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Nassar A, De Ponthaud C, Tzedakis S, Dokmak S, Soubrane O, Thebault B, Sulpice L, Gagnière J, Kianmanesh AR, Souche FR, Fara R, Scwharz L, Gaujoux S, Marchese U. Is there a place for laparoscopic reoperation for complications after minimally invasive pancreatectomy? Surgery 2025; 184:109413. [PMID: 40403477 DOI: 10.1016/j.surg.2025.109413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 04/05/2025] [Accepted: 04/16/2025] [Indexed: 05/24/2025]
Abstract
INTRODUCTION Although the use of the minimally invasive approach is expanding in pancreatic surgery, indications and results of laparoscopic reinterventions after pancreatectomy are unknown. METHODS Based on the multicenter AFC (Association Française de Chirurgie) cohort (2010-2021), patients who underwent open (open reoperation group) or laparoscopic (laparoscopic reoperation group) reoperation within 90 days after minimally invasive pancreatectomy were included and compared. Inverse probability of treatment weighting analysis was performed to determine the impact of laparoscopic reoperation on postoperative mortality. RESULTS Of the 3,412 patients who underwent minimally invasive pancreatectomy, 298 (8.7%) underwent reoperation, with a median delay of 9 days (interquartile range: 4-19 days). Most frequent causes of reintervention were pancreatic fistula with uncontrolled sepsis (postoperative pancreatic fistula) (23%) and hemorrhage (postpancreatectomy hemorrhage) (46%). Sixty-five patients (22%) underwent laparoscopic and 233 (78%) open reoperation. Laparoscopic reoperation was mostly performed for postoperative pancreatic fistula drainage (43%), postpancreatectomy hemorrhage (26%), bowel obstruction (20%), or peritonitis (8%). Patients in the laparoscopic reoperation group were more often reoperated on after distal pancreatectomy (54% vs 36% in open reoperation group, P = .017). After pancreatoduodenectomy, laparoscopic reoperation was more often performed for bowel obstruction compared with open reoperation (20% vs 4%, P = .005). After reintervention, the postoperative mortality rate was 13%. Hospital stay was significantly shorter after laparoscopic reoperation (28 vs 36 days, P = .037). After adjustment for inverse probability of treatment weighting, laparoscopic revision was statistically associated with less postoperative mortality (odds ratio = 0.81, 95% confidence interval: 0.81-0.95). CONCLUSION The laparoscopic approach may be an option for surgical reintervention after minimal invasive pancreatectomy in non-life-threatening indications, mainly after distal pancreatectomy for postoperative pancreatic fistula drainage or after pancreatoduodenectomy for occlusion.
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Affiliation(s)
- Alexandra Nassar
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France.
| | - Charles De Ponthaud
- Department of Hepatobiliary Surgery, Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Stylianos Tzedakis
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
| | - Safi Dokmak
- Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Clichy, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris Cité University, Paris, France
| | - Baudouin Thebault
- Department of Digestive, Endocrine et Thoracic Surgery, Centre Hospitalier Régional, Orléans, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, Centre Hospitalo-Universitaire de Rennes, Rennes, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Auvergne University, Clermont-Auvergne, France
| | - Ali-Reza Kianmanesh
- Department of HPB Surgery, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Francois Regis Souche
- Department of Digestive Surgery A, Centre Hospitalo-Universitaire de Montpellier, Hôpital St-Éloi, Université de Montpellier, Montpellier, France
| | - Regis Fara
- Department of Digestive Surgery, Hôpital Européen, Marseille, France
| | - Lilian Scwharz
- Department of Digestive Surgery, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Sebastien Gaujoux
- Department of Hepatobiliary Surgery, Pancreatic Surgery and Liver Transplantation, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Ugo Marchese
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cité University, Paris, France
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Naderian R, Feyzabadi ZK, Bahoush P, Sanami S, Khatami MS. Congenital absence of omentum with short bowel syndrome: a case report. J Med Case Rep 2025; 19:161. [PMID: 40188137 PMCID: PMC11971864 DOI: 10.1186/s13256-025-05205-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 03/07/2025] [Indexed: 04/07/2025] Open
Abstract
INTRODUCTION Short bowel syndrome can manifest as either an inherited or acquired condition, with the inherited form occurring sporadically. Furthermore, the complete absence of the omentum at birth (congenital absence) is a highly uncommon event. CASE REPORT This case report presents a unique confluence of these rare conditions in a 38-year-old Iranian male with a prior history of intestinal obstruction requiring right hemicolectomy and ileostomy. He subsequently presented to the emergency department experiencing intense abdominal pain and swelling in his lower extremities. Laboratory investigations revealed an elevated white blood cell count and metabolic alkalosis. During the surgical exploration prompted by his acute presentation, both congenital absence of the omentum and short bowel syndrome were confirmed. A jejunostomy was performed, but unfortunately, this intervention resulted in severe malabsorption and subsequent cachexia. This case sheds light on the rare occurrence of anastomotic leakage and subsequent peritonitis following right hemicolectomy and ileostomy in a patient with the combined conditions of congenital short bowel and congenital absence of the omentum. CONCLUSION This unique presentation highlights the potential complexities that can arise due to the convergence of these rare medical conditions.
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Affiliation(s)
- Ramtin Naderian
- Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra Khatibian Feyzabadi
- Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Paniz Bahoush
- Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, Iran
| | - Samira Sanami
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Mir Siamak Khatami
- Department of Surgery, Semnan University of Medical Sciences, Semnan, Iran.
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von Heesen M, Ghadimi M. [Anastomotic leaks in colorectal surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:878-886. [PMID: 39387920 DOI: 10.1007/s00104-024-02180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2024] [Indexed: 10/12/2024]
Abstract
A leakage of a colorectal anastomosis represents a severe complication in visceral surgery. An anastomotic insufficiency (AI) is a potentially life-threatening complication for patients that carries a high risk of subsequent complications and long-term stoma care. Numerous factors influence the risk of AI. Knowing and being able to estimate these factors are essential for successful treatment in colorectal surgery as they help determine the surgical strategy. The recognition of an AI can be challenging for practitioners due to the variability in the clinical presentation. If the presence of AI is suspected appropriate diagnostic measures must therefore be taken. If an AI has occurred a colorectal specialist should definitely be involved in the treatment as this can significantly reduce further complications and the rate of permanent stomas.
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Affiliation(s)
- Maximilian von Heesen
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Michael Ghadimi
- Klinik für Allgemein‑, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Weets V, Meillat H, Saadoun JE, Dazza M, de Chaisemartin C, Lelong B. Impact of an Enhanced Recovery After Surgery (ERAS) program on the management of complications after laparoscopic or robotic colectomy for cancer. Ann Coloproctol 2024; 40:440-450. [PMID: 39477329 PMCID: PMC11532380 DOI: 10.3393/ac.2023.00850.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 11/06/2024] Open
Abstract
PURPOSE Enhanced Recovery After Surgery (ERAS) reduces postoperative complications (POCs) after colorectal surgery; however, its impact on the management of POCs remains unclear. This study compared the diagnosis and management of POCs before and after implementing our ERAS protocol after laparoscopic or robotic colectomy for cancer and examined the short- and mid-term oncologic impacts. METHODS This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic or robotic colectomy for cancer between 2012 and 2021, focusing on the incidence of POCs within 90 days. We compared outcomes before (standard group) and after (ERAS group) the implementation of our ERAS protocol in January 2016. RESULTS Significantly fewer patients in the ERAS group developed POCs (standard vs. ERAS, 136 of 380 patients [35.8%] vs.136 of 660 patients [20.6%]; P<0.01). The ERAS group had a significantly shorter mean total length of stay after POCs (13.1 days vs. 11.4 days, P=0.04), and the rates of life-threatening complications (6.7% vs. 0.7%) and 1-year mortality (7.4% vs. 1.5%) were significantly lower in the ERAS group than in the standard group. Among patients with anastomotic complications, laparoscopic reoperation was significantly more common in the ERAS group than in the standard group (8.3% vs. 75.0%, P<0.01). Among patients with postoperative ileus, the diagnosis and recovery times were significantly shorter in the ERAS group than in the standard group, resulting in a shorter total length of stay (13.5 days vs. 10 days, P<0.01). CONCLUSION The implementation of an ERAS protocol did not eliminate all POCs, but it did accelerate their diagnosis and management and improved patient outcomes.
