1
|
Abstract
Leaks from anastomoses can be a serious complication of any gastrointestinal resection. Leaks lead to increased morbidity, delayed postoperative recovery, and potential delays in adjuvant treatment in cancer cases. Prevention of anastomotic leak has been an area of ongoing research for decades. Methods of assessing bowel perfusion have been developed that may provide forewarning of anastomotic compromise. Physical reinforcement of the anastomosis with buttressing material is an available method employed with the goal of preventing leaks. Liquid-based sealants have also been explored. Lastly, interactions between the gut microbiome and anastomotic healing have been investigated as a mean of manipulating the microenvironment to reduce leak rates. Though no single technology has been successful in eliminating leaks, an understanding of these developing fields will be important for all surgeons who operate on the gastrointestinal tract.
Collapse
Affiliation(s)
- Abhineet Uppal
- Division of Colorectal Surgery, Department of Surgery, University of California at Irvine Medical Center, Orange, California
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California at Irvine Medical Center, Orange, California
| |
Collapse
|
2
|
De Hous N, Lefevre JH, D'Urso A, Van den Broeck S, Komen N. Intraluminal bypass devices as an alternative to protective ostomy for prevention of colorectal anastomotic leakage: a systematic review of the literature. Colorectal Dis 2020; 22:1496-1505. [PMID: 32268451 DOI: 10.1111/codi.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
AIM Anastomotic leakage (AL) is the most important complication of colorectal surgery, leading to high morbidity and mortality. Protective ostomy, the current standard of care for protecting a colorectal anastomosis, has important drawbacks that require the creation of an alternative strategy. Over the past 30 years, several intraluminal bypass devices, designed to shield the anastomosis from the faecal stream, have been developed. The aim of this literature review was to create an updated overview of the devices available and their effectiveness in preventing AL, and to investigate whether they could serve as an alternative to protective ostomy in the future. METHOD A systematic review of the literature on intraluminal bypass devices used for preventing colorectal AL was performed. The MEDLINE and Cochrane Library databases were searched, and articles were marked as relevant if an intraluminal bypass device was studied in an animal or human population. RESULTS The database search yielded 24 relevant articles related to 10 intraluminal bypass devices protecting a colorectal anastomosis. These articles included experimental animal studies, preclinical (pilot) studies, as well as retrospective and prospective clinical studies. Each device was assessed with regard to surgical technique, effectiveness and device-related complications. CONCLUSION Intraluminal bypass devices show promise in preventing AL and its clinical consequences. However, there is insufficient high-level evidence to draw firm conclusions. There is a need for randomized controlled trials that directly compare these devices with the protective ostomy.
Collapse
Affiliation(s)
- N De Hous
- Department of Abdominal Surgery, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium
| | - J H Lefevre
- Department of Digestive Surgery, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - A D'Urso
- Department of General, Digestive, and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - S Van den Broeck
- Department of Abdominal Surgery, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium
| | - N Komen
- Department of Abdominal Surgery, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium
| |
Collapse
|
3
|
Hadavi E, de Vries RHW, Smink AM, de Haan B, Leijten J, Schwab LW, Karperien MHBJ, de Vos P, Dijkstra PJ, van Apeldoorn AA. In vitro degradation profiles and in vivo biomaterial-tissue interactions of microwell array delivery devices. J Biomed Mater Res B Appl Biomater 2020; 109:117-127. [PMID: 32672384 PMCID: PMC7754331 DOI: 10.1002/jbm.b.34686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
To effectively apply microwell array cell delivery devices their biodegradation rate must be tailored towards their intended use and implantation location. Two microwell array devices with distinct degradation profiles, either suitable for the fabrication of retrievable systems in the case of slow degradation, or cell delivery systems capable of extensive remodeling using a fast degrading polymer, were compared in this study. Thin films of a poly(ethylene glycol)‐poly(butylene terephthalate) (PEOT‐PBT) and a poly(ester urethane) were evaluated for their in vitro degradation profiles over 34 weeks incubation in PBS at different pH values. The PEOT‐PBT films showed minimal in vitro degradation over time, while the poly(ester urethane) films showed extensive degradation and fragmentation over time. Subsequently, microwell array cell delivery devices were fabricated from these polymers and intraperitoneally implanted in Albino Oxford rats to study their biocompatibility over a 12‐week period. The PEOT‐PBT implants shown to be capable to maintain the microwell structure over time. Implants provoked a foreign body response resulting in multilayer fibrosis that integrated into the surrounding tissue. The poly(ester urethane) implants showed a loss of the microwell structures over time, as well as a fibrotic response until the onset of fragmentation, at least 4 weeks post implantation. It was concluded that the PEOT‐PBT implants could be used as retrievable cell delivery devices while the poly(ester urethane) implants could be used for cell delivery devices that require remodeling within a 4–12 week period.
