Anastomotic Dehiscence Research Articles

Extended sleeve-lobectomy for centrally located locally advanced non-small cell lung cancer is a feasible approach to avoid pneumonectomy.

BackgroundsThe aim of this study was to report our Institutional experience with extended sleeve lobectomy (ESL) in centrally located non-small cell lung cancer (NSCLC), focusing on technical details, post-operative results, recurrence and survival, to determine whether ESL can be accepted as a favorable alternative procedure to pneumonectomy (PN).MethodsTwenty-two consecutive patients undergoing ESL for centrally located tumors from January 2014 to June 2019 were prospectively enrolled.ResultsSix (27.3%) patients had been preoperatively considered unfit for PN. Neo-adjuvant chemotherapy was administered in 7 (31.8%) out of the 10 patients that showed a cN2 disease. According to Okada classification, 8 cases of type A ESL (resection of right upper plus middle lobe ± segment 6), one case of type B (resection of left upper lobe + segment 6) and 13 cases of type C (resection of left lower lobe + lingulectomy) ESL were performed. Concomitant pulmonary angioplasty was done in 7 (31.8%) patients. Complete resection was achieved in all patients. There was no postoperative mortality. Major postoperative complications developed in 2 (9.1%) patients (one small anastomotic dehiscence healed in few weeks, one pulmonary embolism). Complete long-term patency of the reconstructed airway was documented in all patients by fiber-optic bronchoscopy. At the median follow-up of 21 months (4–57 months), the recurrence rate was 54.5%, with 4 (18.2%) patients developing a loco-regional recurrence but no endobronchial or perianastomotic recurrence occurred. The overall 3-year survival rate was 45% with a median survival of 33 months.ConclusionsESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection.

Evaluation of Prognostic Factors in Outcome of Bowel Anastomosis

Serum albumin can serve as a simple and economical prognosticator of outcome in bowel anastomosis and henceforth, can help in surgeon’s choice making as well as clarifying the risk to the patient. A prospective study was carried out to evaluate the risk factors which effect the result of bowel anastomosis. The objective of the study was to recognize the risk factors for anastomotic leak and study the rate of early complications and mortality of intestinal anastomosis. Study included 50 patients undergoing resection and anastomosis for various indications, both emergency and elective from the 1st December of 2016 to 30th June of 2018, at Krishna Institute of Medical Sciences who satisfied inclusion criteria. Patients with intra-abdominal sepsis, anemia, old age and patients treated with perioperative corticosteroids for pulmonary disease carry a substantial risk for anastomotic dehiscence and in these patients it is advised that anastomoses must be protected by a diverting stoma.

Guidewire-assisted over-the-scope clip delivery method into the distal intestine: a case series

Background The Over-the-scope clip (OTSC) has been recently introduced for multiple purposes, including refractory bleeding, perforation, fistula, and anastomotic dehiscence of the gastrointestinal tract. However, no easy access techniques for delivering OTSCs to distant sites have been described. Therefore, we have developed a simple and safe guidewire-assisted OTSC delivery (GOD) method for use on the distal intestine. This study aimed to investigate the technical feasibility and safety of the method. Material and methods Between June 2018 and April 2019, all eight patients who underwent the GOD method were retrospectively examined. The primary outcome was the successful rate of OTSC delivery to the lesion without complications. The secondary outcomes were GOD procedure time, total procedure time, technical and clinical OTSC success rates, and GOD- and OTSC-associated complications. Results The rate of successful OTSC delivery was 100%. The median procedure time of GOD was 21 min (range 8–29). The median total procedure time was 38.5 min (range 26–41). The technical and clinical success rates of OTSC were 100% and 75% (6/8), respectively. No GOD- or OTSC-associated complications occurred. Conclusions The GOD method is a feasible and safe technique for delivering OTSC toward the small and proximal large intestine.