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Affiliation(s)
- Victoria Weets
- Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France
| | - Hélène Meillat
- Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France
| | | | - Marie Dazza
- Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France
| | | | - Bernard Lelong
- Department of Digestive Surgical Oncology, Institute Paoli-Calmettes, Marseille, France
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Sekra A, Tan T. Endoscopic intermuscular dissection for locally advanced rectal cancer: A case report. World J Surg Proced 2023; 13:22-28. [DOI: 10.5412/wjsp.v13.i3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is < 1000 microns with favourable histopathological features. Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen. To achieve R0 resection, deeper dissection is required.
CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding. He was referred for a colonoscopy test to investigate this further. This revealed a malignant appearing lesion in the rectum. Biopsies however showed high grade dysplasia only. Given endoscopic appearances suspicious for deep submucosal invasion, patient was consented for endoscopic intermuscular dissection (EID). The case was successfully performed, and the presence of muscularis propria was confirmed in the resected specimen. There were no complications and total procedure time was 124 min. Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer. Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.
CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.
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Affiliation(s)
- Anurag Sekra
- Department of Gastroenterology and Hepatology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
| | - Tracy Tan
- Department of Pathology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
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Pyo DH, Huh JW, Lee WY, Yun SH, Kim HC, Cho YB, Park Y, Shin JK. The role of transanal tube after low anterior resection in patients with rectal cancer treated with neoadjuvant chemoradiotherapy: A propensity score-matched study. Surgery 2023; 173:335-341. [PMID: 36494274 DOI: 10.1016/j.surg.2022.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/11/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The protective efficacy of transanal tube for anastomosis was compared with that of diverting stoma in patients with rectal cancer treated with neoadjuvant chemoradiotherapy. METHODS We included consecutive patients with rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery from January 2013 to December 2019. The patients were grouped into transanal tube or diverting stoma, according to the protection methods they received. Propensity score-matching with 1:1 ratio was done. The primary outcome was the incidence of anastomotic leakage. RESULTS Of the 656 eligible patients, 207 (31.6%) and 385 (58.7%) patients were grouped into transanal tube and diverting stoma, respectively, and 64 (9.7%) patients who did not undergo either transanal tube or diverting stoma were excluded. After matching, the incidence of anastomotic leakage was 9.7% and 10.6% in diverting stoma and transanal tube, respectively (P = .871). The overall morbidity was 23.2% and 15.0% in diverting stoma and transanal tube, respectively (P = .045). In the multivariate analysis, tumor size >2.5 cm and level of anastomosis <4 cm were significant risk factors for anastomotic leakage. In a subgroup analysis for patients with the level of anastomosis >4 cm, the incidence of anastomotic leakage was not significantly different between the transanal tube and diverting stoma groups. However, for patients with a level of anastomosis <4 cm, the incidence of grade C anastomotic leakage was significantly greater in the transanal tube than in the diverting stoma group (2.5% vs 9.9%, P = .040). CONCLUSION The protective efficacy of transanal tube may be comparable to diverting stoma, especially for those with a level of anastomosis >4 cm.
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Affiliation(s)
- Dae Hee Pyo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoonah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Casas MA, Angeramo CA, Schlottmann F, Bras Harriott C, Bun ME, Rotholtz NA. Second Laparoscopic Colorectal Resection: Safety and Feasibility. Surg Laparosc Endosc Percutan Tech 2022; 32:696-699. [PMID: 36375109 DOI: 10.1097/sle.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND As laparoscopic colorectal surgery continues increasing worldwide, the need of having a second laparoscopic colorectal resection (SLCR) might increase as well. Experience with this challenging procedure is scarce. The aim of this study was to evaluate the safety and feasibility of SLCR. METHODS A retrospective analysis of a prospectively collected database of patients undergoing colorectal surgery who needed an SLCR during the period 2008-2020 was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A propensity score matching with a control population undergoing a first elective colorectal resection was performed. RESULTS A total of 1918 patients underwent colorectal surgery and 32 patients (1.7%) who required a SLCR were included for analysis; 17 (53.1%) were male, and the mean age was 71 (39 to 89) years. The median time between the first and second operations was 69 (6 to 230) months. At the second resection: The median operative time was 170 (90 to 380) minutes, there were 3 (9%) intraoperative complications and 2 (6%) conversions. Overall postoperative morbidity and major morbidity rates were 34% and 19%, respectively. Four patients (12.5%) required reoperation and 1 (3.1%) died of septic shock after an anastomotic leak. After propensity score matching, SLCR was more frequently performed by colorectal surgeons, and no differences in perioperative variables were observed compared with the control group. CONCLUSIONS SLCR can be safely performed without jeopardizing perioperative outcomes. Further studies are needed to confirm the benefits of the minimally invasive approach in colorectal second resection and to elucidate the long-term outcomes.
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Affiliation(s)
| | | | | | | | - Maximiliano E Bun
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Argentina
| | - Nicolás A Rotholtz
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Argentina
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Chen YC, Tsai YY, Chang SC, Chen HC, Ke TW, Fingerhut A, Chen WTL. Laparoscopic versus open emergent colectomy for ischemic colitis: a propensity score-matched comparison. World J Emerg Surg 2022; 17:53. [PMID: 36229844 PMCID: PMC9563494 DOI: 10.1186/s13017-022-00458-4] [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: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
Methods Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group. Results Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier’s classification (p = 0.023) were independent predictors of mortality. Conclusions Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
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Affiliation(s)
- Yi-Chang Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hung-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong RD, Zhubei City, 30272, Hsinchu County, Taiwan, ROC.
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Angeramo CA, Schlottmann F, Laporte M, Bun ME, Rotholtz NA. Re-laparoscopy to Treat Early Complications After Colorectal Surgery: Is There a Learning Curve? Surg Laparosc Endosc Percutan Tech 2022; 32:362-367. [PMID: 35583576 DOI: 10.1097/sle.0000000000001052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopy for treating complications after laparoscopic colorectal surgery (LCS) is still controversial. Moreover, its learning curve has not been evaluated yet. The aim of this study was to analyze whether operative outcomes were influenced by the learning curve of re-laparoscopy. METHODS A retrospective analysis of patients undergoing LCS and reoperated by a laparoscopic approach during the period 2000-2019 was performed. A cumulative sum analysis was done to determine the number of operations that must be performed to achieve a stable operative time. Based on this analysis, the cohort was divided in 3 groups. Demographics and operative variables were compared between groups. RESULTS From a total of 1911 patients undergoing LCS, 132 (7%) were included. Based on the cumulative sum analysis, the cohort was divided into the first 50 (G1), the following 52 (G2), and the last 30 (G3) patients. Less computed tomography scans were performed in G3 (G1: 72% vs. G2: 63% vs. G3: 43%; P=0.03). There were no differences in the type of operation performed between the groups. The conversion rate (G1: 18% vs. G2: 4% vs. G3: 3%; P=0.02) and the mean operative time (G1: 104 min vs. G2: 80 min vs. G3: 78 min; P=0.003) were higher in G1. Overall morbidity was lower in G3 (G1: 46% vs. G2: 63% vs. G3: 33%; P=0.01). Major morbidity, mortality, and mean length of stay remained similar in all groups. CONCLUSIONS A total of 50 laparoscopic reoperations might be needed to achieve an appropriate learning curve with reduced operative time and lower conversion rates. Further research is needed to determine the learning process of re-laparoscopy for treating complications after colorectal surgery.
