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 Advanced T stage and thick rectus abdominis muscle triggers outlet obstruction and high-output stoma following ileostomy in patients with rectal cancer

2020 ◽  
Author(s):  
Yasuhiro Komatsu ◽  
Kunitoshi Shigeyasu ◽  
Yoshiko Mori ◽  
Kazutaka Takahashi ◽  
Nanako Hata ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Outlet Obstruction ◽  
Muscle Thickness ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
T Stage ◽  
Common Risk Factors ◽  
Postoperative Problems ◽  
High Output

Abstract Background Ileostomy creation is an excellent approach to prevent leakage in patients undergoing low anterior resection for the treatment of rectal cancer. However, the two major complications of ileostomy are outlet obstruction and high-output stoma, and these complications remain unavoidable postoperative problems of ileostomy. Methods Risk factors associated with outlet obstruction and high-output stoma were retrospectively analyzed. The study included 83 patients with rectal cancer who underwent surgery. Of these patients, 34 underwent ileostomy creation. Results We found that outlet obstruction and high-output stoma were highly related (p = 0.03). Additionally, a thick rectus abdominis muscle and advanced T stage were the common risk factors of outlet obstruction (p = 0.0005 and p = 0.01, respectively) and high-output stoma (p = 0.04 and p = 0.03, respectively). Conclusions Our findings suggest that rectus abdominis muscle thickness and advanced T stage are predictive markers of outlet obstruction and high-output stoma.

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.

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.

Electromyographic and ultrasonographic evaluation of neuromuscular electrical stimulation training on the equine rectus abdominis muscle

2020 ◽  
Vol 16 (2) ◽  
pp. 87-100
Author(s):  
T. Hernández-Fernández ◽  
L. Gutiérrez-Cepeda ◽  
J. López-Sanromán ◽  
G. Manso-Díaz ◽  
R. Cediel
Keyword(s):  
Electrical Stimulation ◽  
Muscle Force ◽  
Neuromuscular Electrical Stimulation ◽  
Muscle Thickness ◽  
Muscular Contraction ◽  
Rectus Abdominis ◽  
Wilcoxon Test ◽  
Median Frequency ◽  
Rectus Abdominis Muscle ◽  
Test Analysis

The current study aimed to determine the effects of neuromuscular electrical stimulation (NMES) on equine rectus abdominis using surface electromyography (sEMG) and ultrasonographic muscle thickness evaluation. Five horses were trained with NMES for 12 weeks; muscle thickness and sEMG evaluations were obtained before and after the training period. Three different tests were carried out for sEMG evaluations: Test A tried to elicit a voluntary maximal isometric contraction (VMIC); Test B used NMES to elicit a muscular contraction; and Test C used 1 ms repetitive electrical impulses to elicit a series of M-waves. Muscle strength was evaluated from the root mean square (RMS; Tests A and B) and peak to peak (PP; Test C) values obtained from the sEMG data. Measures related to amplitude (RMSa; RMSm; RMSa; PP) were normalised with their pre-training values for every muscle prior to statistical analysis, leading to values as a proportion of the initial value. The evaluation of muscle fatigue was performed using a Fourier test analysis of the frequency range, obtaining the median frequency (MF) for all tests. Muscle thickness (MT) was measured by ultrasound of left and right sides of the rectus abdominis. Data were analysed using non parametric test of Wilcoxon (Test A RMSa; Test A RMSm; Test B RMSa; Test B RMSm; Test C PP; MT; P<0.05) and t-test (Test A MF; Test B MF; Test C MF; P<0.05). Statistical differences were observed between baseline and trained horses. Muscle force increase following NMES training in Test B (RMSa 2.50±0.69; RMSm 2.59±0.76) and Test C (PP 5.20±1.76). Fatigue of the rectus abdominis decreased in Test A (168.33±55.19 vs 232.63±44.15 Hz) and Test C MF (187.93±20.76 vs 236.98±52.39 Hz), but not in Test B (363.98±45.48 vs 327.95±50.84 Hz). The difference in muscle thickness between the two groups was not significant (10.96±0.64; 11.78±0.79 mm). The results suggest that NMES training could be used as an effective method to increase muscle force and fatigue resistance of the rectus abdominis muscle in the horse.

Rectus abdominis muscle thickness as a predictor of peritoneal catheter dysfunction in emergency-start peritoneal dialysis patients

2021 ◽  
Author(s):  
Jonathan S. Chávez-Iñiguez ◽  
Pablo Maggiani-Aguilera ◽  
José A. Cruz-Ramos ◽  
Guillermo Navarro-Blackaller ◽  
Victor H. Luquín- Arellano ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Muscle Thickness ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Dialysis Patients ◽  
Peritoneal Catheter ◽  
Catheter Dysfunction

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 Analysis of Risk Factor for Anastomotic Leakage after Lower Rectal Cancer Resection, Including Drain Type: A Retrospective Single-Center Study

2020 ◽  
Author(s):  
Tetsushi Kinugasa ◽  
Sachiko Nagasu ◽  
Kenta Murotani ◽  
Tomoaki Mizobe ◽  
Takafumi Ochi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Underlying Disease ◽  
Lower Rectal Cancer ◽  
Open Drainage ◽  
Related Factors ◽  
Closed Drainage ◽  
Score Analysis

Abstract Background: We investigated the correlations between surgery-related factors and the incidence of leakage after low anterior resection (LAR) for lower rectal cancer.Methods: A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were included in this retrospective study. Temporary ileostomy was performed in each patient.Results: Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed that operative duration (p=0.005), transanal hand-sewn anastomosis (p=0.014), and operation procedure (p=0.019) were significantly associated with the occurrence of leakage. Multivariate analysis showed that underlying disease (p=0.044), transanal hand-sewn anastomosis (p=0.019) and drain type (p=0.025) were significantly associated with the occurrence of leakage. Propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to inverse probability of treatment-weighted analysis.Conclusions: Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be risk factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with the less volume of postoperative drain discharge than open drain.

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