Replaced Right Hepatic Artery Originating from the Common Hepatic Artery: A Case Report

The presence of an aberrant right hepatic artery is the most frequently encountered vascular anomaly during pancreaticoduodenectomy, and its recognition and preservation are of paramount importance to prevent ischemia of the bile duct and consequently the bilioenteric anastomosis, which can lead to anastomotic leak or dehiscence and fistula. In this case report, we describe proximal branching of the common hepatic artery (CHA) to give rise to a replaced right hepatic artery (RHA), which courses posterior to the portal vein (PV) and common bile duct (CBD) to the right lobe of the liver. The location of this replaced RHA in the hepatoduodenal ligament is consistent with the location of a replaced RHA described by the Michels classification, although with the important distinction that origin was the CHA instead of the superior mesenteric artery (SMA). From our review of the current literature, this is the first published description of such an anatomic course of the RHA.

Cirugía Robótica Colorectal, en un Hospital de Comunidad Cerrada. Experiencia Inicial

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica.Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires.Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019.Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes).Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.

Uso de sonda nasogástrica en pacientes sometidos a esofaguectomía: ¿Un gesto innecesario?

IntroductionNasogastric decompressive tube utilization has been accepted as one of the basic perioperative care measures after esophageal resection surgery. However, with the development of multimodal rehabilitation programs and without clear evidence to support their use, the systematic indication of this measure may be controversial. Material and methodsRetrospective, descriptive and comparative study of patients who had undergone Ivor-Lewis esophagectomy in our center -from January 2015 to December 2018- with placement (Group S), or without placement (Group N) of a decompressive tube in gastroplasty during postoperative period. Epidemiological variables and differences between groups in post-surgical morbidity and mortality, hospital stay, onset of oral tolerance and the need for nasogastric tube placement were evaluated. ResultsA total of 43 patients were included in this study, with a median age of 61 years, being 86% male. 46.5% were hypertensive, 25.5% had lung disease and 16.3% had diabetes mellitus. The median length of hospital stay was 9 days in group S versus 11.5 days in group N, with no differences in the onset of oral tolerance. Anastomotic dehiscence rate was 5% and 0% respectively. The overall mortality was 2.3% in the first 90 days, without differences between the groups. Placement of nasogastric tube during postoperative period was required only in 1 patient (4.3%) of the group N. ConclusionsNon-use of nasogastric tube during postoperative period of an Ivor-Lewis esophagectomy is a safe measure, as it is not associated with a higher rate of complications or hospital stay. This fact may be able to improve patients’ comfort and postoperative recovery.

A Clinical Study – Resection and Anastomosis of Bowel in Our Surgical Practice

Background: Anastomotic leaks are among the most dreaded complications after bowel surgery. In the present era, even with better understanding of the impact of local and systemic factors on anastomotic healing, dehiscence and leakage remains frequent and serious problem associated with high morbidity and mortality. However, problems with definitions and the retrospective nature of previous analyses have been major limitations. The aim of the study to use a prospective database to study the incidence of intestinal resection and anastomoses, to determine important factors and their significance in the healing of the anastomosis along with identifying the most ideal suture material for these techniques in our practice. Subjects and Methods: This study was carried out on 40 patients who underwent resection and anastomosis of bowel for various pathological causes in Kamineni Institute of Medical Sciences & Hospital Hyderabad during September 2018 to September 2019. Results: Out of the 40 patients who underwent resection and anastomosis of bowel, Anastomotic leaks were observed in 10 (25%) cases and all of them belonged to the group who were operated on emergency basis. Hypoproteinaemia, peritonitis and perioperative blood transfusions, hypovolemia were important attributable factors identified in the leak group. Minimal leaks were observed in the group of patients who were anastomosed with vicryl suture material alone. Mortality was observed in 3patients in the leak group. At 6 month follow up none of them developed anastomosis related complications like stenosis, diverticulum. Conclusion: The present study shows majority of the patients undergoing resection and anastomosis were dealt on an emergency basis. Multivariate analysis showed six predictive variables i.e., serum albumin less than 3 g/l, use of corticosteroids, bacterial peritonitis, malignancy, COPD, perioperative blood transfusions had a higher risk of developing anastomotic leaks. Vicryl when used alone being the suture material of choice.

