Pull-Through in Patients after Pelvic Anastomosis Leak Following Proctectomy: A Cross-Sectional Study / Abaixamento em pacientes após vazamento de anastomose pélvica após proctectomia: Um estudo transversal

Abstract Introduction Colorectal cancer is the second most common type of cancer and the third leading cause ofmortality due to cancers. Anastomosis leak after proctectomy is a dangerous complication that must be managed carefully. The aim of the present study was to assess the procedure of resection and pull-through of the new rectum after anastomosis leak in patients after proctectomy. Methods and Materials This was a cross-sectional study. Patients who visited the Firoozgar Hospital between 2015 and 2018 for rectal cancer surgery and had anastomosis leak entered the study. All patients underwent resection of the residue of rectum and pull-through of colon. Results In the present study, out of the 110 cases who underwent proctectomy, 12 patients with postoperative anastomosis leak were reported. Five (41.7%) were male and 7 (58.3%) were female. Themean age of the patients was 41.5 ± 4.3 years (33-51). Resection of the new rectum and pull-through anastomosis were performed for these 12 patients. No major intraoperative complication occurred. Postoperative course was uneventful in all patients. Discussion Resection of residue of rectum and pull-through in patients with anastomosis leak can be done after rectal cancer surgery. This method is superior to abdominopelvic resection in many aspects, especially regarding accessibility to the new rectum by rectal exam or endosonography to assess recurrence or a relative continence after closure of ostomy.

Resumo Introdução O câncer colorretal é o segundo tipo de câncer mais comum, e a terceira principal causa de mortalidade por câncer. O vazamento da anastomose após a proctectomia é uma complicação perigosa, que deve ser tratada com cuidado. O objetivo do presente estudo foi avaliar o procedimento de ressecção e abaixamento do novo reto após vazamento de anastomose em pacientes submetidos à proctectomia. Métodos e Materiais Este foi um estudo transversal que incluiu pacientes que compareceram ao Firoozgar Hospital entre 2015 e 2018 submetidos a cirurgia de câncer retal e com vazamento de anastomose. Todos os pacientes foram submetidos a ressecção do resíduo do reto e abaixamento do cólon. Resultados No presente estudo, dos 110 casos submetidos a proctectomia, 12 pacientes tiveram vazamento de anastomose pós-operatório: 5 (41,7%) do sexo masculino e 7 (58,3%) do sexo feminino. A idade média dos pacientes foi de 41,5 ± 4,3 anos (gama: 33 a 51 anos). A ressecção do reto novo e a anastomose por abaixamento foram realizadas nesses 12 pacientes. Nenhuma complicação intraoperatória mais grave ocorreu. No pós-operatório, não houve intercorrências em nenhum dos pacientes. Discussão A ressecção de resíduo retal e o abaixamento em pacientes com vazamento de anastomose pode ser feita após cirurgia de câncer retal. Este método é superior à ressecção abdominopélvica em muitos aspectos, especialmente quanto à acessibilidade ao novo reto por exame retal ou endossonografia para avaliar a recorrência ou uma continência relativa após o fechamento da ostomia.

Impacto de las filtraciones anastomóticas en cirugía colorrectal / Impact of anastomotic leak in colorectal surgery

