Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure

Räsänen, Minna; Renkonen–Sinisalo, Laura; Carpelan-Holmström, Monika; Lepistö, Anna

doi:10.1007/s00384-015-2291-x

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…The tailored surgery in deep infiltrated bowel endometriosis is strongly recommended by most specialists experienced in surgery conducted in endometriosis [14,15]. Some centers recommend and perform protective stoma for all low rectum resections [16,17], while others recommend them for patients who have other intraoperative risk factors for leakage [18]. In our group, protective stoma was performed only in a few very complex cases and one case of a very low resection that led to the rate of 2.9% in the entire segmental bowel resection group (138 patients).…”

Section: Discussionmentioning

confidence: 99%

Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?

et al. 2022

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Objectives: To evaluate the novel modified laparoscopic technique of the bowel resection for deep infiltrated endometriosis (DIE) of the bowel versus the classical technique of bowel segmental resection in terms of anastomosis leakage. Material and methods: Patients (n = 138) treated with segmental bowel resections due to DIE were included; 30 patients had the classic, while 108 patients had the modified laparoscopic bowel segmental resection with indocyanine green vascular visualization and fibrin sealant use. Results:The modified technique was used more often in complex operations (65.7% vs 46.6%). More anastomotic leakages occurred in patients undergoing the classic technique than the modified technique (10% vs 2.8%; p = 0.117). No leakage in modified versus 12% in classic technique was observed in simple segmental bowel resections (p = 0.05); 2.5% of cases with leakage in modified versus 7.1% in classic technique were observed in bowel resections with hysterectomy. In complex cases operated with the modified technique, the frequency of anastomotic leakage was 4.2%, which were even less than leakage in simple cases in classic technique group (10%). Although the low location of the lesions increases the risk of leakage, the modified technique was associated with a small percentage of leakages (25% vs 6.3%). The laparotomy conversion rate was similar in both groups (3.4% for classic and 2.7% for modified). Conclusions:In DIE, the modified technique of segmental bowel resection showed superiority over the classic technique in terms of the risk of anastomotic leakage. This risk was lower regardless of the complexity of the surgery and lesion location.

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Section: Discussionmentioning

confidence: 99%

Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?

et al. 2022

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“…The dramatic results and the unaffordable high rate of anastomotic leak, especially for rectal operations, have directed colorectal institutions to adopt and recommend different techniques to limit the consequences of anastomotic leak, including diverting defunctioning loop ileostomies for single low anterior resections, 29,30 trans-anal drainage tubes, trans-anal sponge and other systems of drainage. 31,32 Even if it has been recognised, the fact that the diverting stomas limit the sequels of the anastomotic leak rather its occurrence, a Swedish trial concluded to a reduction of the rate of anastomotic leakage from 28% to 10.3% in patients randomised to a stoma. 29 Recent clinical and experimental studies confirm the presence of new molecular targets and biomarkers in the field of diabetic wound healing.…”

Section: Conclusion and Implications For Future Researchmentioning

confidence: 99%

The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Stergios

Kontzoglou

Pergialiotis

et al. 2017

annals

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Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966-2016) and Scopus (2004-2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.

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“…Consequently, the number of cases requiring diverting stoma (DS) creation has increased. A consensus was reached regarding DS construction during rectal cancer surgery to prevent severe peritonitis related to anastomotic leakage [2][3][4][5]. Anastomotic leakage significantly reduces patients' quality of life (QOL); therefore, the prevention of anastomotic leakagerelated severe peritonitis is crucial.…”

Section: Introductionmentioning

confidence: 99%

Benefits and risks of diverting stoma creation during rectal cancer surgery

et al. 2024

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Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (-) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (-) group (P < 0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (-) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion: Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

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Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure

Abstract: Our standardized surgical regimen with a covering stoma in low anterior resection for rectal cancer resulted in a minor anastomosis failure rate and a low risk of permanent stoma.

Cited by 10 publications

References 30 publications

Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?

Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?

The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Benefits and risks of diverting stoma creation during rectal cancer surgery

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