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.

Colonic invagination anastomosis in surgery of complicated forms of diverticular disease

AIM: to evaluate the prospects of using a colorectal invaginated anastomosis in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, colorectal invaginated anastomosis, was used in 42 patients: 18 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure. The comparison group consisted of 24 patients with CDD and 20 patients with colorectal cancer for stoma closure after Hartmann’s procedure: colorectal anastomosis was created here using traditional double-row handsewn technique. All patients underwent surgery with open access, while the primary anastomosis was performed in 20 (47.6%) patients, and in 22 (52.4%) patients of the group underwent stoma takedown.RESULTS: no anastomosis leakage developed in the main group. Moreover, the presence of single small diverticula with a diameter of 2–3 mm near the area of the anastomosis was not an indication to extend the resection borders. In the control group, in 13 (54.2%) patients, small diverticula were detected in the anastomosis are as well and required to expand the proximal border of resection. In this group, anastomosis leakage occurred in 2 (6.8%) patients with diverticular disease and required Hartmann’s procedure.CONCLUSION: the colorectal invaginated anastomosis is justified for patients with CDD during stoma takedown because it minimizes the risk of anastomosis leakage.

Outcomes of Side to End versus End to End Colorectal Anastomosis in Non-emergent Sigmoid and Rectal Cancers. Randomized Controlled Clinical Trial.

Purpose The outcomes of open side-to-end colorectal anastomosis versus open end to end colorectal anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults were compared. Methods A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018. Results The majority of the participants in the study were between the ages of 50 and 70 years, with a mean age of 62.58±12.3 years in the side-to-end anastomotic group (SEA group = group A = antegrade approach) and 61.03±13.98 years in the end-to-end anastomotic group (EEA group = group B = retrograde approach), respectively. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were all revealed to be significantly associated with leakage in univariate analysis. In a multivariate analysis of anastomotic leaks, infection was the only independent predictor. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (p = 0.04). There is a statistically significant difference regarding incontinence for Flatus in the SEA group only (p = 0.00). A statistically significant change in both groups regards incontinence for liquid stools (p = 0.00) and clustering of stools (p = 0.00 and p = 0.043). The quality of life (QOL) in the SEA group significantly dropped at 6 months and returned to baseline after that as regards PWB, FWB, and CCS with no difference as regards SWB & EWB, while in the EEA group, the exact change happened only as regard PWB & FWB, but SWB and CCS percentage did not return to baseline. Conclusion The SEA group offers a safe and approach alternative to the EEA group.

Preoperative mechanical bowel preparation combined with oral antibacterials in the prevention of complications of surgery for rectal and rectosigmoid junction cancer

Aim: To evaluate the efficacy of mechanical bowel preparation (MBP) combined with oral antibacterials for the prevention of postoperative complications when preparing a patient for anterior rectal resection.Materials and methods: We analyzed shortterm results in 77 patients who had undergone anterior rectal resection for rectal and rectosigmoid junction cancer. Forty five (45) patients were prepared for surgery only with MBP. In 32 patients, in addition to MBP, oral antibacterial agents ciprofloxacin and metronidazole were used preoperatively.Results: The overall rate of postoperative complications was 6.25% (2/32 patients) in the group of combined preparation for surgery and 15.5% (7/45) in the group using only MBP. Surgical wound infection occurred in 1 patient in the combined preparation group and in 4 patients in the MBP only group. There was no anastomotic leak in the combined preparation group, whereas in the MBP only group, anastomotic leak occurred in 2 patients.Conclusion: Combined use of oral antibacterials and MBP before anterior rectal resection makes it possible to achieve an extremely low rate of the colorectal anastomosis leak. Further studies into the efficacy of this preparation regimen are needed, along with their discussion in the professional communities.