scholarly journals Endoluminal Negative Pressure Wound Therapy (E-NPWT) for anastomotic leakage after rectal resection

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Norbert Severin Friedrich Runkel ◽  
Mechthilde Birk
Keyword(s):  
Anastomotic Leakage ◽  
Fibrin Glue ◽  
Rectal Resection ◽  
Damage Control ◽  
Local Treatment ◽  
Case Series ◽  
Closure Rate ◽  
Large Defect ◽  
Surgical Closure ◽  
Anterior Rectal Resection

Background Local management of anastomotic leakage after rectal cancer resection has traditionally consisted of rinsing and drainage. Transanal endoluminal application of NPWT (E-NPWT or endo-VAC or endo-sponge) is an interesting novel concept that has been explored in a few studies and case series over the last decade. We report herein our institutional experience over a three year period during which E-NPWT was the local treatment of choice for all cases with anastomotic leakage after rectal resection.Patients and MethodsThis study retrospectively evaluated the clinical charts of 147 consecutive patients who underwent anterior rectal resection from 2011-2013. A postoperative anastomotic leak occurred in eight (5%) patients from two straight anastomoses, one side-to-end construction, and five colonic pouches. All patients had undergone curative anterior resection with diverting ostomy. Transanal debridement and application of a trimmed foam were performed by rigid or fexibel endoscopy and started without delay after confirmation of diagnosis in seven patients 8-15 days postoperatively. In one patient E-NPWT began after failed fibrin-glue treatment 6 weeks later. The foams were connected to a standard vacuum pump with the pressure set at -70mmHg in a continuous mode. E-NPWT was maintained for a median period of 10 (5-25) days. The treatment intervals were typically 2-3 days.ResultsComplete healing was achieved in three cases during E-NPWT. In the remaining five patients, the defect reduced in size to allow further spontaneous healing. This occurred twice. One persistent sinus was successfully sealed with fibrin glue.  One persisting recto-vaginal fistula required surgical closure. One large defect secondary to ischemic pouch necrosis required secondary pouch explantation and permanent colostomy. The overall ileostomy reversal rate was 75%.ConclusionE-NPWT is feasible and without severe side effects. Early initiation prevents septic progression and results in a high closure rate in patients with pelvic leakage. Although complete healing is not achieved in recto-vaginal fistulas or ischemic necrosis of the neorectum, E-NPWT may play a potential role in bridging and damage control. 

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.

Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

2015 ◽  
Vol 87 (3) ◽  
Author(s):  
Jerzy Piecuch ◽  
Maciej Wiewióra ◽  
Monika Szrot ◽  
Janusz Jopek ◽  
Albert Krzak ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Rectal Resection ◽  
Group Iii ◽  
Group I ◽  
Anterior Rectal Resection ◽  
Mechanical Suture ◽  
The Relationship

AbstractAnterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory.The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/mResults. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53).Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.

scholarly journals Neoadjuvant radio-chemotherapy prolongs healing of anastomotic leakage after rectal resection treated with endoscopic vacuum therapy

2019 ◽  
Vol 12 ◽  
pp. 175628481987760 ◽  
Author(s):  
Leif Schiffmann ◽  
Nicole Wedermann ◽  
Frank Schwandner ◽  
Michael Gock ◽  
Ernst Klar ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Treatment Success ◽  
Neoadjuvant Treatment ◽  
Case Series ◽  
Neoadjuvant Radiochemotherapy ◽  
Vacuum Therapy ◽  
Endoscopic Vacuum Therapy ◽  
Long Term Preservation

Background: Neoadjuvant radiochemotherapy (nRCT) is an important component in the treatment of advanced rectal cancer. Endoscopic vacuum therapy (EVT) has become the treatment of choice for anastomotic leakage after rectal resection in many institutions in Germany. Published case series report on average success and stoma reversal rates of more than 80%. However, so far, there is no distinct report on the potential influence of nRCT on EVT. Methods: A total of 11 patients treated with EVT for anastomotic leakage after nRCT and rectal resection were retrospectively compared with a cohort of eight patients with rectal anastomotic leakage without neoadjuvant treatment. Primary endpoints were death, treatment success, and long-term preservation of intestinal continuity. Secondary endpoint was the duration of treatment. Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 23.0. Results: There was no difference in mortality (0%), success rate (90.9% versus 100%, p = 0.381), or long-term preservation of continuity (63.6% versus 62.5%, p = 0.960). After nRCT, patients showed a significant longer duration of EVT (31.1 days versus 15.9 days, p = 0.040) which was associated with a significantly higher number of sponge applications (9.6 versus 5.0, p = 0.042). Conclusions: In our analysis, EVT showed success in over 90% of patients with anastomotic leakage after rectal resection for colorectal cancer, regardless of neoadjuvant treatment. However, in case of anastomotic leakage, nRCT seems to be associated with the need for a significant longer duration of EVT.

