Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma

Background When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. Methods This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7 Results The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Conclusions Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma

Background When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. Methods This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7 Results The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Conclusions Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

Occult anastomotic leakage after rectal resection in patients with diverting stoma: Exploring optimal indications and examination of early stoma closure

BackgroundIn the immediate postoperative period, neither have the incidence and risk factors of occult anastomotic leakage (AL) in patients with diverting stoma (DS) been clarified, nor have methods to assess anastomosis been standardized. Before introducing “early stoma closure”, both standardized inclusion and exclusion criteria and standardized methods to assess anastomosis are necessary. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage.MethodsThis was a single institutional prospective observational study of patients who had undergone rectal resection with DS between May and October 2019. All patients had undergone CE and CT to assess for anastomosis on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7ResultsThe incidence of occult AL on postoperative day 7 was 40%. Hand-sewn anastomosis, compared with stapled anastomosis, was a statistically significant risk factor (p=0.0406). Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate.ConclusionsHand-sewn anastomosis was a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

Unstable fractures of the pelvis treated by Ilizarov external fixation device

We reviewed seven patients with an unstable fracture of the pelvic ring who had been treated with a Ilizarov external fixation device after a mean follow-up of 5.5 years. There were four 'open-book' injuries (type B according to Tile) and three rotationally and vertically unstable injuries (type C according to Tile). In all patients union of fracture site had been achieved after a mean period of 65 days in patients with type B injuries and 98 days in patients with type C injuries. In the four patients with an 'open-book' injury the symphyseal diastasis was partially reduced from 46 mm to 13 mm, and additional vertical displacement reduced from 24mm to 13mm. The radiological result was excellent in one patient, good in one and poor in two patients. The functional outcome was rated as excellent in three patients and good in one patient. In patients with type C injury vertical displacement was partially reduced from 21mm to 12mm. The patients in this group had excellent, good and poor radiological result, respectively. The functional outcome was excellent in two cases and good in one case. General surgical complications were not seen. Infection at the pin sites was seen in six patients. In our study unsatisfactory or poor functional result was not registrated due to construction characteristics of Ilizarov device. Because of this characteristics there were no residual vertical displacement more then 8 mm.

New Method and Clinical Results of Arthroscopic Mattress-Locking Suture for Small and Medium sized Rotator Cuff Tear

PURPOSE: To compare the clinical and radiological result of arthroscopic Mattress Locking suture repair to that of a Simple suture repair with small and medium-sized rotator cuff tears.MATERIALS AND METHODS: Among 92 patients who were followed up after arthroscopic repair in patients with small and medium-sized rotator cuff tear from April 2007 to October 2010, 27 patients who took Arthroscopic Mattress Locking suture were set as group I and 65 patients who took Simple suture were set as Group II. The average age of patients were 58 years old and average follow-up period was 30 months. For analysis, VAS, ASES and KSS were used to analyze the range of joint movement and pain. And, for the image result, MRI performed after operation were evaluated.RESULTS: The average VAS, KSS, UCLA score and ASES prior to surgery improved in the last follow-up (p<0.001), while was no difference in two groups (p>0.001). In MRI follow-up examination, the 2 cases (7.41%) of group 1 showed increased rupture lesions with improved symptoms. And the 12 cases (18.47%) of group 2 showed increased rupture lesions with improved symptoms. Retears in the group I were significant less than the group II (p<0.001).CONCLUSION: Comparing patients with small and medium-sized rotator cuff tear who took arthroscopic mattress locking suture repair to those who took simple suture repair after over one year follow up period, the clinical result showed no significant difference between two groups. However, Mattress Locking suture repair showed excellent radiological result compared to simple suture repair when comparing rerupture.