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Affiliation(s)
| | | | - Mariano Laporte
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano E Bun
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Nicolas A Rotholtz
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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Rotholtz NA, Laporte M, Matzner M, Schlottmann F, Bun ME. "Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc 2022; 36:3136-3140. [PMID: 34159459 DOI: 10.1007/s00464-021-08616-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic surgery has shown clear benefits that could also be useful in the emergency setting such as early reoperations after colorectal surgery. The aim of this study was to evaluate the safety and feasibility of laparoscopic reintervention ("relaparoscopy") (RL) to manage postoperative complications after laparoscopic colorectal surgery. METHODS We performed a retrospective study based on a prospectively collected database from 2000 to 2019. Patients who required a reoperation after undergoing laparoscopic colorectal surgery were included. According to the approach used at the reoperation, the cohort was divided in laparoscopy (RL) and laparotomy (LPM). Demographics, hospital stay, morbidity, and mortality were analyzed. RESULTS A total of 159 patients underwent a reoperation after a laparoscopic colorectal surgery: 124 (78%) had RL and 35 (22%) LPM. Demographics were similar in both groups. Patients who underwent left colectomy were more frequently reoperated by laparoscopy (RL: 42.7% vs. LPM: 22.8%, p: 0.03). The most common finding at the reoperation was anastomotic leakage, which was treated more often by RL (RL: 67.7% vs. LPM: 25.7%, p: 0.0001), and the most common strategy was drainage and loop ileostomy (RL: 65.8% vs. LPM: 17.6%, p: 0.00001). Conversion was necessary in 12 patients (9.6%). Overall morbidity rate was 52.2%. Patients in the RL group had less postoperative severe complications (RL: 12.1% vs. LPM: 22.8, p: 0.01). Mortality rate was similar in both groups. CONCLUSION Relaparoscopy is feasible and safe for treating early postoperative complications, particularly anastomotic leakage after left colectomy.
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Affiliation(s)
- Nicolas A Rotholtz
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina.
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
| | - Mariano Laporte
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Mariana Matzner
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina
| | - Maximiliano E Bun
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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Chen YC, Ke TW, Tsai YY, Fingerhut A, Chen WTL. Laparoscopic redo anastomosis for management of intraperitoneal anastomotic leakage after colonic surgery. BMC Surg 2022; 22:116. [PMID: 35337322 PMCID: PMC8957142 DOI: 10.1186/s12893-022-01555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still no consensus on the management of intraperitoneal anastomotic leakage after colonic surgery. Among of various treatment strategies, laparoscopic redo anastomosis for intraperitoneal leakage has rarely been reported in the literature and is condemned by some. The aim of this study is to demonstrate the feasibility and safety of laparoscopic redo anastomosis for intraperitoneal anastomotic leakage. METHODS Retrospective chart review of laparoscopic redo anastomosis for intraperitoneal anastomotic leakage after colonic surgery from January 2013 to May 2020. An accompanying video demonstrates the technique. RESULTS Fifteen consecutive patients underwent laparoscopic redo anastomosis for management of leakage after colonic surgery; two patients required conversion to open repair. A protective stoma was created in three patients during the second operation. There was no re-leakage nor mortality in this series. CONCLUSIONS Laparoscopic redo anastomosis was feasible and safe for the management of intraperitoneal anastomotic leakage after colonic surgery. Considering the advantages of re-do laparoscopy, this procedure should be part of every surgeon's armamentarium to deal with anastomotic leakage and represents a logical alternative to the "Diversion and Drainage" technique.
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Affiliation(s)
- Yi-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Minimally Invasive Surgery Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Department of Surgery, Medical University of Graz, Graz, Austria
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12
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Chen YC, Fingerhut A, Tsai YY, Chang SC, Ke TW, Shen MY, Tzu-Liang Chen W. Laparoscopic Reintervention for Intraperitoneal Leaks After Colonic Surgery: Do We Need a Routine Stoma? Surg Innov 2022; 29:697-704. [PMID: 35227152 DOI: 10.1177/15533506211070177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION No universal consensus exists on the management of intraperitoneal anastomosis leakage after colonic surgery. The aim of the study was to evaluate the outcomes of laparoscopic reintervention without stoma creation for intraperitoneal leaks after colonic surgery. MATERIAL AND METHODS Single tertiary center study conducted from January 2010 to December 2020. 54 patients with intraperitoneal leakage were divided into 2 groups according to whether they received a stoma (n = 37) or not (n = 17) during laparoscopic reintervention. Short term outcome was analyzed. RESULTS Patients in the no stoma group had lower American Society of Anesthesiologists (ASA) score (P = .009), lower Acute Physiology And Chronic Health Evaluation II (APACHE II) score (5 vs. 10; P < .001) compared with the stoma group. Intensive care unit admission (43.2% vs. 5.8%; P = .006) and major complications (35.1% vs. 5.8%; P = .015) occurred more in the stoma group compared to the no stoma group. After multivariate logistic regression analysis, initial surgical procedure (P = .001) and APACHE II score (P = .039) were significant predictors of no stoma. The APACHE II score(P = .035) was an independent predictor of major complications. Finally, Receiver Operating Characteristic curve analysis showed that the cutoff value of APACHE II score for no stoma was 7.5. CONCLUSIONS In our study, APACHE II score was an independent predictor of stoma formation and the cutoff value of APACHE II score for no stoma was 7.5. Our results need to be confirmed by larger and randomized studies. In particular, a specific APACHE II threshold to omit a stoma in this setting remains to be determined.
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Affiliation(s)
- Yi-Chang Chen
- Attending Surgeon, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taichung, Taiwan
| | - Abe Fingerhut
- Associate professor Surgical Research Unit, Department of Surgery, Medical University of Graz, and Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Poissy, France
| | - Yuan-Yao Tsai
- Attending Surgeon, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taichung, Taiwan
| | - Sheng-Chi Chang
- Attending Surgeon, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taichung, Taiwan
| | - Tao-Wei Ke
- Attending Surgeon, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taichung, Taiwan
| | - Ming-Yin Shen
- Director, Department of Colorectal Surgery, RinggoldID:%2038020China Medical University Hospital, Taiwan, China
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13
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Chen YC, Tsai YY, Ke TW, Fingerhut A, Chen WTL. Transanal endoluminal repair for anastomotic leakage after low anterior resection. BMC Surg 2022; 22:24. [PMID: 35081948 PMCID: PMC8793212 DOI: 10.1186/s12893-022-01484-4] [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: 10/17/2021] [Accepted: 01/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still no consensus on the management of colorectal anastomotic leakage after low anterior resection. The goal was to evaluate the outcomes of patients who underwent transanal endoluminal repair + laparoscopic drainage ± stoma vs. drainage only ± stoma. METHODS Retrospective chart review of patients sustaining anastomotic leakage after laparoscopic low anterior resection between January 2013 and September 2020 who required laparoscopic reoperation. RESULTS Forty-nine patients were included, 22 patients underwent combined laparoscopy and transanal endoluminal repair and 27 patients had drainage with a stoma (n = 16) or drainage alone (n = 11), without direct anastomotic repair. The overall morbidity rate was 30.6% and the mortality rate was 2%. Combined laparoscopic lavage/drainage and transanal endoluminal repair of anastomotic leakage was associated with a lower complication rate (13.6% vs. 44.4%, p = 0.03) and fewer intraabdominal infections (4.5% vs. 29.6%, p = 0.03) compared with no repair. CONCLUSIONS Combined laparoscopic lavage/drainage and transanal endoluminal repair is effective in the management of colorectal anastomosis leakage and was associated with lower morbidity-in particular intraabdominal infection-compared with no repair. However, our results need to be confirmed in larger, and ideally randomized, studies.