Collapse
Affiliation(s)
- Elahe Hadavi
- Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rick H W de Vries
- Department of Cell Biology - Inspired Tissue Engineering (cBITE), MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| | - Alexandra M Smink
- Department of Pathology and Medical Biology, Section of Immunoendocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bart de Haan
- Department of Pathology and Medical Biology, Section of Immunoendocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jeroen Leijten
- Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Marcel H B J Karperien
- Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Paul de Vos
- Department of Pathology and Medical Biology, Section of Immunoendocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter J Dijkstra
- Department of Developmental BioEngineering, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Aart A van Apeldoorn
- Department of Cell Biology - Inspired Tissue Engineering (cBITE), MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
4
|
Kang SI, Kim SH, Jung SH, Kim JH. The effectiveness of a fecal diverting device for prevention of septic complications in a dog model of ischemic bowel anastomosis. Asian J Surg 2019; 43:251-256. [PMID: 30982561 DOI: 10.1016/j.asjsur.2019.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/09/2019] [Accepted: 03/15/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE A type of bypass tube for a fecal diversion device (FDD) was created to protect colorectal anastomosis. We evaluated the effectiveness of the FDD in an animal study. METHODS The study was performed in an experimental animal laboratory of a tertiary referral center hospital. Thirty mongrel dogs were randomized to the FDD or control group (n = 15, each). An ischemic anastomosis model was used to readily produce anastomotic leakage (AL) in both groups. The FDD was fixed intraluminally at 10 cm above the anastomotic site in the FDD group. No protective methods were used in the control group. The postoperative observation period was 3 weeks. RESULTS The 3 week-survival rates were higher in the FDD group compare with the control group (80%, 12/15 vs. 40%, 6/15; log-rank, P = 0.024). The incidence of AL causing generalized peritonitis was lower in the FDD group than in the control group (20.0%, 3/15 vs. 60.0%, 9/15; P = 0.025) despite the overall incidence of complications being similar in the both groups (53.3%, 8/15 vs. 66.7%, 10/15; P = 0.456). Colonic wall erosions in the FDD fixing area were seen in two subjects (13.3%) in the FDD group. However, the two subjects survived to the end of the experimental period. In the FDD group, five subjects (33.3%, 5/15) did not retain their FDD, and three among them died from generalized peritonitis. CONCLUSION This study shows the effectiveness of the FDD at preventing septic complications in a dog model of ischemic bowel anastomosis.
Collapse
Affiliation(s)
- Sung Il Kang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, South Korea
| | - So Hyun Kim
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Sang Hun Jung
- Department of Surgery, Samil Hospital, Daegu, South Korea
| | - Jae Hwang Kim
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, South Korea.
| |
Collapse
|
5
|
An V, Chandra R, Lawrence M. Anastomotic Failure in Colorectal Surgery: Where Are We at? Indian J Surg 2018; 80:163-170. [DOI: 10.1007/s12262-018-1745-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/12/2018] [Indexed: 12/22/2022] Open
|
6
|
Trotter J, Onos L, McNaught C, Peter M, Gatt M, Maude K, MacFie J. The use of a novel adhesive tissue patch as an aid to anastomotic healing. Ann R Coll Surg Engl 2018; 100:230-234. [PMID: 29484939 PMCID: PMC5930107 DOI: 10.1308/rcsann.2018.0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.