Intra-operative fluorescence angiography is reproducible and reduces the rate of anastomotic leak after colorectal resection for cancer: a prospective case-matched study.

Intra-operative fluorescence angiography (IOFA) with indocyanine green provides information on tissue perfusion that may help prevent an anastomotic leak (AL). The aim of this study was to assess the impact of IOFA on outcomes after left-sided colonic or low anterior resection with anastomosis for colorectal cancer. All patients with left-sided colonic or rectal cancer, operated between June 2017 and December 2018, were prospectively included. IOFA has been routinely implemented since May 2018. Reproducibility of IOFA, after a 1:1 matching for relevant clinical risk factors of AL, was studied in patients with IOFA (IOFA+) and without IOFA (IOFA-). Outcomes were compared in terms of postoperative events such as clinically relevant AL as the primary end-point. In the IOFA+ group, changing of the initially planned colon transection due to inadequate perfusion occurred in five out of 46 patients (10.9%). Agreement between intra-operative assessment and postoperative blind review of IOFA was deemed strong (Cohen's kappa index 0.893, 95% CI 0.788-0.998, P<0.001). Among 111 patients, 42 matched patients were included in each group. There was significantly more clinically relevant AL in the IOFA- group compared to the IOFA+ group (16.7% vs 2.4%, P=0.026) involving significantly more anastomotic dehiscence which required re-intervention (19% vs 2.4%, P=0.014). Additionally, more descending colon ischaemia/necrosis was observed in the IOFA- group compared with the IOFA+ group (9.5% vs 0%, P=0.040). In this prospective case-matched study, IOFA decreased the occurrence of clinically relevant AL due to necrosis of the descending colon or anastomosis. Upon blind review, perfusion assessment using IOFA was reproducible.

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer.

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is amajor surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose atherapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

Massive Postoperative Pnuemoperitoneum—an Unprecedented Etiology

Postoperative pneumoperitoneum is a diagnostic challenge for surgeons, especially after major abdominal surgeries. The challenge is to determine whether this free air in the peritoneum is benign or pathological. Most commonly it is benign, mostly due to retained air following laparotomy and can be followed up. But it is imperative to rule out pathological causes like hollow viscus perforation and anastomotic dehiscence which requires urgent intervention. Also, there are some rare benign etiologies like drain-induced pneumoperitoneum, which are easily overlooked. Here, we present two images of a case of drain-induced pneumoperitoneum following laparotomy for a case of carcinoma–sarcoma of the uterus. This case underlines the importance of considering rare etiologies while evaluating for postoperative pneumoperitoneum.

¿Podemos prevenir la dehiscencia anastomótica en cirugía oncológica colorrectal mediante el empleo de la angiografía de fluorescencia con verde de indocianina?

Objetivo:La dehiscencia anastomótica (DA) en cirugía colorrectal es una de las complicaciones más devastadoras. El empleo de la angiografía de fluorescencia con verde de indocianina, se ha introducido en este campo como una herramienta prometedora para reducir la incidencia de DA. El objetivo de este estudio es valorar en nuestro medio, los resultados de la introducción de esta técnica en cuanto a prevención de DA.Materiales y Métodos:Se llevó a cabo un estudio prospectivo, incluyendo 59 pacientes sometidos a cirugía colorrectal resectiva a los que se les realizó una evaluación mediante angiografía con verde de indocianina intraoperatoria de la vascularización anastomótica.Resultados:Tras la aplicación de la técnica, se modificó el punto de sección en 9 pacientes (15,25%); en los cuales no se registró ninguna DA. La tasa de complicaciones global fue de 35,59% (n=21) objetivando 3 dehiscencias anastomóticas en la serie.Discusión:Esta técnica se perfila como una estrategia adicional en la prevención de la aparición de DA. Serán necesarios estudios randomizados con inclusión de mayor número de pacientes para obtener resultados concluyentes.

