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Rentiya ZS, Palle LRA, Emmanuel S, Shah H, Adegbite A, Chu Carredo CK, Blanco Montecino RM, Asfeen UZ, Hussain A, Akuma O, Khan AM, Kelechi AE. Management of an undetectable Diverticular Bleed: A Case Report and Literature review. Clin Case Rep 2024; 12:e8588. [PMID: 38523824 PMCID: PMC10957488 DOI: 10.1002/ccr3.8588] [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: 11/12/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Diverticular bleeding is the most common cause of lower gastrointestinal bleeding and accounts for 20.8%-41.6% of cases in the Western world. Management involves initial resuscitation followed by diagnostic assessment. Colonoscopy is the investigation of choice as it localizes the bleed and has the potential to effectively deliver therapeutic interventions. Other diagnostic modalities include flexible sigmoidoscopy, a tagged red blood cell scan, or angiography. In cases where the bleeding source cannot be identified, intraoperative enteroscopy has emerged as a valuable tool for investigating obscure gastroenterology bleeds in specific patients. In this case report, we describe the management of a 77-year-old male with recently diagnosed pan-colonic diverticulosis who presented with multiple episodes of rectal bleeding and syncope. Due to his declining hemodynamic status and failed endoscopy and embolization, he was taken to surgery for a colectomy. Intraoperative colonoscopy was utilized to facilitate accurate identification of the pathology, assessment of anastomotic patency, and detection of surgical complications. This case report attempts to portray how the incorporation of endo-videoscopy into surgical planning has the potential to enhance patient outcomes and represent a significant advancement in the field of minimally invasive surgery.
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Affiliation(s)
- Zubir S. Rentiya
- Department of Radiation Oncology & RadiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
- Department of SurgeryMedStar Georgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Sanni Emmanuel
- Department of SurgeryNational Hospital AbujaAbujaNigeria
| | - Heeya Shah
- Medical University of South CarolinaLancasterPennsylvaniaUSA
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Schreiber ME, Schneider MA, Murray FR, Turina M, Gubler C. Routine Endoscopy Prior to Surgical Ostomy Closure: An Obsolete Concept. Dig Dis Sci 2023; 68:4130-4139. [PMID: 37707748 PMCID: PMC10570172 DOI: 10.1007/s10620-023-08088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Closure of temporary diverting ostomies is commonly preceded by an endoscopic study of the colonic mucosa and anastomosis, despite lacking evidence of its relevance and impact on subsequent operative management. AIM We sought to determine the incidence of pathological findings and therefore evaluate the clinical benefit of routine pre-operative endoscopy in asymptomatic patients, hypothesizing sole evaluation of the anastomotic integrity to be sufficient in these cases. METHODS We retrospectively identified all adult patients with ostomy installations who were followed up for potential reversal surgery between 2002 and 2020 at the University Hospital of Zurich, Switzerland. Main outcome measures were the incidence of endoscopically identified pathological findings in the asymptomatic case cohort and their impact on the subsequent course of treatment. RESULTS Pre-procedural endoscopic data of 187 cases evaluated for ostomy closure were evaluated. Relevant mucosal findings in the asymptomatic cohort were documented in 26.3% and findings at the anastomotic site detected in 8.7%. A change in subsequent surgical management was noted in 10 patients of the entire cohort (5.3%) and in 9 (5.1%) of all asymptomatic cases. Upon multivariate analyses, the age range of 51 to 60 years old was found to be significantly linked to the presence of endoscopic findings entailing a change in patient management. CONCLUSION Our findings strongly suggest ostomy closure surgery without previous assessment of the bowel mucosa by means of endoscopy to be acceptable in asymptomatic patients. However, we found it to be indicated in all patients meeting the screening criteria for colorectal carcinoma.
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Affiliation(s)
- Maxine E. Schreiber
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Marcel A. Schneider
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fritz R. Murray
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Gastroenterology, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Gastroenterology, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
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Battah A, Farouji I, DaCosta TR, Okwesili B, Farouji A, John R, Gonzalez D, Lakkasani S, Bains Y. A Rare Presentation of Synchronous Colorectal Adenocarcinoma. Cureus 2023; 15:e47337. [PMID: 38021730 PMCID: PMC10657221 DOI: 10.7759/cureus.47337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Synchronous carcinoma is defined as multiple malignant lesions presented in a single patient at initial diagnosis. Synchronous colorectal adenocarcinoma is a rare entity that has been increasingly recognized, likely due to the significant improvement in imaging and diagnostic tools. Making the appropriate diagnosis of synchronous colorectal cancer has a major role in the management's determination and treatment plans. Herein, we are reporting a case of a 73-year-old gentleman who was diagnosed with synchronous colorectal adenocarcinoma with two masses in the left colon and was treated initially surgically followed by chemotherapy.
