Anastomotic Leakage Complications Research Articles

Surgical cervicothoracic-flap repair of neoesophagus–airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study

ObjectiveTo evaluate outcomes of surgical repair of postesophagectomy neoesophagus–airway fistulas (NEAFs). MethodsWe retrospectively included consecutive patients with NEAF managed by various techniques at our center between August 2009 and July 2021. ResultOf the 11 patients (median age, 60 years; interquartile range, 58, 62), 4 had received induction chemoradiotherapy and 4 others induction chemotherapy. NEAF was mainly a complication of anastomotic leakage (n = 6) or attempted stenosis treatment (n = 3). The airway mainly involved was the trachea (n = 8). Airway defects were repaired by resection–anastomosis (n = 5), perforator flaps (n = 4), pedicled pericardium (n = 1), and/or direct suturing (n = 2). Gastric conduit defects were repaired by perforator flaps (n = 6), direct suturing (n = 2), or pedicled pericardium (n = 1). Of the 7 perforator flaps, 4 were internal mammary–artery, two dorsal intercostal–artery, and one supraclavicular–artery flaps. After a median follow-up of 100 months, 2 patients died on early postoperative course from NEAF repair failure and 3 from late NEAF recurrence at 4, 11, and 33 months. Among the remaining 6 patients, 1 died from local tumoral recurrence at 13 months, 1 was last on follow-up at 27 months, alive and eating normally. The other 4 were free from NEAF recurrence and dysphagia or swallowing disorder at 50 months’ follow-up. These 4 results were obtained thanks to perforator flap interposition and airway resection anastomosis. ConclusionsSurgical NEAF repair using perforator flap interposition may provide satisfactory long-term function after strong prehabilitation.

THE EARLY RESULTS OF RADICAL SURGERY IN TREATMENT OF RECTAL CANCER

Objectives: To evaluate the early result of radical surgical treatment of rectal carcinoma. Subjects and methods: Longitudinal follow-up study on 109 patients diagnosed with rectal carcinoma who were surgically treated at Department of colorectal and perineal surgery, Viet Duchospital from October 2016 to May 2019. Results: Complications of anastomotic leakage (2.75%). Postoperative bleeding (1.83%). Abdominal wound infection (10.09%). Postoperative enteroplegia (5.50%). Urinary retention (4.59%). Intestinal obstruction (2.75%). Bladder leakage and psychosis both accounted for 1.83%. Intra-abdominal bleeding, pelvic abscess, acute pancreatitis all accounted for 0.92%. Parastomal hernia had a patient,accounting for 0.92%. There were 18.37% of patients relapse after surgery. There were 11.22% of patients with distant metastasis detected after surgery, the metastatic organs were liver and lung metastasises.Conclusion: Complications of radical surgery for rectal cancer were mainly anastomic leakage, wound infection, postoperative enteroplegia. The postoperative recurrence rate was 18.37% in allfollowing (11.22% of patients had distant metastases after surgery).

256 DRAINAGE OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY: THROUGH THE FISTULA OR NOT, WHICH IS BETTER?

Abstract Thoracic abscess and/or mediastinal abscess due to anastomotic leakage after esophagectomy are very serious postoperative complications, and adequate surgical drainage is of critical importance to treatment. In this study, we compared the treatment efficacies of two drainage methods (through-the-fistula or not-through-the-fistula). Methods We retrospectively collected the esophageal cancer patients who underwent surgery from Jan 2016 to Aug 2019 who had complications of anastomotic leakage which was above grade III according to Lerut grading system. The drainage methods of thoracic/mediastinal abscess were drainage tube through-the-fistula (TF) (with the aid of X-ray or endoscope) and not-through-the-fistula (nTF) (via thorax or neck). According to the time from drainage tube placed to stable of the fistula, the patients were divided into fast stable group (<14 days) and slow stable group (≥14 days), and the differences of clinical characteristics and drainage methods were compared. Results Among the 495 cases underwent surgery, 43 (8.7%) had anastomotic leakage, 20 (4.0%) of which were grade III. 8 obtained fast stable and 12 were slow stable. As to drainage efficacy, there were 87.5% and 16.7% of the cases adopted TF drainage in fast stable group and slow stable group, respectively (P = 0.002). As to safety, there were 1 case in TF group that needed repeated drainage, whereas in nTF group, there were 2 cases died of bleeding and 2 cases needed repeated drainage (P = 0.319). Furthermore, there were 2 residual cavity cases after recovery in the nTF group. Conclusion TF drainage is safe and reliable for the thoracic/mediastinal abscess caused by anastomotic leakage after esophagectomy, which was better compared to nTF drainage, and facilitated recovery of the anastomosis.

