Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

Abstract

Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

Reducing anastomotic leakage in TaTME by mucosal coverage of staple lines: a pilot study with preliminary results.

“…Recently, it has been hypothesized that AL results from infectious complications caused by local enteric bacteria and that healing at the anastomosis is impaired by a local increase in collagenase activity [6], and Freko A et al reported that anastomotic healing disorders and "restlessness" observed in their analysis of photographic documentation of endoscopic ndings of anastomosis in rectal cancer surgery are associated with local ischemia and local infection, and they reported that the anastomotic healing disorders and restlessness in the anastomotic site are associated with local ischemia and local infection in a study of double-stapled anterior rectal cancer after lower anterior resection of the rectum [1]. The authors reported that the combination of double-staple reinforcement with a unique circular mucosal suture and povidone-iodine-impregnated vacuum sponge drainage resulted in a low rate of early suture failure in patients undergoing reconstruction using the double-stapled technique after low anterior resection of rectal cancer [7].…”

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

“…Endoscopic trans-anorectal closure negative-pressure drainage technology uses flexible endoscopy to check the anastomosis and guide placement of suction sponges. 27 However, because of difficulty in the operation of the flexible mirror as well as poor directionality, intestinal contents easily contaminate the mirror surface, causing poor visualization. In addition, during colonoscopy, gas needs to be injected to expand the bowel, and the pressure is not easy to control.…”