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.

Transanal irrigation to treat bowel dysfunction: an update on practice

Transanal irrigation (TAI) has been receiving increasing attention and acceptance in recent years as a treatment option for bowel dysfunction, including chronic constipation, faecal incontinence, neurogenic bowel disorders and lower anterior resection syndrome. TAI involves the instillation of tepid water into the bowel via a rectal catheter or cone to achieve a controlled bowel cleanout. This article addresses the competencies that health professionals require to use TAI. Prior to instigating TAI, these include how to undertake an adequate bowel assessment; understand the risks and complications associated with TAI; and select the equipment most suitable for an individual's bowel symptoms. The professional must also be able to instruct the user in how to safely perform the procedure; discuss contra-indications and cautions; and collect outcome measures, including reasons for discontinuation.

Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation

An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

No Coil® Placement in Patients Undergoing Left Hemicolectomy and Lower Anterior Resection for Colorectal Cancer: Efficacy, Tolerability and Differences.

Background. Colorectal cancer (CRC) is the most common type of the gastrointestinal tract. Anastomotic leak (AL), is the most important complication of colorectal surgery. In this retrospective study, we evaluated efficacy and tolerability of transanal tube No Coil® in patients with CRC undergoing low anterior resection (LAR) and left hemicolectomy (LC). Methods. Thirty-eight patients operated by the same team for primary colorectal adenocarcinoma were collected, 24 LC and 14 LAR. Neither defuncioning stoma nor neoadjuvant therapy not was administered to anyone patients. No Coil® was placed immediately after the end of surgical treatment.Results. In our experience, LC was performed in 24 individuals (63%), LAR in 14 individuals (37%). AL was evident in 2,63 % of the sample; no statistical difference was found in AL occurrence between LC and LAR with only one patient in LAR group.Conclusion. With our preliminary data, we suggest that No Coil® placement can be considered as a valuable procedure assisting colorectal surgery, but further studies are required to confirm and enlarge actual evidence.

Colorectal anastomotic perforation secondary to acute ruptured appendicitis presenting as septic arthritis

Anastomotic leaks following abdominoperineal resection with rectal anastomosis become clinically significant in 2.9%-22% of cases. Local recurrence of cancer and local inflammation are the most common causes of these leaks . Colonic perforation presenting with suppurative involvement of the lower extremities has been previously reported. We describe herein the case of a colorectal anastomotic leak secondary to pathology-proved acute appendicitis presenting with suppurative necessitation causing right hip septic arthritis five years following lower anterior resection (LAR) for stage unspecified colorectal cancer. No similar case has been demonstrated in the surveyed literature.

Epidural dexamethasone for postoperative analgesia in patients of carcinoma rectum undergoing lower anterior resection (LAR)

Background and Aims: This prospective, randomized, double blind study was undertaken to establish the effect of addition of dexamethasone as an adjunct to epidural ropivacaine in patients of carcinoma rectum undergoing lower anteriorresection. Materials and Methods: Sixty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower anterior resection were enrolled to receive either 6mg or 8mg or 10mg of dexamethasone along with epidural ropivacaine to a total of 10ml test solution in each group for epidural analgesia. Hemodynamic parameters, postoperative analgesia, total requirement of rescue analgesia and adverse events were monitored. Results: Analgesia in the postoperative period was better in Group receiving 10mg of dexamethasone associated with less postoperative rescue analgesic consumption Conclusion: Hence, addition of dexamethasone 10mg to epidural ropivacaine can be advantageous with respect to better postoperative analgesia.

Low anterior resection syndrome score among Nepalese population undergoing lower anterior resection for rectal carcinoma

Background: With more sphincters preserving surgery being performed for distal rectal cancer, these have been associated with clusters of symptoms experienced by the patient after reversal of diverting ileostomy collectively known as low anterior resection syndrome.Objective: Our objective is to know incidence of Lower Anterior Resection (LAR) syndrome in different phase of time in our context using low anterior resection symptom score translate in Nepali language.Methodology: This is an observational descriptive study conducted at Department of Surgery, Kathmandu Medical College and Department of Clinical Oncology, Bir Hospital, Kathmandu from Jan 2015 till Jan 2017. All patients who had undergone low and ultra low anterior resection for middle and low rectal cancer respectively after a long course of neo adjuvant concurrent chemo radiotherapy, having undergone a reversal of diverting ileostomy after 6 weeks of primary surgery were included. A Nepalese version of low anterior resection score was developed after translation from English and scoring was done on 30th day, at the end of 6 months and 1 year postoperative following reversal of ileostomy.Results: Out of 43 consecutive patient 100 % of patients had features of major low anterior resection syndrome during 30 days of ileostomy reversal. However, 46.5% patient showed major low anterior resection syndrome during 6 months of follow up and that decreased to 34.9% showed major LAR syndrome upon one year of follow up.Conclusions: The Low anterior resection syndrome score converted in Nepali language is feasible to use and helps in comparing the functional results of reconstruction after low or ultralow anterior resection and our study have shown improvement in score with time. Journal of Kathmandu Medical College,Vol. 7, No. 2, Issue 24, Apr.-Jun., 2018, page: 59-63