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Affiliation(s)
- Yi-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, People's Republic of China.,Medical University Hospital of Graz, Graz, Austria
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14
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Abstract
Management of the acute anastomotic leak is complex and patient-specific. Clinically stable patients often benefit from a nonoperative approach utilizing antibiotics with or without percutaneous drainage. Clinically unstable patients or nonresponders to conservative management require operative intervention. Surgical management is dictated by the degree of contamination and inflammation but includes drainage with proximal diversion, anastomotic resection with end-stoma creation, or reanastomosis with proximal diversion. Newer therapies, including colorectal stenting, vacuum-assisted rectal drainage, and endoscopic clipping, have also been described.
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Affiliation(s)
- Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - William Kane
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
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15
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Casas MA, Laxague F, Schlottmann F, Sadava EE. Re-laparoscopy for the treatment of complications after laparoscopic appendectomy: is it possible to maintain the minimally invasive approach? Updates Surg 2021; 73:2199-2204. [PMID: 33174113 DOI: 10.1007/s13304-020-00917-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
Despite laparoscopy is considered an adequate tool for the diagnosis and management of postoperative surgical complications, its role after laparoscopic appendectomy (LA) remains uncertain. The aim of this study was to evaluate whether laparoscopy is useful for treating complications after laparoscopic appendectomy. A retrospective analysis of a prospectively collected database of patients undergoing LA, who needed a reoperation for postoperative complications during the period 2006-2020, was performed. Demographics, operative variables, and postoperative outcomes were analyzed. A total of 2019 LA were performed, and 41 patients (2%) underwent a RL for post appendectomy complications. Twenty-three patients (56%) were male. The mean age was 32 years old (16-92 years). The majority of patients (75%) had a complicated acute appendicitis in the first operation. The most common findings at RL were generalized peritonitis (36.4%) and intraabdominal abscesses (26.8%). Five patients (12.1%) developed stump appendicitis, all of them as a late complication. The procedures were completed laparoscopically in 85% and 6 patients (15%) required conversion to an open approach. Three patients (7.3%) required a percutaneous drainage and two patients (4.9%) needed an additional surgery (laparotomy) after RL, all of them presenting with generalized peritonitis at the RL. No mortality was registered. Re-laparoscopy is feasible, safe, and highly effective for the diagnosis and treatment of post appendectomy complications. RL should be encouraged to avoid more aggressive procedures.
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Affiliation(s)
- María A Casas
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina
| | - Emmanuel Ezequiel Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Av. Pueyrredón 1640 (ATT 1118), Buenos Aires, Argentina.
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16
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Rotholtz NA, Angeramo CA, Laporte M, Matzner Perfumo M, Schlottmann F, Bun ME. "Early" Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better. Surg Laparosc Endosc Percutan Tech 2021; 31:756-759. [PMID: 34406166 DOI: 10.1097/sle.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Some postoperative complications after laparoscopic colorectal surgery (LCS) require reoperation to be treated. However, if the timing to perform this reoperation has some influence on outcome remains elusive. The aim of this study was to analyze if the timing to perform the reoperation has some influence in postoperative outcomes. METHODS A retrospective analysis of patients undergoing LCS and required a reoperation during the period 2000 to 2019 were included. The cohort was divided into 2 groups: early reoperation (ER): ≤48 hours or delayed reoperation (DR): ≥48 hours based on the interval between the suspicion of a complication and reoperation. Demographics, operative variables, and postoperative outcomes were compared between groups. RESULTS A total of 1843 LCS were performed, 68 (43%) were included in ER and 91 (57%) in DR. A computed tomography scan was less frequently performed in the ER (ER: 45% vs. DR: 70%; P=0.001). The rates of re-laparoscopy (ER: 86% vs. 73%; P=0.04) and negative findings in the reoperation (ER: 13% vs. DR: 1%, P=0.001) were higher in ER. There were no statistically significant differences in overall major morbidity (ER: 9% vs. DR: 21%; P=0.06) and mortality rate (ER: 4% vs. DR: 8.7%; P=0.28) between groups. The need of intensive care unit was significantly higher and the length of stay longer for patients in the DR group. CONCLUSIONS Despite a greater risk of negative findings, ER within 48 hours after the suspicion of a complication after a LCS offers higher chances of using a laparoscopic approach and it could probably provide better postoperative outcomes.
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Affiliation(s)
- Nicolas A Rotholtz
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Mariano Laporte
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Maximiliano E Bun
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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17
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Borghi F, Migliore M, Cianflocca D, Ruffo G, Patriti A, Delrio P, Scatizzi M, Mancini S, Garulli G, Lucchi A, Carrara A, Pirozzi F, Scabini S, Liverani A, Baiocchi G, Campagnacci R, Muratore A, Longo G, Caricato M, Macarone Palmieri R, Vettoretto N, Ciano P, Benedetti M, Bertocchi E, Ceccaroni M, Pace U, Pandolfini L, Sagnotta A, Pirrera B, Alagna V, Martorelli G, Tirone G, Motter M, Sciuto A, Martino A, Scarinci A, Molfino S, Maurizi A, Marsanic P, Tomassini F, Santoni S, Capolupo GT, Amodio P, Arici E, Cicconi S, Marziali I, Guercioni G, Catarci M. Management and 1-year outcomes of anastomotic leakage after elective colorectal surgery. Int J Colorectal Dis 2021; 36:929-939. [PMID: 33118101 DOI: 10.1007/s00384-020-03777-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To analyze different types of management and one-year outcomes of anastomotic leakage (AL) after elective colorectal resection. METHODS All patients with anastomotic leakage after elective colorectal surgery with anastomosis (76/1,546; 4.9%), with the exclusion of cases with proximal diverting stoma, were followed-up for at least one year. Primary endpoints were as follows: composite outcome of one-year mortality and/or unplanned intensive care unit (ICU) admission and additional morbidity rates. Secondary endpoints were as follows: length of stay (LOS), one-year persistent stoma rate, and rate of return to intended oncologic therapy (RIOT). RESULTS One-year mortality rate was 10.5% and unplanned ICU admission rate was 30.3%. Risk factors of the composite outcome included age (aOR = 1.08 per 1-year increase, p = 0.002) and anastomotic breakdown with end stoma at reoperation (aOR = 2.77, p = 0.007). Additional morbidity rate was 52.6%: risk factors included open versus laparoscopic reoperation (aOR = 4.38, p = 0.03) and ICU admission (aOR = 3.63, p = 0.05). Median (IQR) overall LOS was 20 days (14-26), higher in the subgroup of patients reoperated without stoma. At 1 year, a stoma persisted in 32.0% of patients, higher in the open (41.2%) versus laparoscopic (12.5%) reoperation group (p = 0.04). Only 4 out of 18 patients (22.2%) were able to RIOT. CONCLUSION Mortality and/or unplanned ICU admission rates after AL are influenced by increasing age and by anastomotic breakdown at reoperation; additional morbidity rates are influenced by unplanned ICU admission and by laparoscopic approach to reoperation, the latter also reducing permanent stoma and failure to RIOT rates. TRIAL REGISTRATION ClinicalTrials.gov # NCT03560180.
