ABSTRACT
PURPOSE: The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection. METHODS: Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage. RESULTS: The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage. CONCLUSION: The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.
ABSTRACT
Postoperative adhesions remain a significant complication of abdominal surgery although the wide variety of physical barriers has been developed to reduce the incidence of adhesion. In this study, the bilayered composite membrane formed by the association of a methoxy poly (ethylene glycol)-poly (L-lactide-co-glycolide) (mPEG-PLGA) film and a crosslinked collagen-hyaluronic acid (Col-HA) membrane with fibronectin (FN) coating was prepared for promoting wound healing and providing tissue adhesion resistance simultaneously. In vitro adhesion test revealed that fibroblasts attached better on Col-HA membrane compared to those on mPEG-PLGA film, PLGA film or Interceed (oxidized cellulose) while mPEG-PLGA film had the lowest cell adhesive property. In confocal microscopic observation, the actin filaments were significantly further polymerized when 50 or 100 microg/cm(3) fibronectin was incorporated on the COL-HA membranes. After 7-day culture, fibroblasts penetrated throughout the Col-HA-FN network and the cell density increased whereas very few cells were found attached on the surface of the mPEG-PLGA film. In vivo evaluation test showed that the composite membrane could remain during the critical period of peritoneal healing and did not provoke any inflammation or adverse tissue reaction.
