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

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.

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Risk Factors for Anastomotic Leakage after Low Anterior Resection

Folia Medica ◽

10.3897/folmed.62.e47727 ◽

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.

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THE TRANSANAL REINFORCEMENT OF LOW COLORECTAL ANASTOMOSIS: FIRST EXPERIENCE AND PERSPECTIVES

Koloproktologia ◽

10.33878/2073-7556-2016-0-4-15-21 ◽

2016 ◽

pp. 15-21 ◽

Cited By ~ 2

Author(s):

M. V. Alekseev ◽

Yu. A. Shelygin ◽

E. G. Rybakov

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Colorectal Anastomosis ◽

Careful Selection ◽

Diverting Stoma ◽

Selection Of Patients ◽

Selection Of

AIM. It was to evaluation the effect of using of transanal reinforcement of low colorectal anastomosis to the frequency of anastomotic leakage. MATERIALS AND METHODS. The study included six patients who underwent a low anterior resection for rectal cancer and the transanal reinforcement anastomosis. Preventive stomas not formed. RESULTS. The study contains an analysis of the immediate results of patients treatment. The leakage of the anastomosis was developed in 3 of 6 patents. This required break down of the anastomosis in one and the formation of diverting stoma in two patients. CONCLUSION. The first experience of the transanal reinforcement for low colorectal anastomosis is unsuccessful because of leakage appeared in every second patient. More careful selection of patients for this method is required.

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REINFORCEMENT OF STAPLE LINE OF COLORECTAL ANASTOMOSIS AS A METHOD OF LEAKEAGE PREVENTION

Koloproktologia ◽

10.33878/2073-7556-2018-0-4-16-24 ◽

2018 ◽

pp. 16-24 ◽

Cited By ~ 1

Author(s):

A. A. Balkarov ◽

E. G. Rybakov ◽

A. A. Ponomarenko ◽

M. V. Alekseev ◽

V. N. Kashnikov

Keyword(s):

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Staple Line ◽

Colorectal Anastomosis ◽

Main Group ◽

Leakage Rate ◽

Control Group ◽

Colorectal Anastomoses ◽

Anastomotic Leakage Rate

AIM: to decrease anastomotic leakage rate using transanal and transabdominal reinforcing sutures of staple line of colorectal anastomosis. PATIENTS AND METHODS: a prospective randomized trial is started. The main group included patients which underwent anterior or low anterior resection of the rectum with reinforcing of the staple line of colorectal anastomosis using reinforcing sutures on 2, 4, 6, 8, 10 and 12 by conventional dial. The control group consisted of patients without reinforcing of the anastomosis line. RESULTS: from November 2017 to October 2018, 127 patients underwent anterior or low anterior resection of the rectum, 80 of them were included in the study,six were excluded from the study after surgery. Among these 74 patients 40 (54.0 %) were females, mean age was 63.0± 11.0 years. Forty patients consisted the main group, 34 - control. The anastomotic leakage rate in the main group was 7% (3/40), in the control - was 26 % (9/34) (p=0.06). The clinical anastomotic leakage rate in the main group was 3 % (1/40), in the control group - 21 % (7/34) (p=0.03). The anastomotic leakage rate in the main group, after anterior resection of the rectum was 13 % (2/15), in the control - 0 % (0/8) (p=0.8). After low anterior resection the anastomotic leakage rate in the main group was 4 % (1/25), in the control - 35 % (9/26) (p=0.016). Multivariate analysis of risk factors of anastomotic leakage significance associated with male gender (OR 6.88, CI 1,32-of 35.9, p=0,022), positive bubble test (OR 6.26, CI of 1.22-32,2, p=0.028), absence of reinforcing of the anastomosis (OR 4.39, CI 0,96-20,12, p=0,056). CONCLUSION: the reinforcing of colorectal anastomoses decreases anastomotic leakage rate after low anterior resection.

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

Kazan medical journal ◽

10.17816/kmj2021-335 ◽

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.

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