Colonic Anastomosis Research Articles

OF RECONSTRUCTIVE SURGERY IN PATIENTS WITH COLOSTOMY

Abstract. Literature data on the results of reconstructive surgery in patients with previously imposed colostomy were analyzed. Colostomy application varies from 7 to 63 %. Failure of the seams of the intestinal anastomoses remains a topical issue of abdominal surgery. The incidence of such complications, according to various authors, reaches 3.8–14.6 % — in operations on the colon. The issue of restoring the integrity of the large intestine is quite relevant for colorectal surgery, colostomy varies from 7 to 63 %. Despite the improvement of existing and development of new methods of reconstructive surgery, the active use of intraoperative and postoperative diagnostic methods, it is not possible to completely avoid complications. The incidence of failure of the sutures of colonic anastomoses reaches 3.8–14.6 %. Further study and development of methods of reconstructive surgery after colostomy is needed to minimize the number of postoperative complications and improve the treatment outcomes of patients with colorectal pathology.

Effects of ketogenic diet on colon anastomosis and wound healing in rats

Effects of ketogenic diet on colon anastomosis and wound healing in rats

Fully covered self-expandable metal stent placed over a stapled colon anastomosis in an animal model: A pilot study of colon metabolism over the stent.

Background and AimAnastomotic leakage (AL) in colorectal resection and primary anastomosis is a common and feared complication. Fully covered self‐expandable metal stents (FCSEMSs) have been used for the treatment of AL. It is still unknown whether FCSEMSs affect anastomosis healing negatively by causing ischemia. In an animal study, we investigated the metabolic effects over a FCSEMS covering a stapled colon anastomosis.MethodsSeven pigs were investigated using microdialysis after laparotomy, colon resection, and anastomosis with stent placement. Measurements were done at the proximal and distal ends of the anastomosis and at a reference catheter placed at the small intestine. Measurements of glucose, pyruvate, lactate, glycerol, and the lactate/pyruvate ratio (L/P) were carried out.ResultsLactate and L/P were significantly higher at the oral part of the anastomosis, while glucose showed a small declining tendency. At the distal part of the anastomosis, glucose decreased significantly after the resection but did not reach zero. Lactate increased significantly whereas L/P increased only slightly. Glycerol levels were stable.ConclusionColon resection caused initially hypermetabolism in the intestinal ends next to the resection site. This hypermetabolism neither deteriorated nor turned into ischemia during the initial postoperative course, but the start of hypoxemia could not be excluded during the study and after the placement of an FCSEMS.

Improved Healing of Colonic Anastomosis with Allotransplantation of Axillary Skin Fibroblasts in Rats.

Objective Colonic anastomosis is associated with serious complications leading to significant morbidity and mortality. Fibroblasts have recently been introduced as a practical alternative to stem cells because of their differentiation capacity, anti-inflammatory, and regenerative properties. The aim of this study was to evaluate the effects of intramural injection of fibroblasts on the healing of colonic anastomosis in rats. Materials and Methods Inbred mature male Wistar rats were used in this experimental study (n=36). Fibroblasts were isolated from the axillary skin of a donor rat. In the sham group, manipulation on descending colon was done during laparotomy. A 5 mm segment of the colon was resected, and end-to-end anastomosis was performed. In the control group, 0.5 ml of phosphate buffer saline (PBS) was injected into the colonic wall and in the treatment group, 1×106 fibroblasts were transplanted. Following euthanasia on day 7, intra-abdominal adhesion, leakage and peritonitis were evaluated by necropsy. Mechanical properties were assessed using bursting pressure and tensile tests. Inflammation, angiogenesis, and collagen deposition were examined histopathologically. Results The mean scores for adhesion and leakage were decreased in the treatment group versus control samples. Lower infiltration of inflammatory cells was observed in the treatment group (P=0.03). Angiogenesis and collagen deposition scores were significantly increased in the fibroblast transplanted group (P=0.03). Tensile mechanical properties of the colon were significantly increased in the treatment group compared to the control sample (P=0.01). There was no significant difference between the control and treatment groups in terms of bursting pressure (P=0.10). Positive weight changes were found in sham and treatment groups, but the control rats lost weight after 7 days. ConclusionThe results suggested that allotransplantation of dermal fibroblasts could improve the necroscopic, histopathological, and biomechanical indices of colonic anastomosis repair in rats.

Comparison of the colonic J-pouch versus straight (end-to-end) anastomosis following low anterior resection: a systematic review and meta-analysis.