Collapse
Affiliation(s)
- J Trotter
- York Teaching Hospital NHS Foundation Trust, UK
| | - L Onos
- York Teaching Hospital NHS Foundation Trust, UK
| | - C McNaught
- York Teaching Hospital NHS Foundation Trust, UK
| | - M Peter
- York Teaching Hospital NHS Foundation Trust, UK
| | - M Gatt
- York Teaching Hospital NHS Foundation Trust, UK
| | - K Maude
- York Teaching Hospital NHS Foundation Trust, UK
| | - J MacFie
- York Teaching Hospital NHS Foundation Trust, UK
| |
Collapse
|
7
|
Bakker IS, Morks AN, ten Cate Hoedemaker HO, Burgerhof JGM, Leuvenink HG, van Praagh JB, Ploeg RJ, Havenga K, Bakker IS, Morks AN, ten Cate Hoedemaker HO, Leuvenink HG, Ploeg RJ, Havenga K, van Etten B, Lange JFM, Hemmer PHJ, Burgerhof JGM, Sonneveld DJA, Tanis PJ, Wegdam JA, Jonk A, Lutke Holzik MF, Bosker RJI, Lamme B, Spillenaar Bilgen EJ, Bremers AJ, van der Mijle HC, Hoff C, de Vries DP, Logeman F, Sietses C, Lesanka Versluijs-Ossewaarde FN, Leijtens JW, Tobon Morales RE, Neijenhuis PA, Kloppenberg FW, Schasfoort R, Bleeker WA, Hess D, Rosman C, Wit F, Ton van Engelenburg KC, Pronk A, Bonsing BA, Dekker JW, Consten EC, Patijn GA, Bogdan Rajcs S, Csapó Z, Bálint A, Harsányi L, István G, Horisberger K, Bader F, Kutup A, Mariette C, Cebrián F. Randomized clinical trial of biodegradeable intraluminal sheath to prevent anastomotic leak after stapled colorectal anastomosis. Br J Surg 2017; 104:1010-1019. [DOI: 10.1002/bjs.10534] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/09/2016] [Accepted: 02/08/2017] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Anastomotic leakage is a potential major complication after colorectal surgery. The C-seal was developed to help reduce the clinical leakage rate. It is an intraluminal sheath that is stapled proximal to a colorectal anastomosis, covering it intraluminally and thus preventing intestinal leakage in case of anastomotic dehiscence. The C-seal trial was initiated to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses.
Methods
This RCT was performed in 41 hospitals in the Netherlands, Germany, France, Hungary and Spain. Patients undergoing elective surgery with a stapled colorectal anastomosis less than 15 cm from the anal verge were eligible. Included patients were randomized to the C-seal and control groups, stratified for centre, anastomotic height and intention to create a defunctioning stoma. Primary outcome was anastomotic leakage requiring invasive treatment.
Results
Between December 2011 and December 2013, 402 patients were included in the trial, 202 in the C-seal group and 200 in the control group. Anastomotic leakage was diagnosed in 31 patients (7·7 per cent), with a 10·4 per cent leak rate in the C-seal group and 5·0 per cent in the control group (P = 0·060). Male sex showed a trend towards a higher leak rate (P = 0·055). Construction of a defunctioning stoma led to a lower leakage rate, although this was not significant (P = 0·095).
Conclusion
C-seal application in stapled colorectal anastomoses does not reduce anastomotic leakage. Registration number: NTR3080 (http://www.trialregister.nl/trialreg/index.asp).
