Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch–anal anastomosis

Bartels, Sanne A L; Gardenbroek, Tjibbe J.; Aarts, Mieke J.; Ponsioen, Cyriel Y.; Tanis, Pieter J.; Buskens, Christianne J.; Bemelman, Willem A.

doi:10.1002/bjs.9701

Cited by 64 publications

(29 citation statements)

References 17 publications

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“…Total mesorectal excision has been compared with close rectal dissection in ulcerative colitis, and fewer postoperative complications occurred in patients treated by the latter technique . Restorative proctcolectomy with total mesorectal excision was compared with close rectal dissection in a randomized trial and showed advantages for close dissection, including fewer diverting ileostomies, fewer major complications and a better quality of life . The mesorectum contains autonomic nerve fibres that innervate the bladder .…”

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive rectal resection for deep endometriosis: a promising technique

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive rectal resection for deep endometriosis: a promising technique

et al. 2017

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“…Consistent with previous reports, there was a greater percentage of males in the leak group compared to the no leak group (54.8% v. 68.2%), which lead to a significantly increased rate of post-operative anastomotic leaks in the male versus female population (8.0% v. 4.9%, p<0.001) [5,10,13]. Although some of the articles included in this review have reported older age to be associated with a greater risk of anastomotic leaks [26,30], there was no difference between the mean age of patients with a leak and patients without a leak in this sample, consistent with other reports [10,12]. There was a trend towards a higher rate of anastomotic leaks in patients who smoked compared to those who did not (8.9% v. 6.7%), but this comparison did not reach statistical significance in our sample.…”

Section: Discussionmentioning

confidence: 89%

Estimated Rate of Post-Operative Anastomotic Leak Following Colorectal Resection Surgery: A Systematic Review

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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Purpose: Anastomotic leak following colorectal resection surgery is associated with short and long-term negative patient outcomes, prolonged hospitalization, and increased healthcare costs. Various patient related and surgical factors are known to contribute to the development of postoperative anastomotic leaks. This study systematically reviewed the literature to assess the incidence of post-operative leak and identify patient factors associated with the development of leaks. Methods:Articles published from 1/1/2003 -8/8/2015 reporting on post-operative anastomotic leak following colorectal resection surgery were identified in the Medline and Embase databases. The rate of post-operative leak, as well as patient and surgical characteristics, were extracted.Results: Forty-three articles met study inclusion criteria. Within the 14,102 cases, 867 patients experienced anastomotic leak, yielding an average leak rate of 6.1%. Patients were primarily male (57.0%) and had a mean age of 60.2 years. The majority of patients received a stapled anastomosis (70.9%), and most resection surgeries were performed for a diagnosis of cancer (80.7%). Comparison of patient characteristics with and without a post-operative leak revealed male gender, diabetes, open surgical procedures, and sutured anastomoses to be risk factors of anastomotic leak. Patients with anastomotic leak had a longer length of stay in the hospital and higher mortality rate than patients without a leak. Conclusions:Anastomotic leak remains a major concern in colorectal resection surgery and occurs in approximately 6.1% of cases. Both patient and surgical factors are associated with the development of post-operative anastomotic leak, which is linked to negative patient outcomes and increased mortality.

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“…With regard to this, the measurement of mesenteric peripouch fat area may be more representative that that of total peripouch fat area. Recently published data showed that TME carried a higher risk of postoperative complications than CRD . On the other hand, patients with TME had a lower risk of pouchitis (42.7% vs 51.3%) .…”

Section: Discussionmentioning

confidence: 98%

“…Peripouch fat area partially originates from the remnant mesorectum after rectal dissection in proctocolectomy, which largely depends on the method of dissection. Both total mesorectal excision (TME) and close rectal dissection (CRD) are methods used for performing proctectomy . Almost all of the mesorectal fat is removed in TME, while most of the mesorectal fat is left in situ after CRD.…”

Section: Discussionmentioning

confidence: 99%

Difference in the frequency of pouchitis between ulcerative colitis and familial adenomatous polyposis: is the explanation in peripouch fat?

Xian

Khan

et al. 2019

Colorectal Disease

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Aim Patients with ulcerative colitis (UC) have an unexplained higher incidence of pouchitis and a greater amount of peripouch fat compared with patients with familial adenomatous polyposis (FAP). The aims of this study were to compare the peripouch fat areas between patients with UC and patients with FAP, and to explore relationship between peripouch fat and pouchitis or chronic antibiotic-refractory pouchitis (CARP). ConclusionOur study demonstrates that patients with UC have more peripouch fat than those with FAP, which may explain the difference in the frequency of pouchitis and CARP between these groups of patients.What does this paper add to the literature? Pouchitis occurs frequently in patients with ulcerative colitis, but seldom in patients with familial adenomatous polyposis. We describe a new method for measuring peripouch fat using CT images and found that peripouch fat was likely to be the determining factor in pouchitis. It suggests that we can use peripouch fat to predict pouchitis.

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Short-term morbidity and quality of life from a randomized clinical trial of close rectal dissection and total mesorectal excision in ileal pouch–anal anastomosis

Abstract: CRD led to a lower severe complication rate and better short-term QoL than wide TME.

Cited by 64 publications

References 17 publications

Transanal minimally invasive rectal resection for deep endometriosis: a promising technique

Transanal minimally invasive rectal resection for deep endometriosis: a promising technique

Estimated Rate of Post-Operative Anastomotic Leak Following Colorectal Resection Surgery: A Systematic Review

Difference in the frequency of pouchitis between ulcerative colitis and familial adenomatous polyposis: is the explanation in peripouch fat?

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