To evaluate comparative outcomes of straight (end-to-end) anastomosis versus colonic J-pouch anastomosis following anterior resection. A systematic search of multiple electronic data sources was conducted, and all studies comparing straight (end-to-end) anastomosis versus J-pouch anastomosis were included. Anastomotic complications, post-operative complications, re-operation, mortality, and functional outcomes were the evaluated outcome parameters. Revman 5.3 was used for data analysis. Twenty-seven studies reporting a total number of 3293 patients who underwent straight anastomosis (n = 1581) or J-pouch (n = 1712) were included. Anastomotic leak and re-operation rates were significantly higher in the straight group compared to the J-pouch group [RD 0.03, P = 0.03] and [OR 1.87, P = 0.003], respectively. Stool frequency per 24h at 6months and 12months was lower in the J-pouch group than the straight group [MD 2.13, P = 0.003] and [MD 1.44, P = 0.00001], respectively. In addition, the use of anti-diarrheal medication is lower at 12months in the J-pouch group [MD 3.85, P = 0.03]. Moreover, the two groups showed comparable results regarding SSI, sepsis, paralytic ileus, anastomotic stricture formation, anastomotic bleeding, and mortality. J-pouch anastomosis showed lower risk for anastomotic leak and re-operation. Furthermore, better functional outcomes such as stool frequency were achieved using the colonic J-pouch reconstruction over the conventional straight end-to-end anastomosis.

Closing A Temporary Stoma - The Procedure Tactics.

The paper presents the results of clinical trials and meta-analyses regarding the closing time of: ileostomy (protective) after primary colorectal resection with anastomosis and colostomy - after Hartman's surgery. Rectal cancer surgery and ileal pouch-anal anastomosis (IPAA) in inflammatory bowel diseases often involves an ileostomy (temporary protective, preventive), which in a significant proportion of cases is eliminated at different times from the initial surgery. There is a discussion in the literature regarding the selection of the appropriate time of stoma closure, taking into account the experience of many clinical centers. An ileostomy is performed when the entire colon and rectum must be removed, or to protect the colon or ileorectal anastomosis. The creation of a protective stoma reduces the frequency of clinically significant anastomotic leakages and the need for surgical revisions in patients at increased risk of leakage. Also, the time of digestive system reconstruction, i.e., colostomy elimination, after Hartman's surgery depends on many factors, including the stage of disease and indications for adjuvant treatment. Should it be standard practice to close the stoma early? Based on previous studies and meta-analyses, as well as own experience - it is advisable to individualize the procedure, taking into account many factors that determine the clinical and oncological status (selection of the date - early or deferred, but not as a standard [!]).

Effects of Oral Pirfenidone on Colon Anastomosis Healing and Adhesion Formation in Rats

Introduction: Many experimental studies have examined multiple drugs or treatments to improve the healing of intestinal anastomoses. Synthetic prostacyclin analogs, immunosuppressants, erythropoietin, growth hormone, insulin-like growth factor type 1, synthetic metalloproteinases inhibitors, and hyperbaric oxygen therapy have produced promising results in low-risk models of anastomosis dehiscence. However, in high-risk models, only hyperbaric oxygen therapy has been shown to be useful. Pirfenidone (PFD), a commonly used antifibrosing drug, has not been shown to be effective for this purpose. Our objective was to evaluate the effects of PFD on anastomosis healing and adhesion genesis in a low-risk rat model of dehiscence of colonic anastomosis. Methods: An experimental study was conducted on 40 healthy Wistar rats randomly assigned to the control group or PFD experimental group (20 rats in each group). Colon anastomosis was performed 3 cm above the peritoneal reflection using the same technique in all animals. Mechanical resistance was studied by measuring bursting pressure. Adhesions were evaluated macroscopic and histologically using common staining techniques. Animals received the first PFD dose 12 h after surgery at a dose of 500 mg/kg one a day (SID) for 5 consecutive days. On day 6, the animals were reoperated on to measure the bursting pressure in situ and to classify adhesions macroscopically, and the anastomosed colon was resected for histological analysis. Results: There were no deaths, complications, or anastomosis dehiscence in either group. The mean bursting pressure was 120.8 ± 11 mm Hg and 135.5 ± 12.4 in the control and PFD groups, respectively (p < 0.001). The adhesions were less dense and had less inflammatory cell infiltration in the PFD group (p < 0.02 and 0.002, respectively). Collagen content was slightly higher in the PFD group (p = 0.04). Conclusions: Our results revealed favorable effects of PFD in this low-risk colon anastomosis model; for example, the bursting pressure was higher, and the macroscopic adhesions were soft and exhibited less inflammatory infiltration and higher collagen content in the PFD group than in the control group. The results showing that PFD treatment was associated with better healing of minor adhesions seem to be paradoxical because the therapeutic indications for this drug are directed at treating fibrosing diseases.