Collapse
Affiliation(s)
- I S Bakker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A N Morks
- Department of Surgery, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - H O ten Cate Hoedemaker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J G M Burgerhof
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H G Leuvenink
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J B van Praagh
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - K Havenga
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - I S Bakker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A N Morks
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H O ten Cate Hoedemaker
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H G Leuvenink
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Havenga
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B van Etten
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J F M Lange
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P H J Hemmer
- Departments of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - J G M Burgerhof
- Departments of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | | | - P J Tanis
- Academic Medical Centre, Amsterdam, The Netherlands
| | - J A Wegdam
- Elkerliek Ziekenhuis, Helmond, The Netherlands
| | - A Jonk
- Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands
| | | | | | - B Lamme
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - A J Bremers
- Radboud University, Nijmegen Medical Centre, The Netherlands
| | | | - C Hoff
- Medical Centre, Leeuwarden, The Netherlands
| | - D P de Vries
- Ommelander Ziekenhuis Group, Winschoten, The Netherlands
| | - F Logeman
- Beatrix Hospital, Gorinchem, The Netherlands
| | - C Sietses
- Gelderse Vallei Hospital, Ede, The Netherlands
| | | | | | | | | | | | | | | | - D Hess
- Antonius Hospital, Sneek, The Netherlands
| | - C Rosman
- Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - F Wit
- Tjongerschans Hospital, Heerenveen, The Netherlands
| | | | - A Pronk
- Diakonessenhuis, Utrecht, The Netherlands
| | - B A Bonsing
- Leiden University Medical Centre, The Netherlands
| | - J W Dekker
- Reinier de Graaf Hospital, Delft, The Netherlands
| | - E C Consten
- Meander Medical Centre, Amersfoort, The Netherlands
| | | | - S Bogdan Rajcs
- Szabolcs-Szatmár-Bereg County Hospitals, Jósa András University Teaching Hospital, Nyíregyháza, Hungary
| | - Z Csapó
- Flór Ferenc Hospital of County Pest, Kistarcsa, Hungary
| | - A Bálint
- Szent Imre Hospital, Budapest, Hungary
| | - L Harsányi
- Semmelweis University, First Department of surgery, Budapest, Hungary
| | - G István
- Semmelweis University, Second Department of Surgery, Budapest, Hungary
| | - K Horisberger
- University Medical Centre Mannheim, University of Heidelberg, Germany
| | - F Bader
- Klinikum Rechts der Isar, Technische Universität München, Germany
| | - A Kutup
- University Medical Centre Hamburg–Eppendorf, Germany
| | - C Mariette
- Claude Huriez University Hospital, Lille, France
| | - F Cebrián
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | |
Collapse
|
8
|
Bachmann R, Leonard D, Delzenne N, Kartheuser A, Cani PD. Novel insight into the role of microbiota in colorectal surgery. Gut 2017; 66:738-749. [PMID: 28153961 DOI: 10.1136/gutjnl-2016-312569] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/21/2016] [Accepted: 12/24/2016] [Indexed: 12/12/2022]
Abstract
Recent literature undeniably supports the idea that the microbiota has a strong influence on the healing process of an intestinal anastomosis. Understanding the mechanisms by which the bacterial community of the gut influences intestinal healing could open the door for new preventive and therapeutic approaches. Among the different mechanisms, data have shown that the production of specific reactive oxygen species (ROS) and the activation of specific formyl peptide receptors (FPRs) regulate intestinal wound healing. Evidence suggests that specific gut microbes such as Lactobacillus spp and Akkermansia muciniphila help to regulate healing processes through both ROS-dependent and FPR-dependent mechanisms. In this review, we will discuss the current knowledge and future perspectives concerning the impact of microbiota on wound healing. We will further review available evidence on whether mechanical bowel preparation and the use of specific antibiotics are beneficial or harmful procedures, an ongoing matter of debate. These practices have a profound effect on the gut microbiota composition at the level of both the mucosal and the luminal compartments. Therefore, a key question remains unanswered: should we continue to prepare the gut before surgical intervention? Current knowledge and data do not clearly support the use of one technique or another to avoid complications such as anastomotic leak. There is an urgent need for appropriate interventions with a deep microbiota analysis to investigate both the surgical technical benefits of a proper anastomosis compared with the potential effect of the gut microbes (beneficial vs harmful) on the processes of wound healing and anastomotic leakage reduction.
