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

2018 ◽  
pp. 16-24 ◽  
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.

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 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.

scholarly journals Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

PLoS ONE ◽  
2013 ◽  
Vol 8 (9) ◽  
pp. e75519 ◽  
Author(s):  
Zhi-Jie Cong ◽  
Liang-Hao Hu ◽  
Zheng-Qian Bian ◽  
Guang-Yao Ye ◽  
Min-Hao Yu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Leakage Rate ◽  
Grading System ◽  
Anastomotic Leakage Rate

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

2016 ◽  
pp. 15-21 ◽  
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.

scholarly journals Rehabilitation of patients with low anterior resection syndrome

2021 ◽  
Vol 20 (2) ◽  
pp. 57-64
Author(s):  
I. O. Nafedzov ◽  
S. V. Chernyshov ◽  
A. A. Ponomarenko ◽  
O. Yu. Fomenko ◽  
M. V. Alekseev ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Functional Results ◽  
Voluntary Contraction ◽  
Main Group ◽  
Control Group ◽  
Median Score ◽  
Biofeedback Therapy ◽  
Low Anterior Resection Syndrome

Aim: to develop a conservative rehabilitation program for patients with severe symptoms of LARS.Patients and methods: since January 2019, 50 patients after low anterior resection were included in the study. The main group included 25 patients who underwent biofeedback therapy and tibial neuromodulation in 3–6 months after surgery. Functional results before and after treatment were evaluated by anorectal manometry. The control group included 25 patients, according to the Propensity score matching.Results: the median score on the LARS scale, in the main group was 41.0 ± 2.8 points, in the control — 38 ± 4. With sphincterometry, the median pressure at rest before treatment was 30.0 ± 7.8, with a voluntary contraction of 140.6 ± 56.0 mm Hg. After the conservative treatment, patients in the main group had significantly better results: the median score on the LARS scale decreased from 41 ± 2.8 to 17 ± 8 points (p < 0.0001), the median pressure after treatment increased from 30.0 ± 7.8 to 36.0 ± 8.0 (p = 0.004), with a voluntary contraction from 140.6 ± 56.0 to 157.5 ± 53.2 mmHg (p = 0.008). Comparing the results of the questionnaire of the main group with the control group after the stoma closure and after 12 months, it turned out that in the main group there was a significant decrease in the severity of LARS: 17.0 ± 8.0 scores vs. 35.0 ± 4.5 (p = 0.0003), which shows an improvement in the tone and contractility of the sphincter after conservative treatment.Conclusion: comprehensive biofeedback therapy and tibial neuromodulation improves the functional results of patients with severe LARS.

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