Leakage In Rectal Surgery Research Articles

Prevention of anastomotic leakage using a polyglycolic acid sheet in double-stapling technique anastomosis for rectal surgery

BackgroundDue to the development of surgical techniques and devices, the incidence of anastomosis leakage in rectal surgery has decreased. However, anastomotic leakage in rectal surgery remains a serious postoperative complication. The present study examined whether or not a polyglycolic acid (PGA) sheet is effective for reinforcing rectal anastomosis. Material and methodsFifteen patients who underwent double-stapling technique (DST) anastomosis during rectal surgery were enrolled in this study. The PGA sheet was used as the reinforcing material. DST anastomosis was performed with the PGA sheet sandwiched, and a strip of the PGA sheet was wrapped around the anastomosis. ResultsNo patients had anastomotic leakage. ConclusionA PGA sheet may be effective for preventing anastomotic leakage in DST anastomosis for rectal surgery.

Feasibility of endoscopic hand suturing on rectal anastomoses in ex vivo porcine models

Prevention of postoperative anastomotic leakage in rectal surgery is still required. This study investigated the feasibility of endoscopic hand suturing (EHS) on rectal anastomosis ex vivo. By using isolated porcine colon, we prepared ten anastomoses 6–10 cm from the virtual anus. Then, we sutured anastomoses intraluminally by EHS, which involved a continuous suturing method in 5 cases and a nodule suturing method with extra corporeal ligation in 5 cases. Completeness of suturing, number of stitches, procedure time and presence of stenosis were investigated. Furthermore, the degree of stenosis was compared between the two suturing methods. In all cases, EHS were successfully completed. The median number of stitches and procedure time was 8 and 5.8 min, respectively. Stenosis was created in all continuous suturing cases whereas none was seen in nodule suturing cases. The shortening rate was significantly greater in the continuous suturing method than in the nodule suturing method. Intraluminal reinforcement of rectal anastomosis by EHS using nodule suturing with extra corporeal ligation is feasible without stenosis, which may be helpful as a countermeasure against possible postoperative anastomotic leakage in rectal surgery.

Procalcitonin: the ideal predictor of anastomotic leakage. But, when?

Background: Rectal cancer ranks 3rd among the most common malignancies in both sexes. Abdominal infections that can be seen after rectal cancer surgery are the most feared postoperative complications, as they can also be the harbinger of anastomotic leakage. According to its localization, the rate of anastomotic leak varies between 4% and 29.5%. Procalcitonin (PCT) is an increasing parameter in bacterial infections and sepsis. Therefore, it is used to monitor the infection and the effectiveness of the treatment. Our study we aimed to evaluate the effect of PCT on early diagnosis of anastomotic leakage in rectal surgery and the correlation between PCT and CRP and WBC levels.Methods: File records of 50 patients who were operated on for rectal cancer and had anastomosis between 2016 and 2019 were retrospectively analyzed. Demographic features, operation information, preoperative and postoperative clinical features of the patients were recorded. The WBC, CRP and procalcitonin values of the patients were measured on the preoperative and postoperative 1st and 5th days. Patients were divided into two groups as PC values<2 ng/ml and ≥2 ng/ml. Patients with surgical site infections were found. The relationship between hospital stay and PCT levels and those with surgical incision site infection and those with intra-abdominal infection was examined. The correlation between PCT values and CRP and WBC values of the patients was evaluated.Results: There was no significant difference in PCT values in infections at the surgical incision site. However, it was observed that the PCT values of patients with surgical infection in the abdomen were significantly higher than those without (p=0.005). It was observed that the PCT level was high and the duration of hospital stay was observed to be prolonged in patients with infections in the surgical incision area and in the abdomen.Conclusions: PCT can be used as a biochemical parameter in terms of abdominal infection and anastomotic leaks. It is recommended to be checked especially on the fifth postoperative day and to investigate for anastomotic leakage if it is seen to reach the highest value.

Anastomotic Leakage in Rectal Surgery: Role of the Ghost Ileostomy.

A protective ileostomy performed during anterior resection in rectal surgery is considered a good practice to prevent anastomotic leakage. A derivative ostomy seems to be able to minimize the clinical consequences of an anastomotic leakage, but not to prevent it. The present study examined the role of the ghost ileostomy in anastomotic leakage following rectal surgery. This study included 82 patients that had undergone anterior rectal resection. A total of 32 patients underwent ghost ileostomy (GH) and 50 patients underwent ileostomy (IL). The incidence of anastomotic leakage was equal to 7.32%, occurring in 3 patients of the IL group (6%) and in 3 patients of the GH group (9.38%), in which the ghost was converted into derivative ileostomy. Therefore, 47 patients with IL (94%) underwent useless ileostomy implementation, and 29 patients (90.62%) with GH avoided ileostomy. In this study no increase in morbidity and mortality rate was observed. Therefore, ghost ileostomy proved to be as safe as ileostomy in terms of outcome, morbidity and mortality.

Analysis of anastomotic leakage after rectal surgery: A case-control study.

BackgroundThe incidence of anastomotic leakage in rectal surgery is around 10 percent. Poor blood supply to the anastomosis, high anastomotic pressure and tension, increased operative blood loss, long operative time, and male sex are risk factors of anastomotic leakage. In the present study, we examined anastomotic leakage cases in rectal surgery at our institute and tried to ascertain the risk factors.MethodsThree hundred fifty-seven consecutive patients who underwent rectal resection with anastomosis between January 2008 and October 2013 were included in the study. Patients were divided into two groups according to the existence of anastomotic leakage. Clinicopathological features, operative procedures, and intraoperative outcomes were compared between the two groups. Regarding intraoperative procedure, we focused on the ligation level of the inferior mesenteric artery, installing a transanal drainage tube in the rectum, and constructing a diverting stoma.ResultsAnastomotic leakage occurred in eight patients. All of them were male (p = 0.0284). There were no statistical differences in other characteristics of the patients or tumors, in operative procedures, or in intraoperative outcomes.ConclusionsIn the present study, no statistically significant risk factors for anastomotic leakage in rectal surgery were detected, except for male sex. However, the rate of anastomotic leakage at our institute was revealed to be rather low. Our exertion to preserve good blood flow and to prevent high tension and pressure on the anastomosis in operation may have led to this result.

Risk factors for, and management of anastomotic leakage in rectal surgery

Anastomotic leakage is one of the most serious early complications of any rectal anastomosis. Proximal defunctioning mitigates the consequences of leakage but does not abolish the risk. The lower the anastomosis the higher the risks of leakage. There is evidence that a short colon pouch reduces the risks of leakage. A high index of suspicion is required to detect the early non‐specific signs of anastomotic leakage. Urgent surgical intervention is usually required to avert a life threatening situation. Reports of the demise of temporary defunctioning of the low anastomosis are premature, and judicious use of faecal diversion should never be regarded as surgical temerity.

Risk factors for, and management of anastomotic leakage in rectal surgery.

Anastomotic leakage is one of the most serious early complications of any rectal anastomosis. Proximal defunctioning mitigates the consequences of leakage but does not abolish the risk. The lower the anastomosis the higher the risks of leakage. There is evidence that a short colon pouch reduces the risks of leakage. A high index of suspicion is required to detect the early non-specific signs of anastomotic leakage. Urgent surgical intervention is usually required to avert a life threatening situation. Reports of the demise of temporary defunctioning of the low anastomosis are premature, and judicious use of faecal diversion should never be regarded as surgical temerity.