scholarly journals Pelvic drain after low anterior resection of the rectum: pros and cons

2021 ◽  
Vol 102 (6) ◽  
pp. 902-907
Author(s):  
F Sh Akhmetzyanov ◽  
V I Egorov ◽  
G R Abdulganieva
Keyword(s):  
Anterior Resection ◽  
Personal Experience ◽  
Low Anterior Resection ◽  
Randomized Trials ◽  
Intraoperative Complications ◽  
Colorectal Anastomosis ◽  
Pelvic Cavity ◽  
Surgical Interventions ◽  
High Incidence ◽  
Pros And Cons

Low anterior resection, unlike other large bowel resections with anastomosis, is characterized by a high incidence of postoperative complications, repeated surgical interventions, accompanied by high mortality. To reduce these indicators, the creation of a protective stoma and drainage of the pelvis has become widespread. However, the efficiency of pelvic drainage after low anterior resection remains unclear and controversial. This literature review is devoted to the relevance of the problem of efficiency and analysis of studies on this issue. Most randomized trials have not proven the effectiveness of drainage in colorectal surgery, but in these studies, as a rule, little or no attention was paid to draining the small pelvis after total mesorectal excision. This work analyzes the studies of supporters and opponents of pelvic drainage after low anterior resection of the rectum and provides arguments for and against drainage of the pelvic cavity. Although there are randomized trials showing no benefit of pelvic drainage, many clinics use pelvic drain after low anterior resection. The personal experience of the surgeon and the occurrence of intraoperative complications such as bleeding, contamination, technical difficulties in colorectal anastomosis formation has an important role to play in this. A lower rate of repeated operation in the use of pelvic drainage suggests the possibility of conservative treatment.

scholarly journals The role of transanal drainage tube in low anterior resection for rectal cancer

2021 ◽  
Vol 102 (3) ◽  
pp. 335-341
Author(s):  
F Sh Akhmetzyanov ◽  
V I Egorov ◽  
D M Ruvinskiy ◽  
O V Lûtikovа
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Small Samples ◽  
Mesorectal Excision ◽  
Surgical Interventions ◽  
Anterior Rectal Resection ◽  
Intestinal Stoma

Total mesorectal excision with low anterior resection has significantly improved the long-term outcomes of surgical treatment for rectal cancer, decreasing the local recurrence rate and increasing survival. However, total mesorectal excision is becoming one of the main factors for the development of colorectal anastomosis leakage, the rate of which reaches 20% in these operations. To minimize the complications associated with the inconsistency of the colorectal anastomotic suture, preventive intestinal stoma is formed when performing low anterior resections. That significantly worsen the quality of life of patients, their elimination requires re-hospitalization, and surgical interventions are accompanied by a high incidence of postoperative complications, reaching a rate of 20%, which has a significant impact on the cost of treatment for this category of patients. Transanal drainage is an alternative to the formation of preventive intestinal stoma and is devoid of its shortcomings. This literature review is devoted to an analysis of the effectiveness of transanal drainage in low anterior rectal resection. Until recently, transanal drainage has not yet gained popularity among surgeons due to the lack of evidence of its safety and effectiveness, and many studies are retrospective, including small samples. The review considered single-center, multicenter, randomized trials and a meta-analysis of the use of transanal drainage. Transanal drainage is an effective method for preventing the inconsistency of colorectal anastomotic suture, it is safe, and it surpasses the preventive intestinal stoma in a number of indicators.

scholarly journals Low Anterior Resection Syndrome in Adults with Rectal Cancer in China: a Case Series Analysis

2021 ◽  
Author(s):  
Yuan Qiu ◽  
Yu Pu ◽  
Haidi Guan ◽  
Weijie Fan ◽  
Shuai Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Recovery Time ◽  
Colorectal Anastomosis ◽  
Postoperative Recovery ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Lars Score

AbstractLow anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients’ defecation after restorative surgery for rectal cancer. The aim of this work was to study the incidence and risk factors for LARS in China. Rectal cancer patients undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were identified from a single center. The patients completed the LARS score questionnaire through telephone. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic dimensions on the occurrence of LARS was also analyzed. This study included 337 patients, at an average age of 61.03 SD11.32. The mean LARS score of the patients was 14.08 (range 0–41). A total of 126 patients (37.4%) developed LARS after surgery, including 63 (18.7%) severe cases. Compared with the scores within the initial 6 postoperative months, the LARS scores of the patients in 6~18 months after the surgery showed significant reductions (p < 0.01). In multivariate analysis, lower locations of anastomosis, pre-surgery radiotherapy, and shorter postoperative recovery time were significant predisposing factors for LARS. A subgroup analysis revealed that patients suffering from LARS over 18 months after surgery were found to have a significantly shorter interspinous distance than those without LARS (p < 0.05). LARS could improve over time after surgery. Lower anastomotic level and pre-surgery radiotherapy are risk factors for LARS.

