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Hu C, Zhang H, Yang L, Zhao J, Cai Q, Jiang L, Meng L, Wang Z, Wen Z, Wang Y, Yu Z. Anastomotic occlusion after laparoscopic low anterior rectal resection: a rare case study and literature review. World J Surg Oncol 2022; 20:145. [PMID: 35524309 PMCID: PMC9074226 DOI: 10.1186/s12957-022-02610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background With the development of laparoscopic techniques and the broad clinical application of various anastomotic types, anal-preserving low anterior rectal resection and ultra-low anterior rectal resection have been popularized. Some patients with rectal cancer have retained their anus and improved their quality of life. Nevertheless, the incidence of postoperative anastomotic stenosis remains high, and anastomotic occlusion is even rarer. Case presentation We report a case of anastomotic occlusion in a patient with rectal cancer, which occurred after undergoing laparoscopic low anterior rectal resection + prophylactic terminal ileal fistulation at our department. Under endoscopy, we used a small guidewire to break through the occluded anastomosis, thereby finding the lacuna. After endoscopic balloon dilation, digital anal dilatation, and continuous dilator-assisted dilation, the desired efficacy was achieved, ultimately recovering ileal stoma. Postoperative follow-up condition was generally acceptable, without symptoms like abdominal pain, bloating, or difficulty in defecation. Conclusion Numerous factors cause postoperative anastomotic stenosis in patients with rectal cancer. Complete occlusion of anastomosis occurs relatively rare in clinical practice, and is challenging to treat. This case was our first attempt to remove the anastomotic occlusion successfully, which avoided re-operation or pain from the permanent fistula.
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Affiliation(s)
- Chunhai Hu
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China.,Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Hui Zhang
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China
| | - Lingpeng Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Jian Zhao
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Qiang Cai
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Long Jiang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Lin Meng
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China
| | - Zhi Wang
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China
| | - Zhengrong Wen
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China
| | - Yunhua Wang
- Department II of Hepatobiliary Surgery, The People's Hospital of Chuxiong Yi Autonomous Prefecture, The Fourth Affiliated Hospital of Dali University, Chuxiong, China
| | - Zhiyong Yu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Yunnan University, The Second People's Hospital of Yunnan Province, Kunming, Yunnan Province, China.
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El Bacha H, Jung C, Brieau B, Bordacahar B, Leblanc S, Barret M, de Chaumont A, Dousset B, Prat F. Endoscopic ultrasound-guided luminal remodeling as a novel technique to restore gastroduodenal continuity. SAGE Open Med Case Rep 2020; 8:2050313X20950047. [PMID: 32974023 PMCID: PMC7491220 DOI: 10.1177/2050313x20950047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/26/2020] [Indexed: 01/21/2023] Open
Abstract
Pyloric exclusion is a method of treatment for duodenal injury. Surgery is usually needed to restore digestive continuity in due time, yet a new surgical procedure can be challenging due to fibrotic adhesion development. We present here a retrospective case series of three patients with pyloric exclusion who underwent endoscopic ultrasound–guided duodenal repermeabilization using metallic stents. All procedures were successful with no complication and allowed regular feeding. This case series shows that endoscopic ultrasound–guided recanalization is a feasible and safe procedure.
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Affiliation(s)
- Hicham El Bacha
- Hôpital ibn-sina, Service d'hépatogastro-entérologie et proctologie Medecine B, Rabat, Morocco.,Mohammed V University in Rabat, Rabat, Morocco
| | - Carlo Jung
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France
| | - Bertrand Brieau
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Benoit Bordacahar
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Sarah Leblanc
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | - Maximillien Barret
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
| | | | - Bertand Dousset
- Paris V, Paris Descartes faculty of medicine.,AP-HP, Cochin hospital, department of digestive, hepatobiliary and pancreatic surgery, 75014 Paris, France
| | - Frederic Prat
- AP-HP, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France.,Paris V, Paris Descartes faculty of medicine
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A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.737762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yang S, Lu J, Fu D, Shang D, Zhou F, Liu J, Cao M. Effect of microscopically assisted decompression with micro-hook scalpel in the surgical treatment of ossification of the posterior longitudinal ligament. J Int Med Res 2019; 47:5120-5129. [PMID: 31426689 PMCID: PMC6833369 DOI: 10.1177/0300060519862464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective This study was performed to investigate the effect of microscopically assisted decompression using a micro-hook scalpel on ossification of the posterior longitudinal ligament (OPLL). Methods Sixty-one patients with OPLL were divided into Group A (posterior surgery with laminectomy of the responsible segment and lateral mass screw fixation) and Group B (anterior cervical corpectomy with intervertebral titanium cage fusion). Neurological function was assessed by the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and recovery rate. The fixation status and the result of spinal canal decompression were radiographically assessed. Results In Groups A and B, the JOA score was significantly higher and the VAS score was significantly lower at 1 week postoperatively and at the final follow-up than during the preoperative period. The mean recovery rate in Group A and B was 59.92% ± 13.46% and 62.28% ± 14.00%, respectively. Postoperative radiographs showed good positioning and no damage to the internal fixation materials. The spinal canal was also fully decompressed. Conclusions Microscopically assisted decompression with a micro-hook scalpel in both anterior and posterior surgeries achieved good clinical effects in patients with OPLL.