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Affiliation(s)
- Arwa Battah
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | - Iyad Farouji
- Internal Medicine, Saint Michael's Medical Center, Newark, USA
| | | | - Byron Okwesili
- Gastroenterology and Hepatology, Saint Michael's Medical Center, Newark, USA
| | | | - Reshma John
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
| | - Daphne Gonzalez
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
| | | | - Yatinder Bains
- Gastroenterology, Saint Michael's Medical Center, Newark, USA
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Kitagawa T, Ryu S, Goto K, Okamoto A, Marukuchi R, Hara K, Ito R, Nakabayashi Y. Preoperative fluorescent clip marking vs. India ink tattooing for tumor identification during colorectal surgery. Int J Colorectal Dis 2023; 38:204. [PMID: 37530872 DOI: 10.1007/s00384-023-04502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Identifying tumor location is important in colorectal tumor resection. Preoperative endoscopic India ink marking is a widespread practice, but local injection of ink is an unstable procedure. Although it is often invisible, the ink may be sprayed into the peritoneal cavity and contaminate the surgical field. At our hospital, we introduced fluorescent clip marking (FCM) using the Zeoclip FS®, an endoscopic clip developed using near-infrared fluorescent resin. We tested the usefulness of FCM by retrospectively comparing cases in which FCM was used with cases in which conventional ink marking was used. METHODS We enrolled 305 patients with colorectal tumors who underwent colorectal surgery after preoperative marking from January 2017 to April 2022. We classified the patients into the FCM group (86 patients) and the India ink tattoo group (219 patients). Endoscopic marking was completed in the FCM group by the day before surgery, and fluorescence was evaluated during surgery with a fluorescent laparoscopic system. Patient backgrounds, marking visibility, adverse effects, and early postoperative results were retrospectively compared between groups. RESULTS Marking was visually confirmed in 80 patients in the FCM group (93.02%) and in 166 patients in the India ink tattoo group (75.80%) (p = 0.0006). In the group with India ink tattoos, contamination of the surgical field was observed in seven cases (3.20%). No adverse events were observed in the FCM group. CONCLUSION In colorectal surgery, FCM provides better visibility than the conventional India ink tattooing method and is a simple and safe marking method. CLINICAL TRIAL REGISTRATION Examination of fluorescence navigation for laparoscopic colorectal cancer surgery. Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf .
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Affiliation(s)
- Takahiro Kitagawa
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Keisuke Goto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Atsuko Okamoto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Rui Marukuchi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Keigo Hara
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi City, Saitama, 333-0833, Japan
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Yoo RN, Mun JY, Cho HM, Kye BH, Kim HJ. Assessment of Colorectal Anastomosis with Intraoperative Colonoscopy: Its Role in Reducing Anastomotic Complications. Biomedicines 2023; 11:biomedicines11041162. [PMID: 37189780 DOI: 10.3390/biomedicines11041162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
The use of intraoperative colonoscopy (IOC) to evaluate the integrity of newly created anastomosis has been advocated by some surgeons. However, whether direct visualization of fresh anastomosis can help reduce anastomotic problems is still unclear. This study investigates the impact of immediate endoscopic assessment of colorectal anastomosis on anastomotic problems. This is a retrospective study conducted at a single center. Among six hundred forty-nine patients who underwent stapled anastomosis for left-sided colorectal cancer, the anastomotic complications were compared between patients who underwent IOC and those who did not. Additionally, patients with subsequent intervention after the IOC were compared to those without the intervention. Twenty-seven patients (5.0%) developed anastomotic leakage, and six (1.1%) experienced anastomotic bleeding postoperatively. Of the patients with IOC, 70 patients received reinforcement sutures to secure anastomotic stability. Of 70 patients, 39 patients showed abnormal findings in IOC. Thirty-seven patients (94.9%) who underwent reinforcement sutures did not develop postoperative anastomotic problems. This study demonstrates that IOC assessment with reinforcement sutures does not imminently reduce the rate of anastomotic complications. However, its use may play a role in detecting early technical failure and preventing postoperative anastomotic complications.