Iso-peristaltic colonic loop interposition for the treatment of benign oesophageal stricture: a case report with review of literature

Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.

Intraluminal flexible sheath for the protection of low anastomosis after anterior resection: results from a First-In-Human trial on 15 patients.

Defunctioning ostomy is commonly used to protect patients from anastomotic leakage complications after low anterior resection, but is fraught with its own deleterious effects. This first-in-human study examines the safety and preliminary efficacy of Colovac, an anastomosis protection device. The Colovac consists of a flexible bypass sheath, placed in the lumen of colon and anchored above the anastomosis using a vacuum stent. 15 patients underwent anterior resection (AR) with anastomosis protection by Colovac at 3 European centers. After 14days, the anastomosis integrity was examined by CT scan and endoscopy. The device was then endoscopically removed. Data regarding demographics, surgical details, 30day post-operative complications, and patient satisfaction were collected prospectively. 15 patients (10 male) underwent laparoscopic AR with Colovac placement. Preoperative neoadjuvant therapy was administered to 54% of patients. Device placement was uneventful in all patients with a median duration of 7min and placement was judged as easy or very easy in 93% of the cases. Patients did not report major discomfort during the 14days. Endoscopic removal (10min) was judged as easy or very easy in 87% of the cases. Absence of feces below the Colovac anchoring site was observed in 100% of the cases. 4 anastomotic leakages were observed (including 3 device migrations). Overall 5 patients (33%) required a planned stoma creation. At 3months, 1 had already been closed. Colovac provides a minimally invasive protection of the anastomosis during the healing process by avoiding the need for a diverting ostomy for two-thirds of patients who will not experience anastomotic complications and allowing safe conversion to the standard of care for patients requiring extended anastomotic protection. A larger study is ongoing to confirm these results.

The effect of bilateral U-sutures in pancreaticojejunostomy in 75 consecutive cases

Background: Various technical interventions have been suggested to decrease the frequency of postoperative pancreatic fistulas but the effect is not particularly satisfactory. We have analyzed our application of bilateral U-sutures in pancreaticojejunostomy.Methods: The pancreatic stump is freed over approximately 2 cm, an appropriate diameter silicone catheter with 2–4 lateral holes was inserted into the remnant pancreatic duct (>2 mm in diameter is required) over 2–3 cm as a stent in 69 patients. In six patients with soft pancreas and very small pancreatic duct (<2 mm in diameter), the silicone catheter was not used. An incision was made on the side of the distal section of the jejunum and end-to-side an invaginated pancreaticojejunostomy was performed using bilateral U-sutures.Results: Only two (2.67%) cases developed pancreatic ‘biochemical leaks’. None of the 75 patients developed grade B and grade C pancreatic leakage. The overall morbidity was 29.33%. The anastomosis time was 14 minutes on average. There were no symptoms such as abdominal discomfort, dyspepsia and diarrhea, and no dilatation of pancreatic duct was found by CT in 75 patients after discharge from hospital.Conclusions: Bilateral U-sutures are a safe, simple, and effective technique in pancreaticojejunostomy, preventing the primary complication of anastomotic leakage, and worthy of wide use.

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.

Clinical pathway after gastrectomy for gastric cancer: A case series of laparoscopic gastrectomy and early oral intake with "iEat™".

