Risk Factors for Anastomotic Leakage After Left-Sided Colorectal Resection With Rectal Anastomosis

Mäkelä, Jyrki; Kiviniemi, Heikki; Laitinen, S

doi:10.1007/s10350-004-6627-9

Cited by 328 publications

(154 citation statements)

References 37 publications

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“…Preoperative factors include gender, malnutrition (anemia, hypoalbuminemia), weight loss, and cardiovascular disease, while surgeryrelated factors include long operation time, intraoperative blood loss requiring multiple blood transfusions, intraoperative contamination of the operative field, level of the anastomosis, adequate tissue perfusion in anastomosis, tension-free anastomosis, and the surgeon's experience in colorectal surgery. [15,16] The effect of hemoperitoneum, however, has not been searched yet, and our study is the first in this field.…”

Section: Discussionmentioning

confidence: 97%

Effects of hemoperitoneum on wound healing and fibrinolytic activity in colonic anastomosis

Köksal¹,

Uzun²,

Özkan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 97%

Effects of hemoperitoneum on wound healing and fibrinolytic activity in colonic anastomosis

Köksal¹,

Uzun²,

Özkan³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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“…Two major problems are associated with the technique used for laparoscopic Hartmann procedure reversal exist: As a result of the procedure, dense adhesions develop between the rectal stump and other tissues, and the left-side reconstructed colon may be of an inadequate length to reach to the rectal stump (16,17). In the present study, a high-tie ligation was routinely performed, and consequently, the distal rectal stump was transected at the level of the peritoneal reflection following consideration of the blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, a high-tie ligation was routinely performed, and consequently, the distal rectal stump was transected at the level of the peritoneal reflection following consideration of the blood supply. Previous studies have reported that the length of the distal rectal stump is associated with postoperative complications, and that a short distal rectal stump contributes to a longer duration of surgery and increased postoperative complications (16,17). Although the distal rectal stump may be marked with non-absorbable sutures during the initial surgery, it may be difficult to identify the rectal stump due to the development of dense adhesions with the bladder or vagina, in males and females, respectively (18).…”

Section: Discussionmentioning

confidence: 99%

Second-look surgery following Hartmann's procedure for obstructive left-sided colorectal cancer

et al. 2016

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Abstract. The aim of the present study was to investigate the short-and long-term outcomes of patients undergoing second-look surgery following Hartmann's procedure for obstructive left-sided colorectal cancer (LSCC). All patients included in the present study had undergone radical surgery with Hartmann's procedure for obstructive LSCC. Adjuvant chemotherapy was recommended for all patients, and patients with no signs of recurrence following six months of surveillance were planned to undergo second-look surgery. The aim of second-look surgery was early detection of local recurrence and determination of the efficacy of laparoscopic Hartmann procedure reversal. A total of 15 patients with locally advanced colorectal cancer were included in the study. Three patients exhibited peritoneal dissemination at the time of laparoscopic Hartmann procedure reversal and underwent partial peritonectomy. Following adjuvant chemotherapy treatment, laparoscopic Hartmann procedure reversal was performed in all patients. However, two patients underwent colo-anal anastomosis, and two patients underwent right-sided colon or ileum reconstruction. Regarding the oncological outcomes, two of three patients in whom peritoneal dissemination was identified during laparoscopic Hartmann procedure reversal were eventually in remission following the initial surgery and the second-look surgery with partial peritonectomy. Favorable long-term outcomes were observed in 12/15 patients due to no recurrence, which may be due to the surgical techniques used and the timing of the second-look surgery following Hartmann's procedure for the treatment of obstructive LSCC. IntroductionApproximately 15-20% of patients with left-sided colorectal cancer (LSCC) present with symptoms of acute obstruction (1-4). Patients with obstructive LSCC require emergency surgery, and a high rate of surgical complications and poor prognosis have been reported in these cases (5,6). Emergency management of acute left-sided colonic obstruction remains controversial and at present several treatments options exist, including simple colostomy, primary resection with end colostomy (Hartmann's procedure), one-stage resection anastomosis (subtotal or segmental colectomy) with or without intraoperative colonic irrigation and colonic stenting (7). Emergency surgery for acute colonic obstruction carries a significant risk of mortality and morbidity: The 30-day postoperative mortality rate is 7.6%, with anastomotic dehiscence occurring in 4.9% of cases (2). Thus, 46% of patients require stoma treatment that is permanent (2). To reduce the risk of complications, laparoscopic Hartmann procedure reversal is commonly used for LSCC, since it is considered to reduce the morbidity caused by anastomotic dehiscence (8). However, re-establishing intestinal continuity during laparoscopic Hartmann procedure reversal for LSCC remains a major problem and it carries a serious risk of significant morbidity, with reported anastomotic leak rates of 4-16% and a mortality rate of up to 10% (9,10). Stoma clos...

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“…In conditions where there is significant serious local sepsis such as perforated diverticulum, perforated colorectal cancer or colorectal trauma it is preferable to defer primary anastomosis. [10][11][12] Healing of anastomosis in a septic environment is extremely inadequate and is associated with a high incidence of anastomotic dehiscence. Such cases necessitate proximal diversion in the form of Hartman's procedure.…”

Section: Local Sepsismentioning

confidence: 99%

Anastomotic dehiscence after colorectal surgery

et al. 2016

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Risk Factors for Anastomotic Leakage After Left-Sided Colorectal Resection With Rectal Anastomosis

Cited by 328 publications

References 37 publications

Effects of hemoperitoneum on wound healing and fibrinolytic activity in colonic anastomosis

Effects of hemoperitoneum on wound healing and fibrinolytic activity in colonic anastomosis

Second-look surgery following Hartmann's procedure for obstructive left-sided colorectal cancer

Anastomotic dehiscence after colorectal surgery

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