scholarly journals Introduction of a Handmade Vacuum-Assisted Sponge Drain for the Treatment of Anastomotic Leakage After Low Anterior Rectal Resection

2021 ◽  
Author(s):  
Amir Keshvari ◽  
Abolfazl Badripour ◽  
Mohammad Reza Keramati ◽  
Alireza Kazemeini ◽  
Behnam Behboudi ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Anterior Rectal Resection

Perioperative Management of Nasal Septal Perforation: A Case Series and Review

2021 ◽  
Author(s):  
William James Wakeford ◽  
Eamon Shamil ◽  
Alwyn Ray D'Souza
Keyword(s):  
Patient Selection ◽  
Surgical Techniques ◽  
Case Series ◽  
Postoperative Management ◽  
Good Effect ◽  
Septal Perforation ◽  
Closure Rate ◽  
Surgical Closure ◽  
Clear Cut ◽  
Nasal Septal Perforation

AbstractNasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6–32 mm), and that for perforations with a diameter below 22 mm was 97.9%.

scholarly journals Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial

2021 ◽  
pp. bjophthalmol-2020-317800
Author(s):  
Xiujuan Zhao ◽  
Yonghao Li ◽  
Wei Ma ◽  
Ping Lian ◽  
Xiling Yu ◽  
...  
Keyword(s):  
Success Rate ◽  
Macular Hole ◽  
High Myopia ◽  
Randomised Trial ◽  
Case Series ◽  
Primary Treatment ◽  
Closure Rate ◽  
Macular Detachment ◽  
The Difference ◽  
Myopic Maculopathy

AimTo compare the efficacy of macular buckling (MB) and pars plana vitrectomy (PPV) for full-thickness macular holes (FTMH) and associated macular detachment (MD) in highly myopic eyes.MethodsProspective interventional case series of eyes undergoing PPV or MB for FTMH and MD.Main outcome measuresBest-corrected visual acuity (BCVA) at postoperative month 24. Other measured outcomes include the initial surgical success rate, macular hole closure rate and the progression of myopic maculopathy.ResultsA total of 53 eyes from 53 participants were included in this study (26 participants receiving MB and 27 participants receiving PPV), and finally 49 eyes from 49 participants (25 participants in the MB group and 24 participants in the PPV group) were analysed. At postoperative month 24, the BCVA had improved significantly in those that underwent either MB (p<0.001) or PPV (p=0.04). The difference between the groups was not significant (p=0.653). The surgical failure rate after the primary treatment was significantly higher in the PPV group than the MB group (25.00% vs 4.00%, respectively; p=0.04). The macular closure rate was higher in the MB group compared with the PPV group, but the difference was not statistically significant (64.00% vs 58.33%, respectively; p=0.45). Myopic maculopathy development may be more severe following PPV than following MB surgery.ConclusionPatients with high myopia obtained anatomical and functional improvements from either MB or PPV. However, MB achieved a significantly higher success rate in retinal reattachment compared with PPV.Trial registration numberNCT03433547.

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

2021 ◽  
pp. 000348942098742
Author(s):  
Stephen R. Chorney ◽  
Joanne Stow ◽  
Luv R. Javia ◽  
Karen B. Zur ◽  
Ian N. Jacobs ◽  
...  
Keyword(s):  
Costal Cartilage ◽  
Case Series ◽  
Primary Objective ◽  
Multivariable Logistic Regression Analysis ◽  
Pediatric Airway ◽  
Surgical Closure ◽  
Laryngotracheal Reconstruction ◽  
Airway Reconstruction ◽  
Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

Nerve sparing Laparoscopic Low anterior rectal resection – A video vignette

2021 ◽  
Author(s):  
Swapnil Patel ◽  
Vivek Sukumar ◽  
Mufaddal Kazi ◽  
Anand Mohan ◽  
Sanket Bankar ◽  
...  
Keyword(s):  
Rectal Resection ◽  
Nerve Sparing ◽  
Anterior Rectal Resection ◽  
Video Vignette
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