IntroductionWe investigated the validity of the clinical pathway of early oral intake using a special type of food "iEat™" for patients after laparoscopic gastric cancer surgery.MethodsFifty-two patients who underwent laparoscopic surgery for gastric cancer between April 2012 and October 2013 were the participants. We provided postoperative care in accordance with a clinical pathway for laparoscopic gastrectomy that begins oral intake with "iEat™ the day after surgery. We examined complications resulting from oral intake, postoperative complications, and the length of postoperative hospital stay.ResultsOf the 52 patients, 30 underwent distal gastrectomy and 22 underwent total gastrectomy. 50 patients was able to start early oral intake in accordance with our clinical pathway. No anastomotic leak complications were observed, and 9 patients (17.3%) developed complications as results of surgery. There was no complication related to early oral intake with "iEat™". Re-operation were performed in two cases. Overall mean and median postoperative hospital stays were 8.3 days and 6 days, respectively. There was a single case of hospital re-admission. The completion rate of this early oral intake clinical pathway was 86.5%.ConclusionClinical pathway of recovery program combined laparoscopic suregry and early oral intake with "iEat™" could be useful for gastric cancer. This study indicates that using non-liquid food like iEat™ can be feasiblel, and water or liquid food don't have to be used in early oral feeding after laparoscopic gastrectomy.

Early Enteral Nutrition is Associated with Faster Post-Esophagectomy Recovery in Chinese Esophageal Cancer Patients: A Retrospective Cohort Study

ABSTRACTWe retrospectively examined a large cohort of esophageal carcinoma patients who received early enteral nutrition (EEN) to clarify the validity of EEN compared with total parenteral nutrition (TPN). Included were a total of 665 consecutive patients with histologically confirmed carcinoma of the esophagus or esophagogastric junction; and all patients underwent esophagectomy. The patients were divided into two groups: TPN (n = 262) and EEN (n = 403). The TPN group consisted of patients who only received intravenous nutrition support after operation. The postoperative length of hospital stay (PLOS), anastomotic leakage, mortality after surgery, and hospital charges were reviewed and analyzed. Compared with the TPN group, the EEN group had significantly shorter mean PLOS (15.6 days vs. 22.5 days; P < 0.01). Multivariable linear regression analysis revealed EEN to be associated with shorter PLOS even after adjustment for tumor histology, tumor location, type of esophagectomy, and postoperative albumin infusion. Hospital charges were also significantly less for those in the EEN group than the TPN group. There was no significant difference between the two groups regarding the complication of anastomotic leakage and clinical outcome after surgery. These findings suggest that EEN reduces PLOS and hospital charges of Chinese esophageal cancer patients who had an esophagectomy.

Http://medcraveonline.com/JPNC/JPNC-06-00234.php

Purpose: Tracheo esophageal fistula repair are usually complicated by the development of anastomotic leaks and strictures. The technique of anastomosis has long been a matter of debate. The most common method has been transverse circular esophageal anastomosis. We aim to bring down the frequency of early complications associated with conventional technique of esophageal repair by introduction of a modified repair method. Methods: Twenty patients of congenital tracheo esophageal fistula underwent modified oblique esophago esophageal anastomosis with pleural patch. The patients were followed up for immediate complications of anastomotic leaks and strictures. Results: Contrast esophagogram showed no incidence of anastomotic leak and strictures in all the twenty patients. Conclusion: The oblique esophageal anastomois with pleural patch serves as a wide bore anastomosis compared to the classical circular anastomosis, hence explaining the reduced incidence of decreased leaks and strictures associated with this method.Purpose: Tracheo esophageal fistula repair are usually complicated by the development of anastomotic leaks and strictures. The technique of anastomosis has long been a matter of debate. The most common method has been transverse circular esophageal anastomosis. We aim to bring down the frequency of early complications associated with conventional technique of esophageal repair by introduction of a modified repair method. Methods: Twenty patients of congenital tracheo esophageal fistula underwent modified oblique esophago esophageal anastomosis with pleural patch. The patients were followed up for immediate complications of anastomotic leaks and strictures. Results: Contrast esophagogram showed no incidence of anastomotic leak and strictures in all the twenty patients. Conclusion: The oblique esophageal anastomois with pleural patch serves as a wide bore anastomosis compared to the classical circular anastomosis, hence explaining the reduced incidence of decreased leaks and strictures associated with this method.