Collapse
Affiliation(s)
- Radu Bachmann
- Colorectal Surgery Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Cliniques des Pathologies Tumorales du Colon et de Rectum (CPTCR), Institut Roi Albert II, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Daniel Leonard
- Colorectal Surgery Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Cliniques des Pathologies Tumorales du Colon et de Rectum (CPTCR), Institut Roi Albert II, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Nathalie Delzenne
- Université catholique de Louvain, Louvain Drug Research Institute, Metabolism and Nutrition research group, Brussels, Belgium
| | - Alex Kartheuser
- Colorectal Surgery Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Cliniques des Pathologies Tumorales du Colon et de Rectum (CPTCR), Institut Roi Albert II, Cliniques universitaires Saint Luc, Brussels, Belgium
| | - Patrice D Cani
- Université catholique de Louvain, Louvain Drug Research Institute, Metabolism and Nutrition research group, Brussels, Belgium.,WELBIO (Walloon Excellence in Life sciences and BIOtechnology), Brussels, Belgium
| |
Collapse
|
9
|
Tabola R, Cirocchi R, Fingerhut A, Arezzo A, Randolph J, Grassi V, Binda GA, D'Andrea V, Abraha I, Popivanov G, Di Saverio S, Zbar A. A systematic analysis of controlled clinical trials using the NiTi CAR™ compression ring in colorectal anastomoses. Tech Coloproctol 2017; 21:177-184. [PMID: 28132113 DOI: 10.1007/s10151-017-1583-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023]
Abstract
Anastomotic leak following colorectal surgery can be a devastating adverse event. The ideal stapling device should be capable of rapid creation of an anastomosis with serosal apposition without the persistence of a foreign body or a foreign body reaction which potentially contribute to early anastomotic dehiscence or late anastomotic stricture. A systematic review was performed examining available data on controlled randomized and non-randomized trials assessing the NiTi compression anastomosis ring-(NiTi CAR™) (NiTi Solutions, Netanyah Israel) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards. A protocol for this meta-analysis has been registered on PROSPERO (CRD42016050934). The initial search yielded 45 potentially relevant articles. After screening titles and abstracts for relevance and assessment for eligibility, 39 of these articles were eventually excluded leaving 6 studies for analysis in the review. Regarding the primary outcome measure, the overall anastomotic leak rate was 2.2% (5/230) in the compression anastomosis group compared with 3% (10/335) in the conventional anastomosis group; this difference was not statistically significant (RR 0.75, 95% CI 0.25-2.24; participants = 565; studies = 6; I 2 = 0%). There were no statistically significant differences between compression and conventional anastomoses in any of the secondary outcomes. This review was unable to demonstrate any statistically significant differences in favor of the compression anastomosis technique over conventional manual or stapled mechanical anastomoses.
Collapse
Affiliation(s)
- R Tabola
- Department of General and Gastrointestinal Surgery, Medical University of Wrocław, Wrocław, Poland
| | - R Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
| | - A Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - J Randolph
- Tift College of Education, Mercer University, Atlanta, GA, USA
| | - V Grassi
- Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy
| | - G A Binda
- Colorectal Surgery Unit, Galliera Hospital, Genoa, Italy
| | - V D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - I Abraha
- Department of Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - G Popivanov
- Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
| | - S Di Saverio
- General (Colorectal), Emergency and Trauma Surgery Service, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health Services, Bologna, Italy
| | - A Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Ramat Gan, Israel.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Emerging Trends in the Etiology, Prevention, and Treatment of Gastrointestinal Anastomotic Leakage. J Gastrointest Surg 2016; 20:2035-2051. [PMID: 27638764 DOI: 10.1007/s11605-016-3255-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/12/2016] [Indexed: 02/08/2023]
Abstract
Anastomotic leaks represent one of the most alarming complications following any gastrointestinal anastomosis due to the substantial effects on post-operative morbidity and mortality of the patient with long-lasting effects on the functional and oncologic outcomes. There is a lack of consensus related to the definition of an anastomotic leak, with a variety of options for prevention and management. A number of patient-related and technical risk factors have been found to be associated with the development of an anastomotic leak and have inspired the development of various preventative measures and technologies. The International Multispecialty Anastomotic Leak Global Improvement Exchange group was convened to establish a consensus on the definition of an anastomotic leak as well as to discuss the various diagnostic, preventative, and management measures currently available.