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Affiliation(s)
- Felice Borghi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy.
| | - Marco Migliore
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Desirée Cianflocca
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Giacomo Ruffo
- General Surgery & Gynecology Units, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Alberto Patriti
- Department of Surgery, Marche Nord Hospital, Pesaro e Fano, PU, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, IRCCS G. Pascale Foundation, Napoli, Italy
| | - Marco Scatizzi
- General & Oncologic Surgery Unit, Santo Stefano Hospital, Prato, FI, Italy
| | - Stefano Mancini
- General & Oncologic Surgery Unit, San Filippo Neri Hospital, Roma, Italy
| | | | - Andrea Lucchi
- General Surgery Unit, Ceccarini Hospital, Riccione, RN, Italy
| | | | - Felice Pirozzi
- Abdominal Surgery Unit, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Stefano Scabini
- General & Oncologic Surgery Unit, National Cancer Center San Martino, Genova, Italy
| | - Andrea Liverani
- General Surgery Unit, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - Gianluca Baiocchi
- General Surgery Unit 3, University & Spedali Civili of Brescia, Brescia, Italy
| | | | - Andrea Muratore
- General Surgery Unit, E. Agnelli Hospital, Pinerolo, TO, Italy
| | | | - Marco Caricato
- Colorectal Surgery Unit, University & Policlinico Campus Bio-Medico di Roma, Roma, Italy
| | | | - Nereo Vettoretto
- General Surgery Unit, Spedali Civili of Brescia, Montichiari, BS, Italy
| | - Paolo Ciano
- General Surgery Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
| | - Michele Benedetti
- General Surgery Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
| | - Elisa Bertocchi
- General Surgery & Gynecology Units, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Marcello Ceccaroni
- General Surgery & Gynecology Units, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Ugo Pace
- Colorectal Surgical Oncology, IRCCS G. Pascale Foundation, Napoli, Italy
| | - Lorenzo Pandolfini
- General & Oncologic Surgery Unit, Santo Stefano Hospital, Prato, FI, Italy
| | - Andrea Sagnotta
- General & Oncologic Surgery Unit, San Filippo Neri Hospital, Roma, Italy
| | | | | | | | | | - Michele Motter
- Department of Surgery, Santa Chiara Hospital, Trento, Italy
| | - Antonio Sciuto
- Abdominal Surgery Unit, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, FG, Italy
| | - Antonio Martino
- General & Oncologic Surgery Unit, National Cancer Center San Martino, Genova, Italy
| | - Andrea Scarinci
- General Surgery Unit, Regina Apostolorum Hospital, Albano Laziale, RM, Italy
| | - Sarah Molfino
- General Surgery Unit 3, University & Spedali Civili of Brescia, Brescia, Italy
| | - Angela Maurizi
- Department of Surgery, C. Urbani Hospital, Jesi, AN, Italy
| | | | | | | | | | - Pietro Amodio
- General & Oncologic Surgery Unit, Belcolle Hospital, Viterbo, Italy
| | - Elisa Arici
- General Surgery Unit, Spedali Civili of Brescia, Montichiari, BS, Italy
| | - Simone Cicconi
- General Surgery Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
| | - Irene Marziali
- General Surgery Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
| | | | - Marco Catarci
- General Surgery Unit, C. e G. Mazzoni Hospital, Ascoli Piceno, Italy
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18
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Fransvea P, Costa G, D'Agostino L, Sganga G, Serao A. Redo-laparoscopy in the management of complications after laparoscopic colorectal surgery: a systematic review and meta-analysis of surgical outcomes. Tech Coloproctol 2021; 25:371-383. [PMID: 33230649 DOI: 10.1007/s10151-020-02374-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The laparoscopic approach for colorectal surgery has gradually become widely accepted for the treatment of both benign and malignant diseases thanks to its several advantages over the open approach. However, it is associated with the same potential postoperative complications. Some recent studies have analyzed the potential role of laparoscopy in early diagnosis and management of complications following laparoscopic colorectal surgery. The aim of this systematic review was to investigate the outcomes of redo-laparoscopy (RL) for the management of early postoperative complications following laparoscopic colorectal surgery, focusing on length of stay, morbidity and mortality. METHODS A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines through MEDLINE (PubMed), Embase and Google Scholar from January 1990 to December 2019. The main outcomes examined were conversion rate, length of hospital stay, postoperative morbidity and mortality rates. A meta-analysis of all eligible studies was then conducted and forest plots were generated. RESULTS A total of 19 studies involving 1394 patients who required reoperation after laparoscopic colorectal resection were included. In 539 (38.2%) of these patients, a laparoscopic approach was adopted. The most common indication for returning to the operating theater was anastomotic leakage (64.4% of all redo-surgeries, 67.7% of RL) and the most common type of intervention performed in RL was diverting stoma with or without anastomotic repair/redo (47.1%). Nine studies were included in the pooled analysis. The mean length of stay was significantly shorter in the RL group than in the redo-open one (WMD = - 0.90; 95% CI - 1.04 to - 0.76; Z = - 12,6; p < 0.001). A significantly lower risk of mortality was observed in the RL cohort (OR = - 0.91; 95% CI - 1.58 to - 0.23; Z = - 2.62; p = 0.009). CONCLUSIONS Laparoscopy is a valid and effective approach for the treatment of complications following laparoscopic primary colorectal surgery thanks to it is well-established advantages over the open approach, which remain noticeable even in redo-surgeries.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - G Costa
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - L D'Agostino
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - G Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - A Serao
- General Surgery Department, Ospedale Dei Castelli, ASL RM 6, Rome, Italy
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19
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Halkias C, Zoikas A, Garoufalia Z, Konstantinidis MK, Ioannidis A, Wexner S. Re-Operative Laparoscopic Colorectal Surgery: A Systematic Review. J Clin Med 2021; 10:jcm10071447. [PMID: 33916216 PMCID: PMC8036625 DOI: 10.3390/jcm10071447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and case series were included, with case reports being excluded. Results: Seventeen articles dated from 2007 to 2020 were included in the systematic review. In total, 1555 patients were identified. Five hundred and seventy-four of them had a laparoscopic procedure and 981 an open re-operation. One hundred and eighty-three women had a laparoscopic operation. The median age ranged from to 44.9 years to 68.7 years. In seven studies, the indication of the index operation was malignancy, one study regarded re-laparoscopy for excision of lateral pelvic lymph nodes, and one study looked at redo surgery of ileal J pouch anal anastomosis. There were 16 mortalities in the laparoscopic arm (2.78%) and 93 (9.4%) in the open surgery arm. One hundred and thirty-seven morbidities were recorded in the open arm and 102 in the laparoscopic arm. Thirty-nine conversions to open occurred. The median length of stay ranged from 5.8 days to 19 days in laparoscopy and 9.7 to 34 days in the open surgery arm. Conclusions: Re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. The management of complications, recurrence of malignancy, and lateral pelvic floor dissection can be safely performed. The complication rate is low, with conversion to open procedures being relatively uncommon.
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Affiliation(s)
- Constantine Halkias
- General Surgery Department, Brighton and Sussex University Hospitals, Brighton BN2 5BE, UK
- Correspondence:
| | - Athanasios Zoikas
- The 2nd Department of Surgery, Sismanoglio General Hospital of Attica, 15126 Athens, Greece;
| | - Zoe Garoufalia
- The 2nd Department of Propaedeutic Surgery, Laiko General Hospital, 11527 Athens, Greece;
| | - Michalis K. Konstantinidis
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, 15125 Athens, Greece; (M.K.K.); (A.I.)
| | - Argyrios Ioannidis
- Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, 15125 Athens, Greece; (M.K.K.); (A.I.)
| | - Steven Wexner
- Digestive Disease Center, Cleveland Clinic Florida, Weston, FL 33331, USA;
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20
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Tzu-Liang Chen W, Fingerhut A. Minimal access surgery has its place in the treatment of anastomotic leakage after anterior resection: Suggestion for a modification of the International Study Group of Rectal Cancer (ISREC) classification. Surgery 2021; 170:345-346. [PMID: 33781586 DOI: 10.1016/j.surg.2021.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Abe Fingerhut
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz Austria; Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, People's Republic of China.