Introducción: La filtración de anastomosis es una de las complicaciones de mayor impacto en cirugía colorrectal. Objetivo: Analizar la frecuencia e impacto de las filtraciones anastomóticas en cirugía laparoscópica colorrectal. Material y método: Estudio longitudinal de base de datos prospectiva de pacientes operados por cirugía colorrectal entre julio de 2007 y agosto de 2014. Resultados: De un total de 654 pacientes operados, 52,3% correspondían a hombres con una edad promedio de 57 años (42-72). La indicación más frecuente fue cáncer colorrectal con 244 pacientes, 159 (24,3%) operados por cáncer de colon y 85 (12,9%) por cáncer de recto, seguido por la enfermedad diverticular con 239 pacientes (36,5%) y 171 pacientes (26,1%) con otros diagnósticos. En 44 pacientes (6,7%) se objetivó filtración anastomótica, con una mediana de 4 días desde el postoperatorio para su diagnóstico. Como factores asociados a filtración se identificó al género masculino, riesgo anestesiológico según ASA, necesidad de conversión a laparotomía y la anastomosis ileoanal. En relación con el tratamiento, 15 pacientes (33,7%) fueron tratados de forma médica exitosa y 29 fue necesario reintervenirlos, de los cuales 23 (79,3%) requirieron una ostomía de protección. No hubo mortalidad asociada a la cirugía, y el promedio de hospitalización en los pacientes con filtración fue de 12 vs. 5 días para los pacientes sin filtración de la anastomosis. Conclusión: Este trabajo permite identificar a grupos de pacientes con mayor riesgo de filtraciones anastomóticas, quienes duplican su estadía hospitalaria y en un alto porcentaje deben ser reintervenidos. La sospecha y diagnostico precoz reducen la morbimortalidad.

Introduction: Anastomotic leak is the most important complication on colorectal surgery. Objective: Analyze the frequency and impact of anastomotic leaks in laparoscopic colorectal surgery. Material and methods: Longitudinal study of prospective database of patients undergoing colorectal surgery between July 2007 and August 2014. Results: 654 patients operated, 52.3% were men with an average age of 57 years (42-72). The most frequent indication was colorectal cancer in 244 patients, 159 (24.3%) operated for colon cancer and 85 (12.9%) for rectal cancer followed by diverticular disease in 239 patients (36.5%) and 171 patients (26.1%) with other diagnoses. In 44 patients (6.7%) anastomotic leakage was observed with a median of 4 days post surgery for diagnosis. As factors associated with filtration, we identified male gender, anesthesic risk according to ASA, need for conversion to laparotomy and ileoanal anastomosis. With regard to treatment, 15 (33.7%) were successfully treated with medical therapy alone and 29 required re-intervention, of which 23 (79.3%) required an ostomy protection. There was no mortality associated with surgery and average LOS was 12 vs. 5 days in patients with filtration compared with patients without anastomotic leakeage. Conclusion: This serie helps to identify patients groups with increased risk of anastomotic leakage who double their hospital LOS and in a higher percentage should need re-intervention. Suspicion and early diagnosis reduces morbidity and mortality.

Effects of blood transfusion on gastrointestinal anastomosis – Our experience in 52 patients.

Background: Patients, operative technique and instrumental factors, all affect the intestinal anastomosis outcome. Preoperative, intraoperative and postoperative blood transfusion influences the very common surgical procedure. Blood transfusion is discriminated from other risk factors in that; its intentionally added risk factor. Aims & Objective: The effect of intra-operative and post-operative blood transfusion on elective gastrointestinal anastomosis mainly evaluated by following factors; (1) surgical site complications (2) anastomosis leak (3) faecal fistula and (4) death. Material and Methods: To evaluate the effect of blood transfusion (Intraoperative and Postoperative) in outcome of Gastrointestinal anastomosis at Government General Hospital. Data collected from fifty two patients who underwent elective gastro intestinal anastomosis at our hospital. Results: The total number of patients was 52, 28male and 24 female. Mean age was 43 years, 17.3% were underwent small bowel anastomosis, 83.7% were underwent large bowel anastomosis, and 15.38% were transfused intraoperative and 26.92% were transfused postoperatively. Regardless other risk factors the incidence of surgical site infection was significantly high in transfused patients (25%), also there was a high rate of other complications in transfused patients. Conclusion: Intraoperative and post-operative blood transfusion is a good predictor for development of complications in elective intestinal anastomosis. There were some limitations in this study, as other risk factors might change the outcome and the effect of blood amount wasn’t considered, so more precise studies have to be done to give more support to our results.