Colorectal Anastomotic Stenosis: Lessons Learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis

Bertocchi, Elisa; Barugola, Giuliano; Benini, M.C.; Buracco, Paolo; Rossini, Roberto; Ceccaroni, Marcello; Ruffo, Giacomo

doi:10.1016/j.jmig.2018.03.033

Cited by 31 publications

(17 citation statements)

References 30 publications

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“…There was one partial shrinkage of the intestinal diameter at the site of the anastomosis in one animal from the Control group (12.5%), therefore we assume the material does not cause formation of anastomotic strictures. Those can however develop in longer time periods and thus a longer observation time would be needed to verify this information [37].…”

Section: Discussionmentioning

confidence: 99%

Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig

et al. 2021

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Anastomotic leakage is a dreadful complication in colorectal surgery. It has a negative impact on postoperative mortality, long term life quality and oncological results. Nanofibrous polycaprolactone materials have shown pro-healing properties in various applications before. Our team developed several versions of these for healing support of colorectal anastomoses with promising results in previous years. In this study, we developed highly porous biocompatible polycaprolactone nanofibrous patches. We constructed a defective anastomosis on the large intestine of 16 pigs, covered the anastomoses with the patch in 8 animals (Experimental group) and left the rest uncovered (Control group). After 21 days of observation we evaluated postoperative changes, signs of leakage and other complications. The samples were assessed histologically according to standardized protocols. The material was easy to work with. All animals survived with no major complication. There were no differences in intestinal wall integrity between the groups and there were no signs of anastomotic leakage in any animal. The levels of collagen were significantly higher in the Experimental group, which we consider to be an indirect sign of higher mechanical strength. The material shall be further perfected in the future and possibly combined with active molecules to specifically influence the healing process.

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Section: Discussionmentioning

confidence: 99%

Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig

et al. 2021

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“…The most common definition of a stricture is a narrowing of an anastomosis that does not allow passage of either a 12-mm colonoscope or a rigid proctoscope [131][132][133]. Using this definition, the incidence is likely less than 10% [128,134,135]. Many of these patients will develop obstructive symptoms, which can include constipation, cramping, and a decreased caliber of stool [135].…”

Section: Anastomotic Stricturementioning

confidence: 99%

“…Using this definition, the incidence is likely less than 10% [128,134,135]. Many of these patients will develop obstructive symptoms, which can include constipation, cramping, and a decreased caliber of stool [135]. In extreme cases patients may experience overflow diarrhea and incontinence as solid stool cannot pass the stricture.…”

Section: Anastomotic Stricturementioning

confidence: 99%

“…In extreme cases patients may experience overflow diarrhea and incontinence as solid stool cannot pass the stricture. The diagnosis is usually made several months following the initial resection but usually within 12 months if not associated with recurrent disease [134][135][136]. In addition to impacting patient function, a stric-ture that cannot be traversed limits the ability to completely evaluate the stricture and to monitor the proximal colon.…”

Section: Anastomotic Stricturementioning

confidence: 99%

“…This can be the result of ischemia, infection, anastomotic leak, radiation and/or recurrent disease [131,133]. Proximal diversion has also been shown to be a risk factor for a low pelvic anastomosis since no stool is passing through to dilate the anastomosis regularly [135]. In a Cochrane review left-sided end-to-end stapled anastomoses had a higher stricture rate than handsewn anastomoses (8% vs 2%) [128].…”

Section: Anastomotic Stricturementioning

confidence: 99%

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Anastomotic Complications

Friel

Kin

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Mechanical bowel prep and oral antibiotics prior to colon resection are associated with a lower risk of anastomotic leak.• A significant proportion of anastomotic leaks present after the immediate postoperative period, especially if there is a history of pelvic radiation. • Most early anastomotic bleeds are self-limited; late bleeds may be a sign of anastomotic leak. • Anastomotic stricture after cancer resection should undergo endoscopic biopsy and imaging to rule out recurrent cancer. • Benign anastomotic strictures may be amenable to endoscopic management, but some will require surgical revision or completion proctectomy with permanent colostomy if the strictured anastomosis is in the pelvis. • Anastomotic complications often lead to significant detriments to quality of life with regard to pain, defecatory function, sexual function, and urinary function. Discussion of these issues with patients is critical for surgical decision-making. Anastomotic LeakThe unfortunate reality faced by every surgeon who performs bowel resections is the occurrence of anastomotic leaks. The incidence of anastomotic leak after bowel anastomosis ranges from 2% to 21% and is associated with significant risk of short-and long-term morbidity [1][2][3][4][5]. This complication can be a devastating event that sets off a cascade of other unfortunate events, resulting in significant det-riments to quality of life, increased pain, prolonged disability, and sometimes death. Anastomotic leaks are associated with significantly higher healthcare resource utilization and cost, as patients with this complication are more likely to require additional diagnostic tests, procedures or reoperations, hospital days, outpatient care, and readmissions [6,7]. Perhaps the most frustrating aspect of anastomotic leaks in colorectal surgery is the fact that leaks and their severe consequences still occur despite the adoption of evidence-based perioperative guidelines, efforts to optimize patient risk factors, and adherence to surgical principles. Although important progress has been made toward reducing the risk of anastomotic leak, there is still much work to be done to increase our understanding of the pathophysiology of anastomotic leak, and effective strategies for prevention.

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The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

Behboudi,

Ahmadi‐Tafti,

Hosseini

et al. 2023

Health Science Reports

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IntroductionColorectal cancer (CRC) surgery complications are a major issue affecting morbidity and mortality rates. Anastomotic stricture, which occurs in almost 30% of patients after surgery for rectal cancer, is one of the most serious but underreported side effects. In this study, we tried to assess the effect of stapler size on anastomotic stricture rate.Materials and MethodsAt our facility, all patients underwent low anterior resections (LAR) performed using an open laparotomy technique. A contour‐curved stapler and an end‐to‐end anastomosis (EEA) circular stapler were used in the double stapling technique (DST). All patients also underwent a protective loop ileostomy. Patients who developed stricture following leakage were excluded.ResultsThis study comprised a total of 173 rectal cancer patients. A 29‐mm circle stapler was used to anastomose 77 patients (44.5%), while a 31‐mm circular stapler was used to anastomose 96 patients (55.5%). Six individuals experienced strictures; two had a 29 mm stamper and four (4.4%) had a 31 mm one. There was no significant difference between the two groups (p:0.575). On aggregate, 8 patients experienced leakage; 3 (3.8%) of these patients received treatment with a 29 mm stapler, whereas 5 (5.2%) received treatment with a 31 mm stapler.Conclusionthis study found no statistically significant difference in the stricture rates and stapler size. The findings of this study provide credibility to the notion that in rectal cancer patients having LAR, strictures can be safely avoided by performing the anastomoses with both staplers.

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Colorectal Anastomotic Stenosis: Lessons Learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis

Abstract: The anastomotic stricture is a recognized complication in patients following intestinal resection for DIE, and protective ileostomy is the sole modifiable factor related to anastomotic stenosis. Endoscopic dilatation is a valid option to treat this complication.

Cited by 31 publications

References 30 publications

Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig

Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig

Anastomotic Complications

The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

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