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21
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Laparoscopic Versus Open Re-operations Within 30 Days After Lower Gastrointestinal Tract Surgery: a Retrospective Comparative Study. World J Surg 2021; 45:1548-1560. [PMID: 33506293 DOI: 10.1007/s00268-021-05970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Re-operations within 30 days after lower gastrointestinal tract surgery are associated to high morbidity and mortality. Laparoscopic approach has been reported as feasible and safe in selected patients, but comparative data to laparotomy are scarce. The aim of this study was to review our experience in laparoscopic re-operations and compare it to laparotomy. METHODS From January 2012 to December 2016, patients undergoing a re-operation within one month after lower gastrointestinal tract surgery were included and divided into laparoscopy and laparotomy groups. The primary endpoint was successful re-operation, defined as recovery without any of the following: conversion to laparotomy, need of further invasive treatments or death. Secondary outcomes were the length of hospital stay and 30-day morbidity and mortality. Demographic, clinical and surgical characteristics were collected and analyzed. RESULTS Out of 114 patients who underwent a re-operation, 71 met the inclusion criteria. Thirty (42%) patients underwent laparoscopy and 41 (58%) laparotomy. Thirty (42%) patients were male and median age was 72.0 years-old. The initial operation was elective in 24 (34%) patients, and 50% of the initial operations were colorectal resections in both groups. Multivariate analyses showed that type of approach did not affect the re-operation success rate. Laparotomy was an independent predictor of prolonged hospital stay (OR 3.582, 95%CI 1.191-10.776, p = 0.023) and mortality (OR 13.123, 95%CI 1.301-131.579, p = 0.029). CONCLUSIONS Re-operations within 30 days after lower gastrointestinal tract surgery may be safe in selected patients, as effective as laparotomy, and associated with shorter hospital stay and lower mortality rates.
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22
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Mari G, Achilli P, Crippa J, Cordaro G, Berardi V, Di Fratta E, Maggioni D. Laparoscopic treatment of diffuse peritonitis for ileocolic anastomotic leak following totally laparoscopic right hemicolectomy. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giulio Mari
- Department of General Surgery Desio Hospital Desio (MB) Italy
| | - Pietro Achilli
- University of Milan, General Surgery Residency Program Milan Italy
| | - Jacopo Crippa
- University of Milan, General Surgery Residency Program Milan Italy
| | - Giuseppe Cordaro
- University of Milan, General Surgery Residency Program Milan Italy
| | - Valter Berardi
- Department of General Surgery Desio Hospital Desio (MB) Italy
| | | | - Dario Maggioni
- Department of General Surgery Desio Hospital Desio (MB) Italy
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23
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Kudsi OY, Chang K, Bou-Ayash N. Robotic approach to delayed anastomotic leakage after ileocaecectomy for a neuroendocrine tumour - a video vignette. Colorectal Dis 2020; 22:1470. [PMID: 32372480 DOI: 10.1111/codi.15108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Affiliation(s)
- O Y Kudsi
- Good Samaritan Medical Center, Brockton, Massachusetts, USA.,Tufts University School of Medicine, Brockton, Massachusetts, USA
| | - K Chang
- Good Samaritan Medical Center, Brockton, Massachusetts, USA
| | - N Bou-Ayash
- Good Samaritan Medical Center, Brockton, Massachusetts, USA
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Anastomotic Leak Does Not Impact Oncologic Outcomes After Preoperative Chemoradiotherapy and Resection for Rectal Cancer. Ann Surg 2020; 269:678-685. [PMID: 29112004 DOI: 10.1097/sla.0000000000002582] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship of anastomotic leakage, local recurrence, and overall survival in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection. BACKGROUND Little is known about the association between anastomotic leakage and oncologic outcomes after preoperative CRT. METHODS A total of 698 consecutive primary rectal cancer patients after preoperative CRT between April 19, 2000, and December 27, 2013, were retrospectively reviewed. Forty-seven patients who had anastomotic leakage were compared with 651 patients who had no anastomotic leakage. RESULTS Of 698 patients, 47 (6.7%) patients had anastomotic leakage. Among these 47 patients, 39 (83.0%) had grade C leak that required urgent operation, while 8 (17.0%) had grade B leak that was managed expectantly or by percutaneous drainage. The median follow-up period was 47.6 months (range, 27.1 to 68.9 months). One hundred twenty (17.2%) recurrences were identified among all patients. The median overall disease-free survival was 43 months (range, 22.4 to 66.7 months). Five-year disease-free survival did not differ significantly between the 2 groups (80.5% vs 80.4%, P = 0.839). Five-year local recurrence-free survival did not differ significantly either between the 2 groups (93.7% vs 94.9%, P = 0.653). Five-year overall survival rates of patients with or without leakage were 90.9% and 86.3%, respectively (P = 0.242). Five-year cancer-specific survival rates of patients with or without leakage were 92.2% and 86.3%, respectively (P = 0.248). CONCLUSION After preoperative CRT, an anastomotic leak is not associated with a significant increase in local recurrence or long-term survival in rectal cancer.
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Shelygin YA, Nagudov MA, Ponomarenko AA, Alekseev MV, Rybakov EG, Tarasov MA, Achkasov SI. [Meta-analysis of management of colorectal anastomotic leakage]. Khirurgiia (Mosk) 2018:30-41. [PMID: 30199049 DOI: 10.17116/hirurgia201808230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To identify the most effective management of colorectal anastomosis failure via analysis of available literature sources. RESULTS Systematic review included 20 original trials. Effectiveness of redo interventions for colorectal anastomosis failure including open, laparoscopic, minimally invasive techniques (transanal drainage, endoscopic vacuum therapy, endoscopic drainage) was described. Anastomotic failure rate was 6.5%. Medication was effective in 57% (95% CI 34-77%) of cases. Redo open surgery was applied in 43% (95% CI 23-66%) of patients. Postoperative mortality was 21-27%. Redo laparoscopic procedure was performed in 61% (95% CI 50-70%) of cases for anastomotic failure after previous laparoscopy, incidence of conversion was 12% (95% CI 4-28%). Transanal drainage was effective in 85% (95% CI 61-94%) of cases, endoscopic vacuum therapy - in 82% (95% CI 74-87%), healing of anastomosis without need for colostomy was achieved in 16% (95% CI 9-26%) of cases. Endoscopic clipping for colorectal anastomotic defect was effective in 73.3-77% of cases. CONCLUSION Redo surgery for anastomotic failure is associated with advanced mortality and need for permanent colostomy. Laparoscopic approach reduces incidence of complications after redo surgery and followed by better functional outcomes. Minimally invasive procedures are advisable for colorectal anastomosis failure without need for redo surgery. However, effectiveness of these methods is controversial due to few reports and no comparative trials.
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Affiliation(s)
- Yu A Shelygin
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation; Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - M A Nagudov
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - A A Ponomarenko
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - M V Alekseev
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation; Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - E G Rybakov
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - M A Tarasov
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation
| | - S I Achkasov
- Ryzhikh State Medical Coloproctology Center of Healthcare Ministry of Russia, Moscow, Russian Federation
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Eriksen JR, Ovesen H, Gögenur I. Short- and long-term outcomes after colorectal anastomotic leakage is affected by surgical approach at reoperation. Int J Colorectal Dis 2018; 33:1097-1105. [PMID: 29754169 DOI: 10.1007/s00384-018-3079-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anastomotic leakage is the most serious surgical complication following colorectal resection, and surgical intervention is often required. The purpose of the study was to investigate short- and long-term outcomes after reoperation for anastomotic leakage. METHOD Patients with a symptomatic anastomotic leakage following a laparoscopic colorectal cancer resection from January 2009 to December 2014 were identified from our local prospective database. Patients were grouped according to the management of anastomotic leaks: local, lap, or open approach. Primary outcomes were length of stay, chance of bowel continuity, and overall mortality. RESULTS A total of 113 patients were included. The median follow-up time was 40 months (0-82 months). Overall mortality was significantly associated with UICC stage III-VI disease (vs. UICC stage I-II disease) [adj. HR 5.35 (CI 2.32-12.4), p = 0.0001] and minimal invasive reoperation compared with open approach [local: adj. HR 0.12 (CI 0.03-0.52), p = 0.004; lap: adj. HR 0.32 (CI 0.12-0.86), p = 0.024]. Chance of bowel continuity was significantly increased in younger patients below 67 years [adj. OR 6.15 (1.76-21.5), p = 0.004] and following a local procedure [adj. OR 7.45 (1.07-51.8), p = 0.043]. Patients in the open group had significantly longer length of stay and time to initiation of adjuvant chemotherapy compared with those in the lap group. CONCLUSION Our data confirms that minimal invasive reoperation for anastomotic leakage is a safe and feasible approach associated with short- and long-term advantages and can be chosen in selected cases.