Double Circular Stapler Technique for Bowel Resection in Rectosigmoid Endometriosis

To reduce bladder function impairment and avert the serious complications of anastomotic leakage after segmental rectosigmoidectomy and to minimize the persistence of endometriotic lesions associated with discoid resection, we used the double circular stapling (DCS) technique. This technique enables excision of bowel endometriosis nodules larger than those that can be removed with the single-load technique of the circular stapler. Of 120 patients who underwent surgery to treat bowel endometriosis, intestinal shaving was performed in 24, discoid resection with single circular stapling in 40, and rectosigmoidectomy in 55. Eleven patients (9.2%) underwent the DCS technique. In the DCS group, the size of the rectosigmoid lesion ranged from 2.2 cm to 4.2 cm. Median operative time for the DCS technique was 100 minutes, compared with 150 minutes for rectosigmoidectomy (p = .04). Only 1 of 11 patients (9%) had urinary retention, compared with postoperative urinary retention in 14 of 55 patients (25%) who had undergone rectosigmoidectomy (difference not significant). Only 1 patient, with a 4.2-cm nodule, had a positive margin in the specimen obtained at the second stapling. DCS is a promising technique and may avert rectosigmoidectomy in selected patients.

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Anastomotic leakage (AL) after low anterior resection for rectal cancer is a challenging complication in rectal cancer surgery. The reported frequency is 10–20 % in most publications, irrespective of the creation of a diverting stoma. AL has both immediate and long-term consequences that affect morbidity, mortality, functional and oncological outcome. The oncological impact of AL is still under discussion. Several studies have demonstrated an increase in local recurrence rate and a decreased overall survival, while other studies have failed to demonstrate this connection. A recent study showed that AL, which required reoperation, was associated with a significantly higher local recurrence and lower overall survival rate [1]. In most cases, the clinical presentation of AL is insidious with vague and uncharacteristic abdominal symptoms, which may be masked by the use of epidural analgesia. Some cases may present with extraintestinal manifestations such as atrial fibrillation or mental confusion. Thus, AL is typically not recognized until postoperative day 5–7, which in many cases means there is significant delay in diagnosis. Another explanation of delayed diagnosis might be the low diagnostic sensitivity and specificity of common clinical tests such as body temperature, C-reactive protein (CRP) concentration and leukocyte count in peripheral blood, which moreover may be obscured by other inflammatory conditions such as pneumonia, urinary tract infections and surgical site infections. The same may apply to other inflammatory parameters such as cytokines. A recent pilot study conducted by our group using a panel of 10 cytokines and 2 complement factors in patients with and without AL found that only combined changes in IL-4, IL-6 and IL-10 could accurately predict leak (submitted for publication). A study on postoperative CRP in elective abdominal surgery, published in the present issue, showed that patients with CRP 135 mg/L on postoperative day 3 were unlikely to develop AL. However, the sensitivity and specificity for AL of elevated values were dependent upon the duration of the elevation in the CRP concentration [2]. Regular computed tomography (CT) scan and endoscopy are other possible but less attractive investigations due to irradiation and the risk of iatrogenic anastomotic dehiscence. Early diagnosis of AL is important to reduce the negative effects on the patient’s health and to increase the success rate of treatment without reoperation. Therefore, new tests for early diagnosis of AL, before the development of overt symptoms, are warranted. The problem is that the complete pathophysiological background of AL is unknown. Several factors such as ischemia, inflammation, surgical techniques, comorbidity and preoperative radiochemotherapy may be involved. It is well documented that a diverting loop ileostomy reduces the risk of serious complications due to AL such as fecal peritonitis, reoperation, prolonged morbidity, permanent stoma and death. However, a diverting loop ileostomy is not without consequences and discomfort for the patient. In patients without AL, it has been demonstrated that a diverting stoma is associated with a higher long-term mortality rate than in patients without a stoma, due to stoma-related complications, missed adjuvant chemotherapy and complications of stoma closure. The use of ‘‘ghost’’ ileostomy, which allows selective loop ileostomy formation or early closure of the stoma before postoperative day 8–14, may be an alternative [3, 4]. The use of a transanal tube is dubious [5, 6]. Intraoperative laser M. Ellebaek (&) N. Qvist Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark e-mail: markep01@gmail.com