Cecostomy vs ileostomy for protection of anastomoses in colorectal surgery

Background: The most frequently encountered complication of anastomotic surgery is fistula. In addition to the medical history of the patient, local conditions, the operative moment and surgical technique that were chosen, a series of some other factors can interfere, leading to suture disunity. Aim: The aim of the study was to analyze the existence of a relationship between the use of cecostomy (as a mechanism of temporary diversion) and the frequency of anastomotic fistulas. Materials and methods: We conducted a retrospective study, over a period of 7 years, between 2011-2018 taking into consideration 194 patients who benefited from resections completed with anastomoses in the transverse colon, descending colon, sigmoid and rectum. They were divided into two categories: patients who benefited from cecostomy and patients for whom we did not use this technique. The frequency of fistulas was analyzed for the two main groups and in association with each type of surgery. Results: It was observed the existence of a relationship between the appearance of fistulas and the use of a decompression mechanism such as cecostomy in the sense of a lower number of fistulas for the first situation (2.66%) compared to 11.76% for cases without cecostomy (p=0.034). The duration of hospitalization in the group with cecostomy was shorter than in those without this derivative stoma and the postoperative recovery was good. Conclusions: Cecostomy is a useful protection for the anastomosis line, with the advantage that, when the tube is suppressed, the stoma will spontaneously close.

Risk Factors for Anastomotic Leakage Following Total or Subtotal Colectomy

Abstract Introduction A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. The main aim of the present study was to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity. Methods We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity. Results Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of AL was 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p = 0.038), in the elective-laparoscopic approach subgroup (p = 0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p = 0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA. Discussion A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgery may improve short-term outcomes.

DIFERENTES MÉTODOS CIRÚRGICOS EM ANASTOMOSE DO CÓLON: ESTUDO EXPERIMENTAL

ABSTRACT - BACKGROUND:Although many methods have been defined for colonic anastomosis, anastomotic leak still remains important for sepsis control and successful healing.AIM: The purpose of this study was to compare the effects of conventional suture, polyglactin 910 mesh, and omental flap coverage on healing and anastomotic leak in experimental colonic anastomosis in rats.METHOD: This study was conducted on 18 Wistar rats and the animals were divided into three groups as follows: Group 1: primary suture group; Group 2: primary suture plus polyglactin 910 mesh group; and Group 3: primary suture plus omental flap coverage group. Groups were compared in terms of anastomotic bursting pressure, inflammation, fibroblastic activity, neovascularization, and collagen amount.RESULTS: There was a statistically significant difference in anastomotic bursting pressure between Groups 1 and 2 and between Groups 1 and 3 (p=0.004, p<0.05). There was a significant difference in fibroblastic activity between Groups 1 and 3 (p=0.011, p<0.05) and between Groups 2 and 3 (p=0.030, p<0.05). There was a significant difference in neovascularization and collagen between Groups 1 and 2 and between Groups 1 and 3 (p<0.05).CONCLUSION: This experimental study found that polyglactin 910 mesh and omental flap coverage for colocolic anastomoses improved the physical strength and healing of the anastomosis compared to conventional hand-stitched anastomoses. The polyglactin may be a safe alternative to 910 mesh in cases where the omental flap coverage cannot be used in the colonic anastomosis.

Investigation of the effects of post-operative intraperitoneal, oral, and rectal phenytoin administration on colorectal anastomosis in rats.

Anastomotic leakage is the most feared complication after colonic anastomosis. The purpose of the study is to determine the effects of phenytoin applied by different application routes, on the healing process of colorectal anastomoses. Wistar Albino rats were divided into Intraperitoneal Phenytoin Group, Oral Phenytoin Group (OAP), Rectal Phenytoin Group (RAP), and control groups. The molecular effect of phenytoin on the expression of vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), fibroblast growth factor 2 (FGF2), and p53 genes was evaluated at mRNA and protein level. The effects of phenytoin on anastomotic bursting pressure analysis measured as well as pathohistological examinations. There are statistically significant increase in anastomotic bursting pressure values between control and application groups. Inflammatory cell infiltration of all groups increased in the intestinal anastomosis region compared to control. Collagen scores were found to be significantly higher in the OAP and RAP groups compared to the control group. mRNA of TGF-ß and FGF2 expression increased in all routes of phenytoin applications. Three different administration routes show considerably increase on the bursting pressure. Regarding the results of the expression of FGF2, TGF-β, p53, and VEGF genes, there is a significant increase FGF2 and TGF-β at mRNA and protein level in most administration routes.