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Affiliation(s)
- Jens Ravn Eriksen
- Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Henrik Ovesen
- Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Ismail Gögenur
- Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark
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Numata M, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Furuatni A, Manabe S, Yamaoka Y, Torii K, Kato S. Safety and feasibility of laparoscopic reoperation for treatment of anastomotic leakage after laparoscopic colorectal cancer surgery. Asian J Endosc Surg 2018; 11:227-232. [PMID: 29322627 DOI: 10.1111/ases.12452] [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: 10/11/2017] [Revised: 11/10/2017] [Accepted: 11/26/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The safety and feasibility of laparoscopic reoperation for anastomotic leakage remain unclear. METHODS A total of 3321 patients underwent laparoscopic surgery for primary colorectal cancer at a tertiary referral center from September 2002 to May 2016. Of these, 31 patients who underwent reoperation for treatment of anastomotic leakage were enrolled in this study and divided into two reoperation groups: laparoscopic (n = 15) and open (n = 16). Data regarding patient demographics, operative outcomes, morbidity, length of hospital stay, mortality, and stoma closure after reoperation in the two groups were compared. RESULTS No significant difference was observed in the primary surgery procedure between the two groups. Estimated blood loss (1 vs 9 mL, P = 0.020), total postoperative complications (26.7% vs 68.8%, P = 0.032), wound infection (0.0% vs 31.2%, P = 0.043), and postoperative hospital stay (18 vs 31 days, P = 0.017) were significantly better in the laparoscopic group than in the open group. Although the rate of stoma closure after reoperation was higher in the laparoscopic group, the difference was not significant (86.7% vs 62.5%, P = 0.220). CONCLUSIONS Laparoscopic reoperation exhibited better short-term outcomes than open reoperation for selected patients with anastomotic leakage.
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Affiliation(s)
- Masakatsu Numata
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Akinobu Furuatni
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Kakeru Torii
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shunichiro Kato
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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Chen WTL, Bansal S, Ke TW, Chang SC, Huang YC, Kato T, Wang HM, Fingerhut A. Combined repeat laparoscopy and transanal endolumenal repair (hybrid approach) in the early management of postoperative colorectal anastomotic leaks: technique and outcomes. Surg Endosc 2018; 32:4472-4480. [DOI: 10.1007/s00464-018-6193-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
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Ibáñez N, Abrisqueta J, Luján J, Sánchez P, Soriano MT, Arevalo-Pérez J, Parrilla P. Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages? Cir Esp 2017; 96:109-116. [PMID: 29290377 DOI: 10.1016/j.ciresp.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/19/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. METHODS Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. RESULTS A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). CONCLUSIONS A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.
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Affiliation(s)
- Noelia Ibáñez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Jesús Abrisqueta
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Juan Luján
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pedro Sánchez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - María Teresa Soriano
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Julio Arevalo-Pérez
- Departamento de Radiología, Memorial Sloan-Kettering Cancer Center, Nueva York, Estados Unidos
| | - Pascual Parrilla
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience. Dis Colon Rectum 2017; 60:807-814. [PMID: 28682966 DOI: 10.1097/dcr.0000000000000822] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anastomotic leak after colorectal surgery increases postoperative mortality, cancer recurrence, permanent stoma formation, and poor bowel function. Anastomosis between the colon and rectum is a particularly high risk. Traditional management mandates laparotomy, disassembly of the anastomosis, and formation of an often-permanent stoma. After laparoscopic colorectal surgery it may be possible to manage anastomotic failure with laparoscopy, thus avoiding laparotomy. OBJECTIVE The purpose of this study was to determine the feasibility of the laparoscopic management of failed low colorectal anastomoses. SETTING This was a single-institute case series. PATIENTS A total of 555 laparoscopic patients undergoing anterior resection with primary anastomosis within 10 cm of the anus in the period 2000-2012 were included. MAIN OUTCOME MEASURES Anastomotic failure, defined as any clinical or radiological demonstrable defect in the anastomosis; complications using the Clavien-Dindo system; mortality within 30 days; and patient demographics and risk factors, as defined by the Charlson index, were measured. RESULTS Leakage occurred in 44 (7.9%) of 555 patients, 16 patients with a diverting ileostomy and 28 with no diverting ileostomy. Leakage was more common in those with anastomoses <5 cm form the anus, male patients, and those with a colonic J-pouch and rectal cancer. Diverting ileostomy was not protective of anastomotic leakage. In those patients with anastomotic leakage and a primary diverting ileostomy, recourse to the peritoneal cavity was required in 4 of 16 patients versus 24 of 28 without a diverting ileostomy (p = 0.0002). In 74% of those cases, access to the peritoneal cavity was achieved through laparoscopy. Permanent stoma rates were very low, including 14 (2.5%) of 555 total patients or 8 (18.0%) of 44 patients with anastomotic leakage. Thirty-day mortality was rare (0.6%). LIMITATIONS This study was limited by the lack of a cohort of open cases for comparison. CONCLUSIONS Laparoscopic anterior resection is associated with low levels of complications, including anastomotic leak, postoperative mortality, and permanent stoma formation. Anastomotic leakage can be managed with laparoscopy in the majority of cases. See Video Abstract at http://links.lww.com/DCR/A353.
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Zielińska-Borkowska U, Dib N, Tarnowski W, Skirecki T. Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery. Clin Chem Lab Med 2017; 55:1053-1059. [PMID: 27930362 DOI: 10.1515/cclm-2016-0736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early recognition of patients who have developed anastomotic leakage (AL) after colorectal surgery is crucial for the successful treatment of this complication. The aim of this study was to assess the usefulness of the assessment of procalcitonin (PCT) and interleukin-6 (IL-6) levels in the prognosis of AL. METHODS This observational study included 157 patients who underwent major elective colorectal surgery. The most common indications for surgery were cancer and inflammatory bowel diseases. Serum samples were obtained directly before surgery (D0) and 1 day (D1) after surgery, and the relationships between the serum concentrations of PCT and IL-6 and development of AL were assessed. RESULTS In total, 10.2% of patients developed post-surgical infections due to AL. PCT levels on D1 were significantly higher in patients who developed AL [2.73 (1.40-4.62)] than in those who recovered without complications [0.2 (0.09-0.44)]. The area under the ROC curve for PCT on D1 was 0.94, 95% CI (0.89-0.98). The sensitivity and specificity of the prediction of an infection were 87% and 87%, respectively, for PCT on D1, which was higher than 1.09 ng/mL. The increase in PCT concentration between D0 and D1 was significantly higher in patients with AL (p<0.001). Patients who developed AL had higher concentrations of IL-6 on D1, but the difference was not significant (p=0.28). CONCLUSIONS This study confirms that surgical trauma increases serum PCT concentrations and that the concentration of PCT on D1 can predict AL after colorectal surgery. However, IL-6 is not a good early marker for developing AL.
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Wright DB, Koh CE, Solomon MJ. Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery. Br J Surg 2017; 104:337-346. [DOI: 10.1002/bjs.10469] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/22/2016] [Accepted: 11/25/2016] [Indexed: 12/29/2022]
Abstract
Abstract
Background
Returning to the operating theatre for management of early postoperative complications after colorectal surgery is an important key performance indicator. Laparoscopic surgery has benefits that may be useful in surgical emergencies. This study explored the evidence for the advantages of laparoscopic reoperation.
Methods
A systematic review was performed to identify publications reporting the outcomes of laparoscopy as a mode of reoperation for the management of early postoperative complications of colorectal surgery. The main outcomes examined were 30-day mortality, 30-day morbidity, length of hospital stay, second reoperation rate, ICU admission and stoma formation at reoperation.