Prediction of major postoperative complications and survival for locally advanced esophageal carcinoma patients

Predicting the major complications after esophagectomy is important and may help in preselecting patients who are most likely to benefit from surgery, especially in locally advanced esophageal cancer patients who have poor prognosis. To identify the factors associated with the development of pneumonia and anastomotic leakage complications, and the survival characteristics in locally advanced esophageal cancer patients. A consecutive series of 232 locally advanced esophageal cancer patients (183 men and 49 women, median age 63 years) who underwent esophagectomy at Prince of Songkla University Hospital between 1998 and 2007 was analyzed. There were nine (3.8%) 30-day mortalities. Pneumonia occurred in 53 patients (22.8%) and anastomotic leakage in 37 patients (15.9%). Multivariate analyses showed that low body mass index was related to leakage (p = 0.015), while soft-diet dysphagia (p = 0.009), forced expiratory volume in 1 second <75% (p = 0.0005), type of surgery (McKeown technique) (p = 0.019), and long operative time (p = 0.006) were related to pneumonia. The median survival rate was 13.0 months. Stage 2b patients had longer survival than stages 3 and 4a patients (p = 0.0001). Patient body mass index, dysphagia, spirometry, type of surgical technique, and operative time can help predict the likelihood of pulmonary or leak complications after esophagectomy. TNM (Tumor, Node, Metastasis) staging can help predict the overall survival after resection in locally advanced cases.

Anastomotic Leak Rate after Low Anterior Resection for Rectal Cancer after Chemoradiation Therapy

Anastomotic leak may be the most concerning complication after colorectal anastomosis. To compare open with laparoscopic rectal resection, we must have accurate leak rates in patients who have received neoadjuvant chemoradiation therapy to serve as a benchmark for comparison. All patients who had preoperative chemoradiation therapy with rectal resection and low pelvic anastomosis for cancer in a single colorectal practice over a 7-year period were retrospectively reviewed. All patients had proximal diversion and a contrast enema study before stoma reversal. Eighty-seven consecutive patients were included in the study. Average age was 58 years. Fifty-nine per cent of patients were male. Sixty-six per cent were smokers. Pathologic T stage was 5 per cent T0, 16 per cent T1, 28 per cent T2, 47 per cent T3, and 5 per cent T4. Seventy-five per cent of patients were pathologically lymph node-negative. Average time to stoma reversal was 122 days. Total anastomotic leak rate was 10.3 per cent (8% clinical leaks). Five (56%) patients with leak successfully underwent reversal of their diverting stoma (average time to reversal, 290 days). Patients who had the complication of anastomotic leakage had less likelihood of stoma reversal and a significantly prolonged time to stoma reversal.

Synchronous esophageal and renal cell carcinoma

Multiple cancer associated with esophageal cancer is not uncommon; however, synchronous esophageal and renal cell carcinoma is very rare. Only three cases have been reported to date, and one of these patients was treated in our institution. We have since successfully treated another patient. Here, we report the two cases treated in our institution. In the first case, esophagectomy, nephrectomy, and reconstruction using a gastric tube were carried out in one stage. Post-operative renal function was temporarily impaired by the complications of anastomotic leakage and pyothorax but no hemodialysis was needed. In the second case, as the patient had undergone distal gastrectomy because of gastric cancer, we chose a two-stage operation, i.e. esophagectomy and nephrectomy as the first stage, followed by reconstruction using a colon substitute after 4 weeks, resulting in only slight renal dysfunction. Patients 1 and 2 are alive and well 7 years and 2 years after the operations respectively.