Delayed surgery after radio-chemotherapy for rectal adenocarcinoma is protective for anastomotic dehiscence: a single-center observational retrospective cohort study.

Ideal time interval between end of neoadjuvant radio-chemotherapy (NRCT) and surgery for rectal cancer is debated. Effect that different time intervals have on postoperative complications with particular regard to anastomotic dehiscence (AD) was evaluated on 167 patients who underwent surgery after long-course NRCT. Three different time intervals were considered: (0-42; 43-56; > 57days). A time interval > 57days was significantly protective for AD (p = 0.04, Odds ratio = 0.35; 95% CI 0.1254-0.9585) without influence on early oncological outcomes. Optimal time interval after end of NRCT and surgery may help achieving the best pathological response with lowest postoperative morbidity.Trial registration number: Clinical Trial. Gov NCT04013347. https://clinicaltrials.gov/ct2/results?cond=&term=NCT04013347&cntry=&state=&city=&dist= ).

Causes and Prognosis of Intestinal Failure in Crohn's Disease: An 18-year Experience From a National Centre.

Background and AimsIntestinal failure [IF] is a feared complication of Crohn’s disease [CD]. Although cumulative loss of small bowel due to bowel resections is thought to be the dominant cause, the causes and outcomes have not been reported.MethodsConsecutive adult patients referred to a national intestinal failure unit over 2000–2018 with a diagnosis of CD, and subsequently treated with parenteral nutrition during at least 12 months, were included in this longitudinal cohort study. Data were extracted from a prospective institutional clinical database and patient records.ResultsA total of 121 patients were included. Of these, 62 [51%] of patients developed IF as a consequence of abdominal sepsis complicating abdominal surgery; small bowel resection, primary disease activity, and proximal stoma were less common causes [31%, 12%, and 6%, respectively]. Further, 32 had perianastomotic sepsis, and 15 of those had documented risk factors for anastomotic dehiscence. On Kaplan-Meier analysis, 40% of all patients regained nutritional autonomy within 10 years and none did subsequently; 14% of patients developed intestinal failure-associated liver disease. On Kaplan-Meier analysis, projected mean age of death was 74 years.2ConclusionsIF is a severe complication of CD, with 60% of patients permanently dependent on parenteral nutrition. The most frequent event leading directly to IF was a septic complication following abdominal surgery, in many cases following intestinal anastomosis in the presence of significant risk factors for anastomotic dehiscence. A reduced need for abdominal surgery, an increased awareness of perioperative risk factors, and structured pre-operative optimisation may reduce the incidence of IF in CD.

A Comparative Study between Patients with Mechanical Bowel Preparation and Patients with No Bowel Preparation in Elective Colo-rectal Surgery

Background: Modern surgical techniques and improved preoperative care has reduced both morbidity and mortality of colorectal surgery but the role of mechanical bowel preparation is recently disputed. Primary colonic anastomosis without mechanical bowel preparation is still considered unsafe.&#x0D; Objective: One of the objectives of this study was to evaluate pre-operative mechanical bowel preparation in preventing anastomotic and wound dehiscence in elective colon and rectal surgery.&#x0D; Methods: Fifty patients who were included in this study were randomly divided into two groups (group A &amp; Group B). Group A was the preparatory group and Group B was the non-preparatory group. In preparatory group oral poly ethylene glycol was used for mechanical bowel preparation and in non-preparatory group no bowel preparation done. All patients were operated on by qualified surgeons and followed up for outcome and collected data were analyzed. Results: 80% of the Patients in Group A had adverse effects of bowel preparation like nausea, vomiting, blotting, loose motion and precaution had to be taken for them. All the patients of both groups were given per-operative antibiotics whereas 24 patients of Group A and 23 patients of Group B were given transfusion. 15(60%) patients of Group A had developed post-operative surgical infectious complications. The majority number of patients of Group A had been suffered from surgical site infection (10, 40%) followed by Anastomotic Leak, Intra-abdominal abscess and Peritonitis whereas in Group B 10(40%) patients developed surgical complications.&#x0D; Conclusion: Mechanical bowel preparation before elective colon and rectal surgery is not so effective in preventing complications and without any mechanical preparation of the bowel colorectal surgery can be done safely.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 105-109

