Treatment of chronic presacral sinus after low anterior resection

Sloothaak, D.A.M.; Buskens, C; Bemelman, Willem A.; Tanis, Pieter J.

doi:10.1111/codi.12094

Cited by 41 publications

(46 citation statements)

References 18 publications

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“…Twenty‐seven patients with a chronic presacral sinus after LAR for rectal cancer underwent single‐ or multiple‐stage salvage surgery including completion proctectomy, debridement of the sinus and fistula tract(s) if present, and cavity filling using an omentoplasty (Table ). Thirteen of the 27 had been described in our previous report , but four of these had undergone further surgery since the publication because of non‐healing of the sinus. The details of the remaining 19 patients, who were excluded for the present analysis, are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

“…). The initial cohort of 22 patients included up to March 2012 has already been described in a previous study .…”

Section: Methodsmentioning

confidence: 99%

“…Based on our initial experience, we defined basic treatment principles consisting of either constructing a new anastomosis or intersphincteric completion proctectomy end colostomy and filling of the presacral cavity . For the purpose of the present study, the subgroup of patients who underwent single‐ or multiple‐stage salvage surgery including completion proctectomy and omentoplasty was selected from the enlarged cohort of 46 patients with extended follow‐up.…”

Section: Methodsmentioning

confidence: 99%

“…For the purpose of the present study, the subgroup of patients who underwent single‐ or multiple‐stage salvage surgery including completion proctectomy and omentoplasty was selected from the enlarged cohort of 46 patients with extended follow‐up. We further optimized the approach of salvage surgery based on monitoring of our results .…”

Section: Methodsmentioning

confidence: 99%

“…Based on our initial experience with salvage surgery for chronic presacral sinus, basic treatment principles were defined to increase the success rate . As a result an increasing number of patients with a complicated chronic presacral sinus have been referred to our academic hospital.…”

Section: Introductionmentioning

confidence: 99%

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Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer

et al. 2016

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Aim This study aimed to determine the clinical outcome of salvage surgery without restoring continuity for symptomatic chronic presacral sinus after low anterior resection (LAR) for rectal cancer.Method Out of a prospective cohort of 46 patients with chronic presacral sinus (> 1 year after LAR), 27 underwent completion proctectomy with omentoplasty between January 2005 and July 2014.Results The initial treatment for rectal cancer included neoadjuvant radiotherapy in 26 (96%) patients. Besides a chronic presacral sinus, a secondary fistula was present in 15 (56%) patients. Definitive salvage surgery was performed after a median of 40 (12-350) months from the primary resection. The median hospital stay after singleand multiple-stage salvage surgery was 11 and 17 days. Postoperative complications occurred in 44% of patients. The re-intervention rate was 33% with a range of 1-10 interventions per patient. During a median follow-up of 20 (4-45) months from salvage surgery, healing of the chronic presacral sinus occurred in 78% of patients, with a healing rate after single-and multiplestage procedures of 88% and 64% respectively (P = 0.19). ConclusionPatients with a symptomatic chronic presacral sinus after LAR for rectal cancer, in whom restoration of continuity is not intended, can be effectively managed by completion proctectomy with complete debridement of the sinus and fistula tracts followed by an omentoplasty to fill the presacral cavity, preferably as a single-stage procedure.

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Section: Resultsmentioning

confidence: 99%

“…). The initial cohort of 22 patients included up to March 2012 has already been described in a previous study .…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer

et al. 2016

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Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer

et al. 2021

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Preventing anastomotic leakage (AL) is crucial for colorectal surgery. Some studies have suggested a positive role of transanal drainage tubes (TDTs) in AL prevention after low anterior resection, but this finding is controversial.OBJECTIVE To assess the effect of TDTs in AL prevention after laparoscopic low anterior resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical trial with parallel groups (TDT vs non-TDT) was performed from February 26, 2016, to September 30, 2020. Participants included patients from 7 different hospitals in China who were undergoing laparoscopic low anterior resection with the double-stapling technique for mid-low rectal cancer; 576 patients were initially enrolled in this study, and 16 were later excluded. Ultimately, 560 patients were randomly divided between the TDT and non-TDT groups.INTERVENTIONS A silicone tube was inserted through the anus, and the tip of the tube was placed approximately 5 cm above the anastomosis under laparoscopy at the conclusion of surgery. The tube was fixed with a skin suture and connected to a drainage bag. The TDT was scheduled for removal 3 to 7 days after surgery. MAIN OUTCOMES AND MEASURESThe primary end point was the postoperative AL rate within 30 days. RESULTSIn total, 576 patients were initially enrolled in this study; 16 of these patients were excluded. Ultimately, 560 patients were randomly divided between the TDT group (n = 280; median age, 61.5 years [IQR, 54.0-68.8 years]; 177 men [63.2%]) and the non-TDT group (n = 280; median age, 62.0 years [IQR, 52.0-69.0 years]; 169 men [60.4%]). Intention-to-treat analysis showed no significant difference between the TDT and non-TDT groups in AL rates (18 [6.4%] vs 19 [6.8%]; relative risk, 0.947; 95% CI, 0.508-1.766; P = .87) or AL grades (grade B, 14 [5.0%] and grade C, 4 [1.4%] vs grade B, 11 [3.9%] and grade C, 8 [2.9%]; P = .43). In the stratified analysis based on diverting stomas, there was no significant difference in the AL rate between the groups, regardless of whether a diverting stoma was present (without stoma, 12 [5.8%] vs 15 [7.9%], P = .41; and with stoma, 6 [8.3%] vs 4 [4.5%], P = .50). Anal pain was the most common complaint from patients in the TDT group (130 of 280, 46.4%). Accidental early TDT removal occurred in 20 patients (7.1%), and no bleeding or iatrogenic colonic perforations were detected. CONCLUSIONS AND RELEVANCEThe results from this randomized clinical trial indicated that TDTs may not confer any benefit for AL prevention in patients who undergo laparoscopic low anterior resection for mid-low rectal cancer without preoperative radiotherapy.

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Safety of elective colorectal cancer surgery: Non‐surgical complications and colectomies are targets for quality improvement

Henneman

Berge

Snijders

et al. 2013

Journal of Surgical Oncology

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Treatment of chronic presacral sinus after low anterior resection

Abstract: Successful treatment of a chronic presacral sinus after low anterior resection appears to be achieved by salvage surgery with anastomotic reconstruction in highly selected patients or intersphincteric completion proctectomy and omentoplasty.

Cited by 41 publications

References 18 publications

Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer

Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer

Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer

Safety of elective colorectal cancer surgery: Non‐surgical complications and colectomies are targets for quality improvement

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