Risk factors and the management of anastomotic leakage after anus-preserving operation for rectal cancer

To investigate the risk factors and management of anastomotic leakage after radical resection for rectal cancer and preservation of anal sphincter. The clinical data of 190 rectal cancer patients, undergone sphincter preserving procedures from Jan. 2004 to Jan. 2006, were analyzed retrospectively. The incidence of anastomotic leakage among the 190 rectal cancer patients was 7.9% (15 patients). The leakage occurred from 2 to 17 days postoperatively and the average time of appearance was 5.8 days. Thirteen cases of anastomotic leakage were healed by conservative therapy. The treatment included nutritional support, catheter drainage of abdominal abscesses and the use of antibiotics. Healing time ranged from 10 to 60 days and the mean time was 21.8 days. The other 2 patients were healed by abdominal perineal resection and loop colostomy of transverse colon respectively. The complication of anastomotic leakage was associated with age (10.2% in older than 60 years versus 3.2% in younger than 60 years), physical status (20.7% in poor condition patients versus 5.6% in good condition patients), bowel obstruction (19.1% with obstruction versus 6.5% without obstruction), anastomotic procedure (12.2% in Parks' anastomosis versus 6.7% Dixon anastomosis), anastomotic location (9.2% for outside of peritoneal anastomosis versus 2.7 for inside of peritoneal anastomosis). The rates of anastomotic leakage in staple-line manual reinforce group and postoperative anorectal drainage group were significantly decreased than those in control groups (1.9% versus 11.4% and 2.9% versus 10.7%)(P<0.05). Elderly patients, poor general condition, preoperative tumor obstruction, outside of peritoneal anastomosis are independent risk factors for the development of anastomotic leakage. Manual staple-line reinforce after stapled anastomosis and postoperative placement of drainage in rectum may be effective in decreasing the rate of anastomotic failure. Early and active conservative approach should be considered as the main treatment of anastomotic leakage.

A Defunctioning Stoma in the Treatment of Lower Third Rectal Carcinoma

Introduction: Total mesorectal excision (TME) is the accepted standard for rectal cancer treatment. However, there is an increased risk of symptomatic anastomotic leakage associated with TME as TME potentially endangers the blood supply of the remaining rectum. On top of this, many patients will receive neo-adjuvant radio-chemotherapy. A defunctioning stoma helps in avoiding severe complications of anastomotic failure.Material and mehods: We prospectively collected data of all patients with a rectal carcinoma within reach of the palpating finger, operated on in our department between December 2000 and January 2005. There were 70 patients (42 men and 28 women, median age 70 (range 32–95)).Results: In 40 patients (40/70 = 57%) a sphincter-saving procedure was performed. Eleven patients were diagnosed with anastomotic leakage or failure. Seven patients had neo-adjuvant radio-chemotherapy, 4 had no neo-adjuvant therapy. In 4 patients signs of anastomotic leakage were seen on the barium-enema that is routinely performed before closing the defunctioning stoma. Seven patients (7/40 = 17,5%) had clinical signs of anastomotic leakage. Three of them could be treated conservatively with antibiotics and parenteral nutrition. Two of these patients did not have a defunc-tioning stoma. Four patients needed re-intervention and were treated in intensive care for several days. Three of these patients did not have a defunctioning stoma.Conclusion: Neo-adjuvant radio-chemotherapy and TME resection are two factors in the treatment of rectal cancer that might interfere with anastomotic healing in the case of a sphincter-saving procedure. The construction of a defunctioning stoma helps in limiting the complications of anastomotic leakage or failure.

Primary Resection and Anastomosis in Obstructed Descending Colon due to Cancer

Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.