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Affiliation(s)
- Ri-Na Yoo
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Ji-Yeon Mun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Hyung-Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul 03312, Republic of Korea
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Minimally invasive surgery for maximally invasive tumors-pelvic exenterations for rectal cancers: are we prepared? JOURNAL OF MINIMALLY INVASIVE SURGERY 2022; 25:127-128. [PMID: 36601489 PMCID: PMC9763478 DOI: 10.7602/jmis.2022.25.4.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Despite the public awareness of colorectal cancer screening with more and more early premalignant or malignant lesions detected, surgeons still face the challenges of operating for a patient suffering from locally advanced rectal carcinoma which required pelvic exenterations, and surgical outcomes mostly influenced by margin status, adjuvant chemotherapy, positive lymph nodes and liver metastasis, etc. Open pelvic exenteration has been the adopted approach in the past and laparoscopic surgery is another option in expert centers. A study in this issue of the Journal of Minimally Invasive Surgery demonstrated promising results of minimally invasive approaches for pelvic exenteration in patients with locally advanced rectal carcinoma, with overall complication rate of 28.2% with a 7.3% circumferential resection margin positivity and with no distal margin involvement, with local recurrence rate of 8.1% and overall survival of 85.2% by 2-year follow-up. We are expecting more results in the future to support the routine implementation of minimally invasive pelvic exenterations.
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Calborean A, Macavei S, Mocan M, Ciuce C, Bintintan A, Cordos A, Pestean C, Chira R, Zarbo L, Barbu-Tudoran L, Dindelegan G, Nickel F, Mocan B, Surlin V, Bintintan V. Non-invasive laparoscopic detection of small tumors of the digestive tract using inductive sensors of proximity. Sci Rep 2022; 12:760. [PMID: 35031673 PMCID: PMC8760327 DOI: 10.1038/s41598-022-04822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on the normal bowel mucosa, adjacent to the tumor. In the current in-vivo experiments performed on large animals, the modified clips were transported without difficulties to the point of interest and attached to the mucosa of the bowel. Using a laparoscopic approach, the detection rate of this system reached 65% when the sensor scanned the bowel at a speed of 0.3 cm/s, and applying slight pressure on the serosa. This value increased to 95% when the sensor was guided directly on the point of clip attachment. The detection rate dropped sharply when the scanning speed exceeded 1 cm/s and when the sensor-clip distance exceeded the cut-off value of 3 mm. In conclusion, the proposed detection system demonstrated its potential to offer a swift and convenient solution for the digestive laparoscopic surgeons, however its detection range still needs to be improved to render it useful for the clinical setting.
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Affiliation(s)
- Adrian Calborean
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania.
| | - Sergiu Macavei
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Mihaela Mocan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Catalin Ciuce
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adriana Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Adrian Cordos
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Cosmin Pestean
- University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Manastur Street No. 3-5, Cluj-Napoca, Romania
| | - Romeo Chira
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Liviu Zarbo
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- National Institute for Research and Development of Isotopic and Molecular Technologies, Donath Street, No 67-103, Cluj-Napoca, Romania
| | - George Dindelegan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
| | - Felix Nickel
- Clinic for General, Visceral and Transplantation Surgery, University of Heidelberg, INF 110, Heidelberg, Germany
| | - Bogdan Mocan
- Technical University Cluj-Napoca, Memorandumului, Street No.28, Cluj-Napoca, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy Craiova, Petru Rares Street No. 2, 700115, Craiova, Romania
| | - Vasile Bintintan
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, V. Babeş Street No. 8, 400012, Cluj-Napoca, Romania
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Castaño R, Molina-Meneses SP, Puerta JD, Palacios LJ, Jaramillo R, Piñeres A, Aristizábal F. Impact of intraoperative colonoscopy on anastomotic leakage detection and prevention in colorectal anastomosis for rectal cancer. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:312-319. [PMID: 34872887 DOI: 10.1016/j.rgmxen.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND AIM The value of leakage testing during colorectal resections to identify anastomotic leaks or bleeding has not been established. Our aim was to compare the impact of intraoperative colonoscopy (IOC) versus insufflation with a syringe, as leakage testing in lower anterior resection (LAR) for rectal cancer, with respect to the incidence of postoperative leakage (PL). MATERIALS AND METHODS A retrospective study utilizing a prospective database of 426 patients with rectal cancer that underwent elective LAR, within the time frame of January 2015 and December 2019, was conducted. The anastomotic leak test was chosen by the surgeon. The incidence of postoperative leakage was compared between patients that underwent IOC and those that had the syringe leak test, utilizing the logistic regression analysis. Propensity score matching was included. RESULTS There were no significant differences in the clinical characteristics or morbidity and mortality rates between the two groups. Four patients were excluded, leaving a patient total of 422. Seventy patients with IOC were compared with 352 that had the syringe leak test. The incidence of postoperative leakage was 5.7% in the IOC group and 12.2% in the control group (p = 0.001). After propensity score matching (n = 221), balancing the characteristics between the groups, the incidence of postoperative leakage was 5.7% in the IOC group and 13.9% in the syringe leak test group (p = 0.001). CONCLUSION IOC was shown to be a safe method for evaluating the integrity of colorectal anastomosis and was associated with a higher percentage of protective stoma use, appearing to reduce the risk for PL.