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Affiliation(s)
- Sheng Yang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Jianmin Lu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Dapeng Fu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Depeng Shang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Fei Zhou
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Jifeng Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
| | - Meng Cao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, P.R. China
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Yuan X, Liu W, Ye L, Wu M, Hu B. Combination of endoscopic incision and balloon dilation for treatment of a completely obstructed anastomotic stenosis following colorectal resection: A case report. Medicine (Baltimore) 2019; 98:e16292. [PMID: 31261603 PMCID: PMC6617396 DOI: 10.1097/md.0000000000016292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE The management of complete obstruction of anastomosis following colorectal surgery is challenging. Some modified minimally invasive methods have been reported to be successfully implemented in some cases. In this case report, we present a case to share our experience. PATIENT CONCERNS A 64-year-old man underwent low anterior resection and single barrel ileostomy for rectal cancer 5 months ago. Completely obstructed anastomotic stenosis was found during colonoscopy. DIAGNOSIS Colonoscopy showed the anastomosis at 8 cm from the anal verge was completely obstructed. INTERVENTIONS A small incision was made by a needle knife, and then the stenosis was sequentially dilated by using a wire-guided balloon dilator. OUTCOMES The luminal continuity was reestablished. The patient underwent successful ileostomy closure 2 months later. At 18-months follow-up, no restenosis of the anastomosis was observed during colonoscopy. LESSONS Endoscopic small incision with a needle knife along with balloon dilation could be an alternative method for patients with complete obstruction of anastomosis after colorectal resection. But this procedure should be performed with great caution in selected patients and performed only by highly experienced endoscopists.
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Bong JW, Lim SB. Transanal minimally invasive surgery as a treatment option for a completely occluded anastomosis after low anterior resection: A new approach to severe anastomotic stenosis. Asian J Endosc Surg 2019; 12:175-177. [PMID: 29790661 DOI: 10.1111/ases.12599] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
Abstract
New techniques have been developed to treat severe anastomotic strictures after rectal surgery. This report describes a new approach using transanal minimally invasive surgery for the treatment of complete anastomotic occlusion. A 49-year-old man presented with a completely occluded anastomosis after low anterior resection with temporary ileostomy for rectal cancer. The lumen was completely obstructed with a blind wall. A transanal surgical approach was used to treat the obstruction. Water-soluble radiopaque contrast medium was injected intraoperatively to identify the proximal lumen, and an incision was made by electrocautery until the luminal diameter was sufficient. There was no sign of bleeding or perforation after surgery. The patient underwent ileostomy takedown after all the chemotherapy sessions were completed. This report shows that transanal minimally invasive surgery is safe and feasible for the treatment of complete anastomotic occlusions requiring invasive interventions.
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Affiliation(s)
- Jun Woo Bong
- Division of Colon and Rectal Surgery, and Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, and Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Yazawa K, Morioka D, Matsumoto C, Miura Y, Togo S. Blunt penetration technique for treatment of a completely obstructed anastomosis after rectal resection: a case report. J Med Case Rep 2014; 8:236. [PMID: 24972628 PMCID: PMC4096522 DOI: 10.1186/1752-1947-8-236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 05/05/2014] [Indexed: 01/18/2023] Open
Abstract
Introduction We present a case of completely obstructed anastomosis after rectal resection which was nonsurgically and successfully treated with a blunt penetration technique using a commonly used device for transanal ileus drainage. The technique we used in this case has not been previously reported. Case presentation A 79-year-old Japanese man underwent redo rectal resection for completely separated anastomosis which was caused by anastomotic leakage after a sigmoidectomy performed 3 years previously that was remedied by diverging ileostomy. Immediately after the redo surgery, fluoroscopy showed good passage through the colorectal anastomosis but no anastomotic leakage. However, fluoroscopy and colonoscopy prior to the ileostomy takedown showed complete obstruction of the anastomosis. Unlike usual anastomotic strictures, the lumen between colon oral and rectum anal to the anastomosis was completely discontinued by a membranous structure. Therefore, a conventional balloon dilatation technique was unsuitable for this condition. We applied a blunt penetration technique using a commercially available device designed as a transanal drainage system for obstructing colorectal cancer to restore the continuity between the colon oral and rectum anal to the anastomosis. After restoring the continuity, we performed conventional balloon dilatation for the anastomosis and successfully treated the anastomotic obstruction. Subsequently, the patient underwent ileostomy takedown and is currently doing well 12 months after the ileostomy takedown. Conclusions The penetration technique we applied is easy and less stressful to adopt because it does not require usage of materials specialized for other particular purposes. Furthermore, we believe that this technique is superior in safety to other reported methods for this condition even if applied in the wrong direction because this technique does not utilize electrocision or sharp needle puncture.
