ObjectivesAssessing bowel perfusion with indocyanine green fluorescence angiography (ICG-FA) shows positive effects on anastomotic healing in colorectal surgery.MethodsA retrospective evaluation of 296 colorectal resections where we performed ICG-FA was undertaken from January 2014 until December 2018. Perfusion of the bowel ends measured with ICG-FA was compared to the visual assessment before and after performing the anastomosis. According to the observations, the operative strategy was confirmed or changed. Sixty-seven low anterior rectal resections (LARs) and 76 right hemicolectomies were evaluated statistically, as ICG-FA was logistically not available for every patient in our service and thus a control group for comparison resulted.ResultsThe operative strategy based on the ICG-FA results was changed in 48 patients (16.2%), from which only one developed an anastomotic leakage (AL) (2.1%). The overall AL rate was calculated as 5.4%. Within the 67 patients with LAR, the strategy was changed in 11 patients (16.4%). No leakage was seen in those. In total three AL happened (4.5%), which was three times lower than the AL rate of 13.6% in the control group but statistically not significant. From the 76 right hemicolectomies a strategy change was undertaken in 10 patients (13.2%), from which only one developed an AL. This was the only AL reported in the whole group (1.3%), which was six times lower than the leakage rate of the control group (8.1%). This difference was statistically significant (p=0.032).ConclusionsBased on the positive impact by ICG-FA on the AL rate, we established the ICG-FA into our clinical routine. Although randomized studies are still missing, ICG-FA can raise patient safety, with only about 10 min longer operating time and almost no additional risk for the patients.

Zusammenfassung Hintergrund Eine perioperative Hypothermie kann die Ursache vieler schwerwiegender Komplikationen, insbesondere Wundinfektionen, darstellen. Diese Arbeit untersucht den Einfluss einer lokalen Insufflation von angewärmtem, angefeuchtetem Kohlendioxid (feucht-warm-CO2) während offener Kolorektalchirurgie auf die Körperkern- und Wundoberflächentemperatur sowie die Rate an Wundheilungsstörungen (WHS). Methode Zwischen 02/2018 und 07/2019 wurden 50 Patienten zur offenen Resektion bei Kolon- oder Rektumkarzinom rekrutiert und in eine Kontroll- (n = 25) sowie in eine Experimentalgruppe (n = 25) randomisiert. In der Experimentalgruppe wurde eine Vorrichtung zur Insufflation von feucht-warm-CO2 in die Operationswunde verwendet. Erfasst wurden die Körperkern- sowie die Wundoberflächentemperatur. Das Serum-IL-6 wurde im Verlauf sequenziell bestimmt. Die klinische Beobachtung der Wundheilung reichte bis zum 30. postoperativen Tag. Ergebnisse In der Kontrollgruppe lag die Körperkerntemperatur im Median (1. Quartil/3. Quartil) zu Beginn des Eingriffs bei 36,2 °C (36/36,4 °C) und am OP-Ende bei 36,2 °C (35,9/36,45 °C), während sie in der Experimentalgruppe initial bei 36,2 °C (35,7/36,4 °C) und am OP-Ende bei 36,4 °C (36/36,7 °C) lag. Hier ergab sich kein statistisch signifikanter Unterschied (p = 0,08). Die mittlere Wundoberflächentemperatur sank in der Kontrollgruppe von 32,8 °C (Median; 31,85/34,05 °C) auf 30,7 °C (Median; 29,85/32,15 °C) ab. In der Experimentalgruppe war ein Rückgang von 31,9 °C (Median; 30,25/32,95 °C) auf 31,6 °C (Median; 30,25/31,85 °C) zu verzeichnen. Dies bedeutet einen statistisch signifikanten Unterschied (p = 0,000475). Die Dynamik des Serum-IL-6 ergab keinen signifikanten Unterschied (p = 0,66; p = 0,88; p = 0,88). In der Kontrollgruppe traten bei 8 Patienten eine oberflächliche WHS sowie 2 Anastomoseninsuffizienzen (AI) auf, während in der Experimentalgruppe 5-mal eine WHS sowie eine AI beobachtet wurde. Die Unterschiede waren für alle WHS nicht signifikant (p = 0,42). Schlussfolgerung Die bereits etablierten Maßnahmen zur Vorbeugung der perioperativen Hypothermie bei elektiven Eingriffen können als ausreichend erachtet werden. Die lokale Wundoberflächentemperatur bleibt dabei allerdings unbeeinflusst. Die Verwendung von intraoperativer Gasinsufflation mit feucht-warm-CO2 kann zur Aufrechterhaltung der lokalen Normothermie beitragen. Größere Studien sollten die Frage nach einer signifikanten Wirkung dieses Verfahrens auf die postoperative Wundheilung beantworten.

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Objectives Pelvic floor disorders are frequently caused by an organ prolapse involving multiple pelvic floor compartments. In such cases, a multidisciplinary strategy for diagnostic work-up and therapy is required. Methods All patients who underwent transabdominal rectopexy/resection rectopexy alone or in combination with simultaneous gynecological pelvic floor reconstruction at our institution between 01/2006 and 12/2021 were included in this retrospective study. The study aimed to evaluate the functional outcome and postoperative complications. Results Two hundred and eighty seven patients were assigned to one of the following groups: PG1 – patient group one: after resection rectopexy (n=141); PG2 – after ventral rectopexy (n=8); PG3 – after combined resection rectopexy and sacro (cervico)colpopexy (n=62); PG4 – after combined resection rectopexy and trans-vaginal pelvic floor repair (n=76). The duration of follow-up was 14 months for PG1 (median, IQR 37 months), 11 months for PG2 (mean, SD 9 months), 7 months for PG 3 (median, IQR 33 months), and 12 months for PG 4 (median, IQR 51 Months). The surgical procedure resulted in improvement of symptoms related to obstructed defecation in 56.4 % (22/39) of the patients in PG1, 25 % in PG2 (1/4), 62.5 % (20/32) in PG3, and 71.8 % (28/39) in PG4. “De novo” constipation was reported by 2.4 % (2/141) of patients from PG1. Improvement in fecal incontinence symptoms was reported by 69 % (40/58) of patients in PG1, 100 % in PG2 (2/2), 93.1 % (27/29) in PG3, and 87.2 % (34/39) in PG4. The recurrence rate for external rectal prolapse was 7.1 % in PG1, 50 % in PG2 (1/2), 2.7 % in PG3, and 6.3 % in PG4. A significant difference in terms of severe morbidity (grade ≥ IIIb) and mortality could not be determined between the non-interdisciplinary (PG1 with PG2) and interdisciplinary surgery (PG3 with PG4) (p=0.88, p=0.499). Conclusions Based on our results, we can assume that combined surgery is as feasible as rectal surgery alone. In our study, combined interventions were effective and not associated with an increased risk of postoperative complications.