External Coloanal Anastomosis Without Covering Stoma in Low-Lying Rectal Cancer

Mohamed, Ashraf A; Abdel-Fatah, Abdel-Fatah Saleh; Mahran, Khaled; Mohie-ElDin, Abo-Bakr Mohamed

doi:10.1007/s12262-010-0179-0

Cited by 4 publications

(5 citation statements)

References 34 publications

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“…Those cases were also presented locally with pelvic abscess without developing peritonitis. 11 At the end of their study, they concluded that using a covering stoma with CAA does not decrease the rate of anastomotic leakage. However, we believe that if a covering stoma does not prevent complications of leakage, it minimizes their severity, moreover, radiological leaks that would be discovered prior to closure of ileostomy, could be managed conservatively and most of them will close spontaneously if stoma closure was delayed for few weeks.…”

Section: Discussionmentioning

confidence: 97%

“…16 We also reported four patients (19%) that developed mild to moderate degree of incontinence, however, frequent defecation was reported in around 30% of patients included in other studies. 11,17,18 This was explained by reducing the capacity of the rectal reservoir which was then increased with time due to progressive distention of the distal colon.…”

Section: Discussionmentioning

confidence: 99%

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Coloanal Anastomosis: A Helpful Technique in Difficult Situations

Nada

El-Abbassy

2017

Ain Shams Journal of Surgery

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Coloanal anastomosis (CAA) is used to preserve anal defecation after proctectomy. It is a savior technique when there are difficulties while performing low rectal anastomosis.The aim of the study: was to highlight some of the indications, technique and the outcomes of CAA to raise the awareness of the young generations to use it when needed. Patients and methods:This was a retrospective study that included 21 patients that had proctectomy and hand-sewn CAA with covering loop ileostomy. Full history, preoperative examination, operative details, and the follow-up notes were collected from our sheets. All patients were operated on by the same team of surgeons using the same technique. Closure of ileostomy was performed two to six months after the primary procedure.Results: Out of the 21 patients, eight (38%) had benign lesions, whereas 13 (61.9%) had low rectal tumors. Pelvic abscess and complete dehiscence of the anastomosis, burst abdomen, and dehydrarion and renal impairment each occurred in one patient (4.76%). Three patients (14.3%) developed anastomotic stenosis and four (19%) developed mild to moderate incontinence. Two patients developed radiological leak (9.5%) that was observed via thin enema study after the 6 th postoperative week and disappeared after the 12 th week. All patients had a good quality of life after reversal of the stoma. Conclusion:There is a time intra-operatively that a colorectal surgeon has to accept that stapled anastomosis is not feasible and should change to hand-sewn CAA as it could be the safest solution for many intra-operative anastomotic problems.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Coloanal Anastomosis: A Helpful Technique in Difficult Situations

Nada

El-Abbassy

2017

Ain Shams Journal of Surgery

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“…With the purpose of optimizing partial or complete rectal resection, the surgical method of rectal stump eversion can be used, 8–10 which affords the surgeon a direct view of the rectal mucosa and anal canal, allowing safe margins for resection of tumors along the pectinate line that would not be easily resected by abdominal approach. This technique also enables lowering the colon by means of perineal anastomosis without sectioning or manipulating the colon inside the abdomen.…”

Section: Introductionmentioning

confidence: 99%

Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis

Roriz-Silva

Andrade

Ivankovics

2014

International Journal of Surgery Case Reports

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INTRODUCTIONColorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required.PRESENTATION OF CASEThe case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14 cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free.DISCUSSIONRemoval of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer.CONCLUSIONEversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.

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“…Th e fi rst operation to allow patients with rectal cancer to avoid permanent stoma was anterior resection performed by Dixon in the 1940s in patients with tumors of the upper third of the rectum [5]. Coloanal anastomosis was proposed for patients with low rectal cancers, allowing sphincter preservation with normal anal continence [5].…”

Section: Introductionmentioning

confidence: 99%

“…Coloanal anastomosis was proposed for patients with low rectal cancers, allowing sphincter preservation with normal anal continence [5]. Th e fi nal decision to perform coloanal anastomosis or abdominoperineal resection was always taken intraoperatively, as assessment of the distance separating the tumor from the sphincter preoperatively is sometimes impossible [5].…”

Section: Introductionmentioning

confidence: 99%

Rectal Cancer - Sphincter Saving Techniques

Russu¹,

Molnar²,

Pantiru³

et al. 2014

Acta Medica Marisiensis

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Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles. Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 -April 2013 and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed. Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior rectosigmoidian resections with low and very low colorectal anastomosis ("very low" Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications. Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and "physiological" alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.

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External Coloanal Anastomosis Without Covering Stoma in Low-Lying Rectal Cancer

Abstract: The aim of this study was to evaluate the safety and functional outcome of external coloanal anastomosis without covering stoma in treating low-lying rectal cancer. All patients undergoing the coloanal anastomosis for low lying rectal carcer in the

Cited by 4 publications

References 34 publications

Coloanal Anastomosis: A Helpful Technique in Difficult Situations

Coloanal Anastomosis: A Helpful Technique in Difficult Situations

Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis

Rectal Cancer - Sphincter Saving Techniques

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