scholarly journals METHOD OF «HIDDEN COLOSTOMY» IN LOW ANTERIOR RESECTIONS OF RECTUM

2016 ◽  
Vol 175 (6) ◽  
pp. 52-55
Author(s):  
E. A. Kalivo ◽  
G. M. Manikhas ◽  
M. D. Khanevich ◽  
M. Kh. Fridman ◽  
G. N. Khrykov
Keyword(s):  
Anastomotic Leakage ◽  
Large Intestine ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Rectal Anastomosis ◽  
Intestinal Stoma ◽  
Dressing Room

The authors present their experience, methodology and advantages of the method of «hidden colostomy» in treatment of anastomotic leakage after low anterior resection of rectum. The operations using the method of «hidden colostomy» were performed on 67 patients. All the patients underwent the low anterior resection of rectum operation concerning cancer with anastomosis formation at the distance of 3-8 cm from anus. The leakage of rectal anastomosis was revealed in 6 (8,9%) patients. A delayed double-barrel transverse stoma using preventive turnpike was formed in surgical dressing room without typical relaparotomy according to described method. Continuity of large intestine was restored in all patients during 2 months after operation. The method of «hidden colostomy» allowed doctors to avoid formation of vain protective intestinal stoma. This method helped to treat patients in a very simple and effective way in case of leakage of colorectal anastomosis.

scholarly journals Low Anterior Resection of Rectal Cancer and Vaginal Specimen Extraction with Da Vinci Xi

2018 ◽  
Author(s):  
Tuğrul Çakır ◽  
Arif Aslaner
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Da Vinci ◽  
Loop Ileostomy ◽  
Colorectal Anastomosis ◽  
Operation Time ◽  
Da Vinci Xi ◽  
Specimen Extraction ◽  
First Case

Introduction: Novel robotic surgery systems (da Vinci Xi) are superior to classical open and laparoscopic techniques with its clear and three-dimensional view. We aimed to present the first case low anterior resection of rectal cancer and vaginal specimen extraction with Da Vinci Xi.Case: A 75-year-old female patient with rectum adenocarcinoma was undergone robotic-assisted low anterior resection (LAR) of the rectum, vaginal removal of the specimen, colorectal anastomosis and loop ileostomy. The operation time was 190 minutes. There were no postoperative complications. Pathological tumor stage was stage pT1N0 with negative proximal, distal and radial resection margins. The patient was discharged on the third postoperative day.Conclusion: Robot-assisted LAR, total mesorectal excision, vaginal removal of the specimen, colorectal anastomosis, and loop ileostomy can be performed easily and safely with Da Vinci Xi at early stage rectal cancer. And the vaginal extraction of the specimen avoids us from a traditional abdominal incision.

scholarly journals Risk Factors for Anastomotic Leakage after Low Anterior Resection

Folia Medica ◽  
2020 ◽  
Vol 62 (2) ◽  
pp. 290-294
Author(s):  
Gancho G. Kostov ◽  
Rossen S, Dimov ◽  
Daniela D. Almeida
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Dentate Line ◽  
Sphincter Preservation ◽  
University Hospital ◽  
Permanent Colostomy

Introduction: Low anterior resection (LAR) is a standard surgical procedure for distal rectal carcinoma that allows creation of a colorectal anastomosis, with anal sphincter preservation and permanent colostomy avoidance. Anastomotic leakage (AL) is a potential complication of LAR present in 3% to 20% of cases leading to a significant increase in postoperative morbidity. AL represents a communication between the intra luminal and extra luminal compartments caused by a violation of the integrity of the intestinal wall. The risk factors of this procedure have been discussed and still remain a controversial issue. Prevention is the best management. Patients with predisposing factors should be paid special attention. Aim: Our objective was to identify and analyze the risk factors of anastomotic leakage after low anterior resection of rectal carcinoma. Patients and methods: This study included all patients who underwent low anterior resection for rectal cancer at the Department of Surgery of University Hospital Kaspela between 2011 and 2016. Results: Low anterior resections were performed in 141 patients during the study period. Due to a positive air leak test on 16 patients, a protective ileostomy was created and these patients were eliminated from the study. The sex distribution of the remaining 125 patients was 69 men (55.2%) and 56 women (44.8%). The height of the anastomosis from the dentate line was 3.0 cm on an average (range 2.5 to 4 cm). Conclusion: Anastomotic leakage remains the most feared and serious complication after low anterior resection surgery. The evidence suggests that the main risk factors for anastomotic leakage at low anterior resection are the height of the anastomosis and the high ASA score.

Sign in / Sign up

Export Citation Format

Share Document