Use of Barbed Suture for the Closure of Enterocolotomy after Laparoscopic Right Hemicolectomy With Intracorporeal Anastomosis. A Prospective Descriptive Study

IntroductionPerforming intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. Patients and methodsThis is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. ResultsA total of 80 patients were treated (47.5% women), with an average age of 70.6 ± 9 (49–92) years. The average operative time was 99.5 ± 38 min. Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of two leaks, two obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3–173) days. ConclusionsThe use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings.

Complications of stapled hemorrhoidectomy

Background: Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. Immediate complications (first week) were: severe pain in all patients, bleeding, thrombosis, urinary retention, anastomotic Dehiscence, fissurePerineal intramural hematoma, and submucosal abscess The most common complication after 1 week was recurrence of hemorrhoids in of patients, severe pain, stenosis, fissure, bleeding, skin tag, thrombosis, papillary hypertrophy, fecal urgency, staples problems, gas flatus and fecal incontinence, intramural abscess, partial dehiscence, mucosal septum, and intussusceptions. The most common complication in the first 25 cases of the surgeon’s experience was the pain. Even though SH and banding are necessary before recommending the procedure. It was a prospective and retrograde study conducted in R.D. Gardi Medical College, Ujjain. Study Duration was from November 2017 to November 2019. All the patients who were post-op (stapled hemorrhoidectomy) case of hemorrhoid disease. The total number of patients operated with stapled hemorrhoidectomy in the 2 years period (2017-2019) was 400.

IS LAPAROSCOPIC REOPERATION FEASIBLE TO TREAT EARLY COMPLICATIONS AFTER LAPAROSCOPIC COLORECTAL RESECTIONS?

ABSTRACT Background:Recently, with the performance of minimally invasive procedures for the management of colorectal disorders, it was allowed to extend the indication of laparoscopy in handling various early and late postoperative complications. Aim:To present the experience with laparoscopic reoperations for early complications after laparoscopic colorectal resections. Methods:Patients undergoing laparoscopic colorectal resections with postoperative surgical complications were included and re-treated laparoscopically. Selection for laparoscopic approach were those cases with early diagnosis of complications, hemodynamic stability without significant abdominal distention and without clinical comorbidities that would preclude the procedure. Results:In four years, nine of 290 (3.1%) patients who underwent laparoscopic colorectal resections were re-approached laparoscopically. There were five men. The mean age was 40.67 years. Diagnoses of primary disease included adenocarcinoma (n=3), familial adenomatous polyposis (n=3), ulcerative colitis (n=1), colonic inertia (n=1) and chagasic megacolon (n=1). Initial procedures included four total proctocolectomy with ileal pouch anal anastomosis; three anterior resections; one completion of total colectomy; and one right hemicolectomy. Anastomotic dehiscence was the most common complication that resulted in reoperations (n=6). There was only one case of an unfavorable outcome, with death on the 40th day of the first approach, after consecutive complications. The remaining cases had favorable outcome. Conclusion:In selected cases, laparoscopic access may be a safe and minimally invasive approach for complications of colorectal resection. However, laparoscopic reoperation must be cautiously selected, considering the type of complication, patient’s clinical condition and experience of the surgical team.