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Affiliation(s)
- R Castaño
- Cirugía Gastrointestinal y Endoscopia, Grupo de Gastrohepatología, Universidad de Antioquia, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - S P Molina-Meneses
- Cirugía General, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia.
| | - J D Puerta
- Coloproctología, Clínica Las Américas, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - L J Palacios
- Cirugía Oncológica, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - R Jaramillo
- Cirugía Oncológica, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - A Piñeres
- Cirugía Gastrointestinal y Endoscopia, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - F Aristizábal
- Cirugía General, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
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Tattooing or Metallic Clip Placement? A Review of the Outcome Surrounding Preoperative Localization Methods in Minimally Invasive Anterior Resection Performed at a Single Center. Surg Laparosc Endosc Percutan Tech 2021; 32:101-106. [PMID: 34653111 PMCID: PMC8812424 DOI: 10.1097/sle.0000000000001010] [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: 05/05/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND For minimally invasive colorectal surgery, preoperative localization is a typical procedure. We here aimed to analyze compared 2 different localization methods in terms of short-term outcomes, like the operative outcome and postoperative complication rates based on real-world data. MATERIALS AND METHODS This was a retrospective analysis study conducted at a medical center. We enrolled patients who were presented with colonic tumor between January 1, 2016, and December 31, 2019, and they had undergone laparoscopic anterior resection in a single institution. Data included patient characteristics, operative outcome, length of hospital stay, and postoperative complications. RESULTS The preoperative localization group had a better resection margin (4 vs. 3 cm; P<0.001) and fewer procedures of intraoperative colonoscopy (4.67% vs. 18.22%; P=0.002). Lymph node harvest occurred more in patients with endoscopic tattooing procedures than with metallic clip procedures (25 vs. 20; P=0.031). No significant difference was found regarding postoperative complications and the length of hospital stay. CONCLUSIONS Preoperative localization in a laparoscopic anterior resection led to better surgical planning and resection margin. The metallic clip placement was helpful in the preoperative localization and setting. The endoscopic tattooing method had a larger lymph node harvest and with fewer intraoperative colonoscopy.
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Wang W, Tao F, Lv J. Three-step measures of endoscopic polyp localization in laparoscopic segmental colectomy. ANZ J Surg 2021; 91:1948-1949. [PMID: 34506061 DOI: 10.1111/ans.16975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/15/2021] [Accepted: 05/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wei Wang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, China
| | - Feng Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, China
| | - Jieqing Lv
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, China
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Clifford RE, Fowler H, Manu N, Sutton P, Vimalachandran D. Intra-operative assessment of left-sided colorectal anastomotic integrity: a systematic review of available techniques. Colorectal Dis 2021; 23:582-591. [PMID: 32978892 DOI: 10.1111/codi.15380] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
AIM Anastomotic leak (AL) after colorectal resection is associated with increased rates of morbidity and mortality: potential permanent stoma formation, increased local recurrence, reduced cancer-related survival, poor functional outcomes and associated quality of life. Techniques to reduce leak rates are therefore highly sought. METHOD A literature search was performed for published full text articles using PubMed, Cochrane and Scopus databases with a focus on colorectal surgery 1990-2020. Additional papers were detected by scanning references of relevant papers. RESULTS A total of 53 papers were included after a thorough literature search. Techniques assessed included leak tests, endoscopy, perfusion assessment and fluorescence studies. Air-leak testing remains the most commonly used method across Europe, due to ease of reproducibility and low cost. There is no evidence that this reduces the leak rate; however, identification of a leak intra-operatively provides the opportunity for either suture reinforcement or formal takedown with or without re-do of the anastomosis and consideration of diversion. Suture repair alone of a positive air-leak test is associated with an increased AL rate. The use of fluorescence studies to guide the site of anastomosis has demonstrated reduced leak rates in distal anastomoses, is safe, feasible and has a promising future. CONCLUSION Although over reliance on any assessment tool should be avoided, intra-operative techniques with the aim of reducing AL rates are increasingly being employed. Standardization of these methods is imperative for routine use. However, in the interim it is recommended that all anastomoses should be assessed intra-operatively for mechanical failure, particularly distal anastomoses.