Fast track recovery protocols for extended pelvic surgery

To compare the immediate results of extended pelvic surgery before and after introduction of standardized fast track surgery (FTS) protocol into routine clinical practice. The study included 111 patients with pelvic tumors who underwent extended pelvic surgery. The control group included 59 patients whose perioperative management implied traditional approaches (2018-2019), the main group - 52 patients with FTS protocol (2020-2021). Age, BMI and ECOG status were similar. In the main group, females (90.4% vs. 74.6%; p=0.046), patients with recurrent (46.2% vs. 22.0%; p=0.009) and complicated tumors (26.9% vs. 11.9%; p=0.054) prevailed. Obstructive resection without anastomosis was less common in the main group (28.8% vs. 47.5%; p=0.068). Surgery time was higher (319±125 min vs. 236±79 min, p<0.001) in the main group, but blood loss (238±154 ml vs. 282±150 ml, p=0.029) and incidence of blood transfusions (23.1% vs. 42.4%, p=0.043) were lower. Moreover, complications (36.6% vs. 54.3%; p=0.086), mild complications (Clavien-Dindo class I-II) (11.6% vs. 28.8%; p=0.034) and local infectious complications (19.2% vs. 42.4%; p=0.009) were less common in the main group. Two patients died in the control group due to sepsis following colonic anastomosis and bladder suture failure, respectively. Postoperative hospital-stay was similar (14±9.1 days vs. 14.4±9 days; p=0.89). FTS protocol is possible and safe in patients with locally advanced and recurrent malignant pelvic tumors. This approach reduces blood loss, the number of blood transfusions and risk of postoperative infections.

Single Layer versus Double Layer Technique for Intestinal Anastomosis: A Comparative Study

Introduction: Intestinal anastomosis is a surgical procedure executed to ascertain communication between two segments of the intestine, after the removal of pathology affecting the bowel. It depends on factors like anastomosis site, bowel capability and the type of the pathogenesis. Aims: To compare single versus double layer method in terms of time taken for anastomosis, hospital stay, post-operative leak and cost effectiveness. Methods: This is a comparative hospital based study carried out at the department of surgery Nepalgunj Medical College from September 2017 to August 2020. Patients requiring emergency laparotomy with resection and anastomosis of small bowel were included. Patients requiring colonic anastomosis, diversion stoma and multiple anastomoses were excluded. Patients were divided in to two groups- single layer and double layer group. Each group was compared for outcome measures like time taken to construct the anastomosis, hospital stay, post-operative leak and cost of surgery. Results: The total number of patients was 50. The mean age was 45.57±17.42 years for single layer and 48.67±18.16 years for double layer group. Time taken for intestinal anostomosis in single and double layer were 18.28±5.08 and 25.27±6.18 respectively which was statistically significant (p - &lt;0.012). Hospital stay was 10.9±1.43 in single layer and 11.2±1.87 which was statistically not significant (p - &gt;0.342). Similarly, the anastomosis leak was seen in 2 patients in single layer and 3 in double layer. Which was statistically not significant (p - &gt;0.318). While comparing the cost effectiveness single layer technique was cost effective. Conclusion: The single layer anastomosis is a preferable, safe and economic technique in comparison to the conventional double layered 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.

In Right Colon Gunshot Injuries, Resection and Anastomosis Versus Primary Repair

In Right Colon Gunshot Injuries, Resection and Anastomosis Versus Primary Repair

Comments on the article. Colonic invagination anastomosis in surgery of complicated forms of diverticular disease

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Does Rectal Application of Red-Ginseng have an Effect on Colorectal Anastomosis Healing? An Experimental Study

Aim: To evaluate the possible effects of red-ginseng on colon anastomosis healing in an experimental rat model.&#x0D; Methods: In Group 1 (sham), laparotomy and colonic mobilization were performed. Colonic transection and anastomosis were performed to Groups 2 and 3. In Group 2 (control), 2 ml of saline was administered rectally to all rats for 10 days. Group 3 (drug group) rats were given 2.5 gr/kg ml red ginseng extract rectally for 10 days.&#x0D; Results: The rats in the sham group had the highest bursting pressure and the rats in the red ginseng group had higher bursting pressure than in the control group (p

Justification of the diagnostic algorithm and treatment strategies in patients with severe chronic slow-transit constipation

Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a segmental type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the common type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.

Anastomotic Troubleshooting.

Anastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.

Intravenous Injection of Contrast to Assess Colonic Anastomosis in Non-emergent Colorectal Surgery Does Not Reduce Anastomotic Leak Rate: A Retrospective Analysis Using the NSQIP Database

Intravenous Injection of Contrast to Assess Colonic Anastomosis in Non-emergent Colorectal Surgery Does Not Reduce Anastomotic Leak Rate: A Retrospective Analysis Using the NSQIP Database