OBLIQUE VS. CIRCULAR ANASTOMOSIS IN THE CHILDREN UNDERWENT SOAVE’S PULL-THROUGH SURGERY FOR THE TREATMENT OF HIRSCHSPRUNG’S DISEASE: WHICH IS THE BEST?

ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung’s disease. Aim: To compare circular and oblique anastomoses following Soave’s procedure for the treatment of Hirschsprung’s disease. Methods: Children who underwent Saove’s pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave’s procedure.

A prospective study in esophageal atresia with tracheoesophageal fistula: Oblique versus circular anastomosis

Background: Congenital esophageal atresia with tracheo-esophageal fistula is a common congenital anomaly facing at our centre. There is various proposed anastomotic technique to avoid post-op stricture. In this study we compare outcome of oblique and circular anastomosis technique at our centre.Methods: This study conducted in 60 cases of congenital esophageal atresia with tracheo-esophageal fistula, designed randomly in two groups. Oblique anastomosis in group A and Circular anastomosis in group B. The complications of anastomotic leaks, anastomotic narrowing with strictures and recurrent fistula were studied.Results: Anastomotic leak rate in case oblique anastomosis was 6.7% as compared to circular anastomosis was 16.7%. Stricture formation in oblique anastomosis was 13.3% in comparison to circular anastomosis there was 43.3% stricture formation. None of the cases required re-exploration in Oblique anastomosis, whereas two (6.7%) cases required re-exploration in circular anastomosis.Conclusions: Present study showed that oblique anastomotic technique is superior to circular anastomotic technique, in term of less stricture and leak rate.

Diagnosis and Management of Intraoperative Colorectal Anastomotic Leaks: A Global Retrospective Patient Chart Review Study

Background. This targeted chart review study reports the first ever detailed global account of clinical approaches adopted to detect and manage anastomotic leaks identified during surgery in routine clinical practice. Method. 156 surgeons from eight countries retrospectively extracted data from surgical records of 458 patients who underwent colorectal surgery with an identified intraoperative leak at the circular anastomosis. Demographic details, procedures, and outcomes were analyzed descriptively, by country. Results. Most surgeries were performed laparoscopically (57.6%), followed by open surgeries (35.8%). The burden of intraoperative leaks on the healthcare system is driven in large part by the additional interventions such as using a sealant, recreating the anastomosis, and diverting the anastomosis to a colostomy bag, undertaken to manage the leak. The mean duration of hospitalization was 19.9 days. Postoperative anastomotic leaks occurred in 62 patients (13.5%), most frequently 4 to 7 days after surgery. Overall, country-specific differences were observed in patient characteristics, surgical procedures, method of diagnosis of intraoperative leak, interventions, and length of hospital stay. Conclusion. The potential cost of time and material needed to repair intraoperative leaks during surgery is substantial and often hidden to the healthcare system, potentially leading to an underestimation of the impact of this complication.