Collapse
|
11
|
Marsman EM, de Rooij T, van Eijck CH, Boerma D, Bonsing BA, van Dam RM, van Dieren S, Erdmann JI, Gerhards MF, de Hingh IH, Kazemier G, Klaase J, Molenaar IQ, Patijn GA, Scheepers JJ, Tanis PJ, Busch OR, Besselink MG. Pancreatoduodenectomy with colon resection for cancer: A nationwide retrospective analysis. Surgery 2016; 160:145-152. [DOI: 10.1016/j.surg.2016.02.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 01/02/2023]
|
12
|
Willenz U, Wasserberg N, Botero-Anug AM, Greenberg R. Feasibility of an Intraluminal Bypass Device in Low Colorectal Anastomosis. Surg Innov 2015; 23:298-304. [DOI: 10.1177/1553350615617250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: The Cologuard CG-100 is a novel intraluminal bypass device designed to reduce the clinical outcomes associated with low colorectal anastomotic leak. The device is inserted transanally, anchored to the colon above the anastomosis, and deployed intraluminally to cover the anastomosis from within. The purpose of this study was to evaluate the safety and performance of the device in a porcine model. Method: Twelve pigs underwent low colorectal anastomosis with insertion of the Cologuard CG-100 device. Contrast material injection, abdominal X-ray, and histologic studies were used to evaluate sealing quality, device positioning, and tissue damage, respectively. The surgeons completed a usability and satisfaction questionnaire after completion of the procedure. Results: Absolute sealing was observed in all 4 animals euthanized immediately after surgery. In the other 8 animals, the device was kept in situ for 10 days and then extracted. X-ray films with injection of contrast material through a designated injection tube before device removal showed that the sheath and ring were correctly placed. No leak was demonstrated. There were no device-related adverse events, and no critical histological abnormalities were noted in the bowel area that was compressed by the device. The device was found to be easy to insert, position, and extract. Conclusion: The Cologuard CG-100 device efficiently reduced contact between fecal content and low colorectal anastomosis in a porcine model and is easily deployed and extracted. It holds promise for possible clinical use pending further studies.
Collapse
Affiliation(s)
- Udi Willenz
- The Institute of Animal Research, Kibbutz Lahav, Israel
| | - Nir Wasserberg
- Rabin Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Ron Greenberg
- Tel Aviv University, Tel Aviv, Israel
- Tel Aviv Medical Center, Tel Aviv, Israel
| |
Collapse
|
13
|
Warwick A, Marshall M, Daniels I, Smart N. Evidence for the C-seal device remains inconclusive. Int J Colorectal Dis 2014; 29:1309. [PMID: 24853481 DOI: 10.1007/s00384-014-1896-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Andrea Warwick
- Department of Colorectal Surgery, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK,
| | | | | | | |
Collapse
|
14
|
Bakker IS, Morks AN, Hoedemaker HOTC, Burgerhof JGM, Leuvenink HG, Ploeg RJ, Havenga K. The C-seal trial: colorectal anastomosis protected by a biodegradable drain fixed to the anastomosis by a circular stapler, a multi-center randomized controlled trial. BMC Surg 2012; 12:23. [PMID: 23153188 PMCID: PMC3558481 DOI: 10.1186/1471-2482-12-23] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/12/2012] [Indexed: 01/03/2023] Open
Abstract
Background Anastomotic leakage is a major complication in colorectal surgery and with an incidence of 11% the most common cause of morbidity and mortality. In order to reduce the incidence of anastomotic leakage the C-seal is developed. This intraluminal biodegradable drain is stapled to the anastomosis with a circular stapler and prevents extravasation of intracolonic content in case of an anastomotic dehiscence. The aim of this study is to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses, as assessed by anastomotic leakage leading to invasive treatment within 30 days postoperative. Methods The C-seal trial is a prospective multi-center randomized controlled trial with primary endpoint, anastomotic leakage leading to re-intervention within 30 days after operation. In this trial 616 patients will be randomized to the C-seal or control group (1:1), stratified by center, anastomotic height (proximal or distal of peritoneal reflection) and the intention to create a temporary deviating ostomy. Interim analyses are planned after 50% and 75% of patient inclusion. Eligible patients are at least 18 years of age, have any colorectal disease requiring a colorectal anastomosis to be made with a circular stapler in an elective setting, with an ASA-classification < 4. Oral mechanical bowel preparation is mandatory and patients with signs of peritonitis are excluded. The C-seal student team will perform the randomization procedure, supports the operating surgeon during the C-seal application and achieves the monitoring of the trial. Patients are followed for one year after randomization en will be analyzed on an intention to treat basis. Discussion This Randomized Clinical trial is designed to evaluate the effectiveness of the C-seal in preventing clinical anastomotic leakage. Trial registration NTR3080
Collapse
Affiliation(s)
- Ilsalien S Bakker
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | | | | | | | | | | | | |
Collapse
|