Anastomotic integrity and function: Role of the colonic J-pouch

Wexner, Steven D.; Alabaz, Ömer

doi:10.1002/(sici)1098-2388(199809)15:2<91::aid-ssu6>3.0.co;2-0

Cited by 27 publications

(7 citation statements)

References 91 publications

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“…In the colorectal literature, while some investigators have shown a significant AL risk reduction with protective stomas [17, 45], others have observed no difference in AL when a stoma is utilized [39, 41, 42, 46, 48–54]. In a recent Cochrane systematic review and meta-analysis of colorectal literature, a 67% relative risk reduction of clinically significant AL was observed [55]; however, the authors cautioned that there were methodological drawbacks with their analyses.…”

Section: Discussionmentioning

confidence: 99%

Multiple large bowel resections: Potential risk factor for anastomotic leak

Kalogera¹,

Dowdy²,

Mariani³

et al. 2013

Gynecologic Oncology

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Objectives Identify risk factors of anastomotic leak (AL) after large bowel resection (LBR) for ovarian cancer (OC) and compare outcomes between AL and no AL. Methods All cases of AL after LBR for OC between 01/01/1994-05/20/2011 were identified and matched 1:2 with controls for age (+/−5years), sub-stage (IIIA/IIIB;IIIC;IV), and date of surgery (+/−4years). Patient-specific and intraoperative risk factors, use of protective stomas, and outcomes were abstracted. A stratified conditional logistic regression model was fit to determine the association between each factor and AL. Results 42 AL cases were evaluable and matched with 84 controls. Two-thirds of the AL had stage IIIC disease and >90% of both cases and controls were cytoreduced to <1cm residual disease. No patient-specific risk factors were associated with AL (pre-operative albumin was not available for most patients). Rectosigmoid resection coupled with additional LBR was associated with AL (OR=2.73, 95%CI 1.13–6.59, P=0.025), and protective stomas were associated with decreased risk of AL (0% vs. 10.7%, P=0.024). AL had longer length of stay (P<0.001), were less likely to start chemotherapy (P=0.020), and had longer time to chemotherapy (P=0.007). Cases tended to have higher 90-day mortality (P=0.061) and were more likely to have poorer overall survival (HR=2.05, 95%CI 1.18–3.57, P=0.011). Conclusions Multiple LBRs appear to be associated with increased risk of AL and protective stomas with decreased risk. Since AL after OC cytoreduction significantly delays chemotherapy and negatively impacts survival, surgeons should strongly consider temporary diversion in selected patients (poor nutritional status, multiple LBRs, previous pelvic radiation, very low anterior resection, steroid use).

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Section: Discussionmentioning

confidence: 99%

Multiple large bowel resections: Potential risk factor for anastomotic leak

Kalogera¹,

Dowdy²,

Mariani³

et al. 2013

Gynecologic Oncology

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“…However, functional results a er low and ultra-low resections and anastomosis may indeed be so poor, that this technique also compromises the patient's QoL (Lewis 1995;Ortiz 1996;Wexner 1998). There are reports indicating that the QoL a er AR might even be poorer than a er APE (Camilleri-Brennan 1998;Ortiz 1996;Sprangers 1995).…”

Section: How the Intervention Might Workmentioning

confidence: 99%

Quality of life after rectal resection for cancer, with or without permanent colostomy.

Pachler

Wille‐Jørgensen

2012

Cochrane Database of Systematic Reviews

175

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The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision/Hartmann's operation. The included studies challenges the assumption that anterior resection patients fare better. Larger, better designed and executed prospective studies are needed to answer this question.

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“…Removal of the right colon, which possesses a significant absorbable function, in conjunction with impaired continence mechanisms that may be present in older patients, and multiparous women in particular, led to an increase in the number of bowel movements during the immediate postoperative period and even frank faecal incontinence in more than 5% of cases 1,6 . Postoperative diarrhoea appears more frequently when an ileorectal anastomosis is performed, because the frequency of defaecation is partly related to the length of the remaining rectal stump 7 . The presence of a short rectal stump, along with the changes in resting and perhaps squeeze anal pressures caused by operative damage to the sphincters during the insertion of the circular stapler device, 4 may aggravate postoperative diarrhoea and promote further faecal incontinence.…”

Section: Discussionmentioning

confidence: 99%