Outcomes of Open Side to End Antegrade Colorectal Single Stapler Anastomosis Versus Open End to End Retrograde Trans-anal Colorectal Single Stapler Anastomosis in Non-emergent Sigmoid and Rectal Cancers. Randomized Controlled Clinical Trial

Introduction: Cancer rectum and sigmoid is increasing nowadays. Resection is done by open and laparoscopic approaches. Laparoscopic approach is not available in many sites worldwide. Aim of this study: To analyze the outcomes of open side to end (antegrade) colorectal single stapling anastomosis versus open end to end (retrograde) Trans-anal colorectal stapling anastomosis in non-emergent sigmoid and rectal cancers open surgery in adults.Patients and Methods: Randomized controlled trial was performed on patients with sigmoid and rectal cancers between September 2016 and September 2018. Results: The majority of studied group were between 50-70 years with mean of 62.58±12.3 years and 61.03±13.98 years in group A and group B respectively. Intraoperative data showed no significant difference was founded between studied group except at operative time and mean anastomotic time as group A was significantly shorter. Univariate analysis showed that perioperative blood loss, length of stay, reoperation, inpatient death, infection and bleeding were significantly associated with leakage. Multivariate analysis of anastomotic leak showed that infection is the only independent predictors for anastomotic leak. There is statistically significant change as regard range of bowel frequency in end to end group only (p=0.04) and there is statistically significant difference as regard incontinence for Flatus in side to end group only (p=0.00) .There is statistically significant change in both group regard Incontinence for liquid stools(p=0.00) and Clustering of stool(p=0.00 and p=0.043).The quality of life in Antegrade group significantly drop at 6 months and return to baseline after that as regard PWB, FWB and CCS with no difference as regard SWB & EWB while in retrograde group, the same change happened only as regard PWB & FWB but SWB and CCS percentage didn’t return to baselineConclusion: The side-to-end anastomoses approach is a safe approach of anastomosis and may be used as alternative to retrograde approach.

Triple Stapling Resection and J pouch anal Stapling Anastomosis for Ulcerative Colitis

Background: In 2017, we reported laparoscopic total proctocolectomy with J pouch anal anastomosis, which was created at the dentate line by our original procedure using staplers, Triple Stapling Resection and J pouch Anal Stapling Anastomosis (TSRJASA), for ulcerative colitis (UC) patients. UC patients have undergone TSRJASA since it was introduced in our institution. However, the feasibility and usefulness of TSRJASA for UC patients has not been elucidated.Methods: From January 2014 to December 2018, fourteen patients with ulcerative colitis, including three cases of concomitant cancer, who underwent TSRJASA were enrolled in this study. Anal manometry was performed using the Pock Monitor GMMS-100 system (STAR MEDICAL, INC., Tokyo, Japan) one year and two years after surgery. Maximum resting pressure, maximum squeeze pressure, and the length of the high-pressure zone were measured. Fecal incontinence was evaluated using the Wexner incontinence questionnaire.Results: J pouch anal anastomosis was created at the dentate line in all patients. In a manometric examination two years after surgery, maximum resting pressure was 75.3 (54-88) mmHg, maximum squeeze pressure was 125.0 (90-160) mmHg, and the length of the high-pressure zone was 39.6 (35-42) mm. Wexner score was 2.8 (1-4).Conclusion: TSRJASA seems to be a useful procedure for UC patients given its acceptable defecation function.

P146 AN IMPROVEMENT TO THE CIRCULAR STAPLING ANASTOMOSIS TECHNIQUE DURING MINIMALLY

Aim The circular stapled (CS) technique with transoral placement of the anvil is commonly used to perform the esophago-gastric anastomosis during minimally invasive esophagectomy (MIE). The procedure is safe, efficient and highly reproducible, however the intersection between the circular plane of the stapler and the linear staple line of the esophageal stump can expose the anastomosis to the formation of dog ears and therefore increase the risk of anastomotic leakage (AL). We describe a simple modification of the CS technique that avoid the formation of staple lines intersection. Background and Methods We prospectively collected data on a small group of patients who underwent MIE for cancer using our modified CS technique. Our technical modification consists in folding the linear esophageal transection line with a stitch around the anvil shaft, in order to include the staple line in the resection during the EEATM firing (figure 1). Feasibility has been evaluated as the percentage of cases in which the improved anastomosis technique has been carried out successfully with the formation of a complete anastomotic ring. Safety has been defined as the absence of procedure related complications. Results MIE was performed in ten patients using our modified CS technique, median age was 55 years. All the procedures were successfully completed with complete resection of the linear esophageal staple line and no intraoperative complication. Only one patient developed a postoperative AL, that was only detected by barium swallow and did not cause any symptom or clinical sign. Conclusions Our modified CS technique is simple, feasible and safe. Further studies are needed to evaluate its efficacy in preventing the occurrence of anastomosis leakage.

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model

Background. Compression anastomosis has been recently abandoned because of a nonsuperiority compared to stapling anastomosis. Nonremoval of the rings has frequently been reported and this technique does not support a routine use. The aim of this experimental study was to assess the feasibility of anastomosis using compression with a device consisting of fragmented rings. Methods. A new compression device, the “Anastocom,” was compared to standard double-stapled colocolonic anastomosis in 2 groups of 8 pigs. In each group, colocolonic anastomosis was performed with a circular stapler (DST Series EEA Staplers) in 4 pigs and with the Anastocom device for the other 4 pigs. Results. The anastomotic rings were expelled between postoperative day 7 and day 13 from the 4 animals sacrificed at day 30. The anastomosis was clean and intact in all pigs. After sacrifice, there was no difference in the bursting pressure at day 7 ( P = .226) or at day 30 ( P = .885) between the 2 types of anastomosis. After sacrifice at day 7, the mean bursting pressure values for the Anastocom and EEA anastomoses were 128.6 mm Hg (range 119-143 mm Hg) and 218.9 mm Hg (range 84-240 mm Hg), respectively. After sacrifice at day 30, the mean bursting pressure values for the Anastocom and EEA anastomoses were 111 mm Hg (range 59-234 mm Hg) and 105 mm Hg (range 81-130 mmHg), respectively. Conclusion. No bowel obstruction was observed with Anastocom. This fragmentation mechanism should better prevent nonexpulsion compared to basic compression anastomosis.

STAPLING INTERINTESTINAL ANASTOMOSIS IN COLORECTAL CANCER: SHORT-TERM RESULTS

AIM to assess results of stapling anastomosis in colorectal surgery. PATIENTS AND METHODS. The results of surgical treatment of 427 patients with rectal cancer and 458 patients with colon cancer (T1-4N0-2M0-1) were analyzed. A circular stapler was used to perform end-to-end (347patients) and side-to-end (80 patients) anastomosis. 164 patients underwent stapling colonic anastomosis. RESULTS. Anastomotic leak rate after stapled colorectal anastomosis was 8,7% (n=37) and was lower after side-to-end anastomosis 3,8% (n=3). Anastomotic leakage developed in only 2 (1,2%) patients after colon anastomosis. CONCLUSION. Proper use of stapling devices and proper surgical technique allow to create reliable anastomosis which safety is comparable the manual one.