of the rectum (lower, intermediary and superior part). Material and methods. This retrospective observational study included 106 patients; among these cases there were 79 patients who accepted surgical treatment of rectal cancer (treated in a governmental hospital between 2014 and 2017) and who were submitted to anterior resection with Hartmann’s procedure (6.5% of patients), anterior resection of rectosigmoid with colorectal anastomosis (78% of cases) and abdominoperineal resection (15% of cases). Results. After a 2 year follow-up, pelvic recurrence was reported in 11patients ~ 14% of cases: 33% rate of recurrence after Hartmann procedure, 9% rate of recurrence after abdominoperineal resection, and 10% rate of recurrence after anterior resection of rectosigmoid with colorectal anastomosis. 39 patients (49% of cases) had been submitted to preoperative radiotherapy: the pelvic recurrence rate among these cases was of 11% (9 patients). The rate of recurrence (RR) was also significantly influenced by the stage at diagnostic: stage III had RR = 52% of cases, stage II had RR = 41% of cases and stage I had RR = 0% of cases). The survival rate among surgically treated patients after 1 one year was 86%, and 80% in the first 2 years after treatment. Conclusions. Rectal cancer diagnosed in advanced stages has a high recurrence rate. A low recurrence rate indicates successful curative surgical treatment. The highest recurrence rate was reported after Hartmann procedure (which was usually performed as an emergency operation for locally advanced lesions).

scholarly journals Association of Timing of Colostomy Reversal With Outcomes Following Hartmann Procedure for Diverticulitis

JAMA Surgery ◽  
2019 ◽  
Vol 154 (3) ◽  
pp. 218 ◽  
Author(s):  
Benjamin J. Resio ◽  
Raymond Jean ◽  
Alexander S. Chiu ◽  
Kevin Y. Pei
Keyword(s):  
Hartmann Procedure ◽  
Colostomy Reversal

scholarly journals Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

2021 ◽  
Author(s):  
Alexander Ferko ◽  
Juraj Váňa ◽  
Marek Adámik ◽  
Adam Švec ◽  
Michal Žáček ◽  
...  
Keyword(s):  
Pilot Study ◽  
Povidone Iodine ◽  
Anal Verge ◽  
Colorectal Anastomosis ◽  
Stapled Anastomosis ◽  
Neoadjuvant Radiotherapy ◽  
Lower Upper ◽  
Registration Number ◽  
The Mean ◽  
Diversion Rate

AbstractDehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

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