Comparison of side-to-end with end-to-end Anastomosis technique for colorectal anastomosis

Objective: To compared the functional and anatomic outcomes of end-to-end anastpmosis (EEA) technique with side-to-end anastomosis (SEA) technique for colorectal anastomosis. Methods: A randomized clinical trail was conducted in Jinnah Postgraduate Medical Center (JPMC), Karachi. We recruited 60 patients who were planned for colorectal surgery from January 2020 to January 2021. Patients having histology proven adenocarcinoma of rectum of sigmoid colon, with normal sphincter function were included. Patients were randomly attributed into two groups in 1:1 ratio. The primary endpoint was to determine immediate post-operative complications, and assessment of intestinal function (using Lower anterior resection syndrome (LARS) score) at one-month follow-up. Results: There was no statistical difference in anatomic and functional outcomes in SEA and EEA groups, mean operative time was 168±43 minutes in SEA group versus 159±38 minutes in EEA group. Anastomosis leakage was diagnosed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). Redo-procedure was needed in 1 (3.3%) patients in SEA group versus in 2 (6.7%) patients in EEA group (p-value 0.55). At one-month follow-up, major LARS was diagnosed in 03 (10.0%) patients in EEA group, while minor LARS was diagnosed in 5 (16.7%) patients in SEA group versus in 4 (13.3%) patients in EEA group (p-value 0.52). Conclusion: Both side to end anastomosis and end to end anastomosis are comparable in-terms of functional and anatomic outcomes. So the operating surgeons can adopt any of these techniques for colorectal anastomosis. Keywords: side-to-end anastomosis, end-to-end anastomosis, lower anterior resection syndrome, colorectal anastomosis.

Using transanal irrigation in the management of low anterior resection syndrome: a service audit

Low anterior resection syndrome (LARS) is a collection of symptoms that can occur as a result of a low anterior resection for bowel cancer. Transanal irrigation (TAI) can be used to manage these symptoms. This article describes a retrospective audit of 15 patients who were using TAI to manage symptoms of LARS. The aim of the audit was to ascertain whether the use of TAI improved outcomes for these patients. The data suggest that TAI has reduced both the frequency of bowel movements and episodes of faecal incontinence. Those patients using higher volumes of water seem to have experienced more benefit than those patients using lower volumes of water. These findings are consistent with current literature around TAI for LARS and suggest research into optimum volume of water would be beneficial.