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Affiliation(s)
| | - Daisuke Morioka
- Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama 231-0036, Japan.
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Raimondo D, Facella T, Rossi F, Sinagra E, Di Caro S. Endoscopic rendezvous in stricture of colorectal anastomosis: a new approach. Dig Liver Dis 2013; 45:1063-4. [PMID: 23906518 DOI: 10.1016/j.dld.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/02/2013] [Accepted: 06/12/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Dario Raimondo
- Department of Gastroenterology and Digestive Endoscopy, San Raffaele-Giglio Hospital, Cefalù, Italy.
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9
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Postoperative Complications. Updates Surg 2013. [DOI: 10.1007/978-88-470-2670-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Janík V, Horák L, Hnaníček J, Málek J, Laasch HU. Biodegradable polydioxanone stents: a new option for therapy-resistant anastomotic strictures of the colon. Eur Radiol 2011; 21:1956-61. [PMID: 21533633 DOI: 10.1007/s00330-011-2131-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 03/07/2011] [Accepted: 03/10/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the outcome of self-expandable, biodegradable stent insertion for anastomotic strictures following treatment for rectosigmoid carcinoma. METHODS Three male patients (median age 66) developed benign strictures after radiotherapy and resection of a recto-sigmoid carcinoma. These were resistant to balloon dilatation and prevented stoma reversal. Biodegradable stent insertion was performed as an experimental treatment on a named-patient basis with approval of the institutional review board. Patients had monthly follow-up with endoscopy and contrast medium enemas to monitor performance and degradation of the stents. RESULTS All stents were placed successfully without complications after pre-dilatation to 20 mm under fluoroscopic guidance. Stent degradation occurred in all patients 4-5 months following implantation, and long-term anastomotic patency was demonstrated in all. This allowed reversal of the colostomy and physiological defecation in two patients. Reversal was not undertaken in one due to subsequent development of liver metastases. No stent migration or occlusion occurred. CONCLUSIONS Biodegradable stents can maintain an adequate lumen across anastomotic strictures resistant to balloon dilatation. They seem to allow stricture re-modelling resulting in maintained dilatation after degradation. This potentially allows reversal of a colostomy, which might otherwise be prevented by stricture recurrence.
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Affiliation(s)
- Václav Janík
- Department of Radiodiagnostics, 3rd Medical Faculty, Charles University, Prague, Czech Republic
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Curcio G, Spada M, Francesco FD, Tarantino I, Barresi L, Burgio G, Traina M. Completely obstructed colorectal anastomosis: A new non-electrosurgical endoscopic approach before balloon dilatation. World J Gastroenterol 2010; 16:4751-4. [PMID: 20872979 PMCID: PMC2951529 DOI: 10.3748/wjg.v16.i37.4751] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Benign stricture is a relatively common complication of colorectal anastomosis after low anterior resection. On occasion, the anastomosis may close completely. A variety of endoscopic techniques have been described, but there is a lack of data from controlled prospective trials as to the optimal approach. Through-the-scope balloon dilatation is well known and easy to perform. Some case reports describe different endoscopic approaches, including endoscopic electrocision with a papillotomy knife or hook knife. We report a case of a colorectal anastomosis web occlusion, treated without electrocision. Gastrografin enema and sigmoidoscopy showed complete obstruction at the anastomotic site due to the presence of an anastomotic occlusive web. In order to avoid thermal injuries, we decided to use a suprapapillary biliary puncture catheter. The Artifon catheter was inserted into the center of the circular staple line at the level of the anastomosis, and fluoroscopic identification of the proximal bowel was obtained with dye injection. A 0.025-inch guidewire was then passed through the catheter into the colon and progressive pneumatic dilatation was performed. The successful destruction of the occlusive web facilitated passage of the colonoscope, allowing evaluation of the entire colon and stoma closure after three months of follow-up. The patient tolerated the procedure well, with no complications. This report highlights an alternative non-electrosurgical approach that uses a new device that proved to be safe and useful.
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