Transanal Endorectal Pull-Through With or Without Laparoscopic Assistance

Hirschsprung’s disease requires surgical treatment. Depending on the form of aganglionosis and severity of pathology, open or minimally invasive, transanal endorectal pull-through with or without laparoscopic assistance may be used.&#x0D; The objective of the research was to study the efficiency of using transanal endorectal pull-through with and without laparoscopic assistance for treating Hirschsprung’s disease in children. We compared outcomes between approaches.&#x0D; Materials and Methods. Over the period 2011-2016, 145 children with Hirschsprung’s disease were surgically treated using transanal endorectal pull-through (n=81) and laparoscopic-assisted transanal endorectal pull-through (n=64). A systematic literature review and meta-analysis were carried out.&#x0D; Results. We noticed that transanal endorectal pull-through without laparoscopic assistance could be easily used in children under 4 years of age with aganglionosis including the sigmoid colon without significant colon dilatation considering a significant mesosigmoid mobility at such age. In other cases, we used laparoscopic-assisted transanal endorectal pull-through. The advantages of laparoscopic stage included the possibility for correct planning of surgical strategy, a thorough revision of the affected colon, determination of aganglionosis level, mobilization of the mesenterium, elimination of the adhesions and ligaments holding the colon, thereby avoiding tension in coloanal anastomosis, control and prevention of pull-through colon twisting which may cause an obstruction. In older patients, the proximal end of the rectum could be dissected laparoscopically. This allowed transanal endorectal pull-through to be performed quicker and safer. In the postoperative period, patients underwent rehabilitation with good functional results. Two children developed coloanal anastomotic dehiscence which was corrected by open stage treatment.&#x0D; Conclusions. Age-related and anatomical features of the colon in the patients with Hirschsprung’s disease allowed performing transanal endorectal pull-through with or without laparoscopic assistance. Significant dilation of the colon, aganglionosis above the sigmoid area and the patient’s age over 4 years were indications for performing transanal endorectal pull-through with laparoscopic assistance. In other cases, transanal endorectal pull-through could be performed without laparoscopic assistance. The laparoscopic-assisted transanal endorectal pull-through procedure turned to be a safe and feasible technique for patients with Hirschsprung’s disease.

Uso de la sutura barbada para el cierre de la enterocolotomía tras hemicolectomía derecha con anastomosis intracorpórea. Estudio prospectivo descriptivo

IntroductionPerforming intracorporeal anastomoses and sutures is possibly the technique that requires the greatest skill in laparoscopic surgery. The appearance of the new barbed sutures in recent years has seemed to facilitate this surgical step. The aim of our study is to evaluate short-term results in patients with neoplasms of the right colon, after laparoscopic right hemicolectomy with intracorporeal anastomosis using barbed suture at the closure of the enterocolotomy. MethodsThis is a multicenter, prospective, descriptive study that includes patients who underwent laparoscopic right hemicolectomy for neoplastic colonic pathologies between June 2015 and December 2018. In all patients, the intracorporeal anastomosis was performed using the endocutter, and closure of the enterocolotomy was done with a double layer of barbed suture. ResultsA total of 80 patients were treated (47.5% women), with an average age of 70.6±9 (49-92) years. The average operative time was 99.5±38minutes Anastomotic dehiscence was observed in 2.5% of the sample, and 5 patients required re-operation (6.2%) as a result of 2leaks, 2obstructive symptoms and one peritoneal bleeding. Mean hospital stay was 7 (3-173) days. ConclusionsThe use of barbed suture in laparoscopic right hemicolectomy with intracorporeal anastomosis seems to present a morbidity similar to series described in literature. Prospective, controlled and randomized studies with a larger number of patients would be necessary to confirm these findings.

La cirugía transanal como herramienta en la dehiscencia de la anastomosis colorrectal

The treatment of anastomotic leakage after oncological surgery for rectal cancer is a surgical challenge. The goal of this study is to show how transanal surgery combined with the abdominal approach is a very useful tool to decide on individualized treatment depending on the degree of dehiscence and to assist us in its local management. We present three cases of patients with colorectal anastomotic dehiscence. In two, we demonstrate the treatment of acute colorectal leakage and how transanal surgery allows us to confirm its viability and rule out any underlying ischemia. Furthermore, it facilitates good drainage of the adjacent collection as well as the placement of a vacuum system, if necessary, and its subsequent replacements. The last case is a delayed dehiscence with chronic presacral sinus, and its treatment by transanal access for fenestration.