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Affiliation(s)
| | - Hayley Fowler
- Institute of Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Nicola Manu
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Paul Sutton
- Institute of Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Dale Vimalachandran
- Institute of Cancer Medicine, University of Liverpool, Liverpool, UK.,Countess of Chester Hospital NHS Foundation Trust, Chester, UK
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12
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Warps AK, Detering R, Dekker JWT, Tollenaar RAEM, Tanis PJ. A 10-Year Evaluation of Short-Term Outcomes After Synchronous Colorectal Cancer Surgery: a Dutch Population-Based Study. J Gastrointest Surg 2021; 25:2637-2648. [PMID: 34031855 PMCID: PMC8523499 DOI: 10.1007/s11605-021-05036-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/03/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Synchronous colorectal cancer (CRC) has been associated with higher postoperative morbidity and mortality rates compared to solitary CRC. The influence of improved CRC care and introduction of screening on these outcomes remains unknown. This study aimed to evaluate time trends in incidence, population characteristics, and short-term outcomes of synchronous CRC patients at the population level over a 10-year time period. METHODS Data of all patients that underwent resection for primary CRC were extracted from the Dutch ColoRectal Audit (2010-2019). Analyses were stratified for solitary and synchronous colon and rectal cancer. Multilevel logistic regression analyses were used to determine factors associated with pathological and surgical outcomes. RESULTS Among 100,474 patients, 3.1% underwent surgery for synchronous CRC. A screening-related decrease for surgically treated left-sided solitary and synchronous colon cancer and a temporary increase for exclusively right-sided colon cancer were observed. Synchronous CRC patients had higher rates of complicated postoperative course, failure to rescue, and mortality. Bilateral synchronous colon cancer was more often treated with subtotal colectomy (25.4%) and demonstrated higher rates of surgical complications, reinterventions, prolonged hospital stay, and mortality than other synchronous tumor locations. DISCUSSION National bowel screening resulted in contradictory effects on surgical resections for synchronous CRCs depending on sidedness. Bilateral synchronous colon cancer required more often extended resection resulting in significantly worse outcomes than other synchronous tumor locations. Identification of low volume, high complex CRC subpopulations is relevant for individualized care and has implications for case-mix correction and benchmarking in clinical auditing.
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Affiliation(s)
- A. K. Warps
- grid.10419.3d0000000089452978Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,grid.511517.6Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - R. Detering
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J. W. T. Dekker
- grid.415868.60000 0004 0624 5690Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - R. A. E. M. Tollenaar
- grid.10419.3d0000000089452978Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,grid.511517.6Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
| | - P. J. Tanis
- grid.7177.60000000084992262Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Chaouch MA, Kellil T, Jeddi C, Saidani A, Chebbi F, Zouari K. How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review. Ann Coloproctol 2020; 36:213-222. [PMID: 32919437 PMCID: PMC7508486 DOI: 10.3393/ac.2020.05.14.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 02/07/2023] Open
Abstract
Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Tarek Kellil
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Camillia Jeddi
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
| | - Ahmed Saidani
- Department of Digestive Surgery, Mahmoud Matri Hospital, University of Tunis Manar, Tunis, Tunisia
| | - Faouzi Chebbi
- Department of Digestive Surgery, Mahmoud Matri Hospital, University of Tunis Manar, Tunis, Tunisia
| | - Khadija Zouari
- Department of Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
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