Results
After screening 3657 citations, ten non-randomized cohort studies were identified (1137 reoperations). Laparoscopic reoperation was equivalent to or better than open reoperation, with lower rates of 30-day mortality (0–4·4 versus 0–13·6 per cent), 30-day morbidity (6–40 versus 30–80 per cent), length of stay (mean(s.d.) 15·8(2·8) versus 29·1(14·5) days), ICU admission and duration of stay in the ICU. Anastomotic leak was the most common indication, after which more patients received a defunctioning loop stoma instead of an end stoma at laparoscopic than open reoperation.
Conclusion
Laparoscopic reoperation is feasible in selected patients, with the advantages of improved short-term outcomes.
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Affiliation(s)
- D B Wright
- Academic Colorectal Unit, Sydney Medical School – Concord, Sydney, Australia
| | - C E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - M J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
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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: 131] [Impact Index Per Article: 14.6] [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.
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Ryu S, Bae BN. Rectal free perforation after stapled hemorrhoidopexy: A case report of laparoscopic peritoneal lavage and repair without stoma. Int J Surg Case Rep 2016; 30:40-42. [PMID: 27902953 PMCID: PMC5133467 DOI: 10.1016/j.ijscr.2016.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 12/26/2022] Open
Abstract
Stapled hemorrhoidopexy (SH) is common treatment for prolapsed hemorrhoid. Unexpected abdominal pain following SH may related rectal perforation. Laparoscopic repair of rectal perforation is feasible in selective patients. A transanal rectal tube keep in several days may substitute diverting stoma. Introduction Stapled hemorrhoidopexy is widely performed for treatment of prolapsed hemorrhoids because of advantages, including shorter hospital stay and less discomfort, compared with conventional hemorrhoidectomy. However, it can have severe adverse effects, such as rectal bleeding, perforation, and sepsis. Presentation of case We report the case of a healthy 28-year-old man who presented to the emergency department with sudden-onset diffuse abdominal pain and hematochezia. He had undergone stapled hemorrhoidopexy 5 days earlier and was discharged after an uneventful postoperative course. For the present condition, after immediate evaluation, we successfully performed emergency laparoscopic repair of the rectal perforation without any stoma. His postoperative course was uneventful, and he was discharged on postoperative day 16. Discussion This is a rare case of rectal perforation after stapled hemorrhoidopexy in which the perforation was treated successfully by laparoscopic repair. In most cases of rectal perforation following stapled hemorrhoidopexy, surgeons perform open laparotomy and create diverting stoma. However, our patient underwent totally laparoscopic lavage and primary closure without diverting stoma. Multiple investigators have reported that laparoscopic lavage for perforated diverticulitis may be an appropriate treatment option. Factors favoring this approach include early surgery, young age, sufficient irrigation, and meticulous primary closure. Conclusion Stapled hemorrhoidopexy can have severe adverse effects, such as rectal bleeding, pelvic sepsis, and rectal perforation, which are potentially life-threatening. Laparoscopic lavage and primary repair without stoma can be performed successfully in select patients with rectal perforation following stapled hemorrhoidopexy.
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Affiliation(s)
- Seokyong Ryu
- Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Byung-Noe Bae
- Department of General Surgery, Inje University Sanggye Paik Hospital, Seoul,Republic of Korea.
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Marano A, Giuffrida MC, Giraudo G, Pellegrino L, Borghi F. Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy? J Laparoendosc Adv Surg Tech A 2016; 27:342-347. [PMID: 27792472 DOI: 10.1089/lap.2016.0374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although laparoscopy is becoming the standard of care for the treatment of colorectal disease, its application in case of postoperative peritonitis is still not widespread. The objective of this article is to evaluate the role of laparoscopy in the management of postoperative peritonitis after elective minimally invasive colorectal resection for malignant and benign diseases. MATERIALS AND METHODS Between April 2010 and May 2016, 536 patients received primary minimally invasive colorectal surgery at our Department. Among this series, we carried out a retrospective study of those patients who, having developed signs of peritonitis, were treated with a laparoscopic reintervention. Patient demographics, type of complication and of the main relaparoscopic treatment, and main outcomes of reoperation were recorded. RESULTS A total of 20 patients (3.7%) underwent relaparoscopy for the management of postoperative peritonitis, of which exact causes were detected by laparoscopy in 75% as follows: anastomotic leakage (n = 8, 40%), colonic ischemia (n = 2, 10%), iatrogenic bowel tear (n = 4, 20%), and other (n = 1, 5%). The median time between operations was 3.5 days (range, 2-8). The laparoscopic reintervention was tailored case by case and ranged from lavage and drainage to redo anastomosis with ostomy fashioning. Conversion rate was 10% and overall morbidity was 50%. No cases required additional surgery and 30-day mortality was nil. Three patients (15%) were admitted to intensive care unit for 24-hour surveillance. CONCLUSION Our experience suggests that in experienced hands and in hemodynamically stable patients, a prompt laparoscopic reoperation appears as an accurate diagnostic tool and an effective and safe option for the treatment of postoperative peritonitis after primary colorectal minimally invasive surgery.
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Affiliation(s)
- Alessandra Marano
- Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy
| | | | - Giorgio Giraudo
- Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy
| | - Luca Pellegrino
- Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy
| | - Felice Borghi
- Department of General and Oncologic Surgery , ASO Santa Croce e Carle, Cuneo, Italy
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Sevim Y, Celik SU, Yavarifar H, Akyol C. Minimally invasive management of anastomotic leaks in colorectal surgery. World J Gastrointest Surg 2016; 8:621-626. [PMID: 27721925 PMCID: PMC5037335 DOI: 10.4240/wjgs.v8.i9.621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/06/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023] Open
Abstract
Anastomotic leakage is an unfortunate complication of colorectal surgery. This distressing situation can cause severe morbidity and significantly affects the patient's quality of life. Additional interventions may cause further morbidity and mortality. Parenteral nutrition and temporary diverting ostomy are the standard treatments of anastomotic leaks. However, technological developments in minimally invasive treatment modalities for anastomotic dehiscence have caused them to be used widely. These modalities include laparoscopic repair, endoscopic self-expandable metallic stents, endoscopic clips, over the scope clips, endoanal repair and endoanal sponges. The review aimed to provide an overview of the current knowledge on the minimally invasive management of anastomotic leaks.
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Abstract
The aim of this article is to present strategies for preventing and managing the failure of the surgical restoration of intestinal continuity. Despite improvements in surgical technique and perioperative care, anastomotic leaks still occur, and with them occur increased morbidity, mortality, length of stay, and costs. Due to the devastating consequences for patients with failed anastomoses, there have been a myriad of materials and techniques used by surgeons to create better intestinal anastomoses. We will also discuss the management strategies for anastomotic leak when they do inevitably occur.
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Affiliation(s)
- Michael S Thomas
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | - David A Margolin
- Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, University of Queensland Ochsner Clinical School, New Orleans, Louisiana
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Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery. Medicine (Baltimore) 2016; 95:e2890. [PMID: 26937928 PMCID: PMC4779025 DOI: 10.1097/md.0000000000002890] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes.We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data.Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively).AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery.
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Affiliation(s)
- Jong Seob Park
- From the Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine (JSP); and Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (JWH, YAP, YBC, SHY, HCK, WYL), Seoul, Korea
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Agrusa A, Frazzetta G, Chianetta D, Di Giovanni S, Gulotta L, Di Buno G, Sorce V, Romano G, Gulotta G. "Relaparoscopic" management of surgical complications: The experience of an Emergency Center. Surg Endosc 2015; 30:2804-10. [PMID: 26490773 DOI: 10.1007/s00464-015-4558-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. MATERIALS AND METHODS We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. RESULTS Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixty-three patients (84 %) had no more or further complications and were discharged from hospital between 4 ± 3 days after "second-look" surgery; three patients (4 %) developed postoperative complications requiring a third surgery. Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 ± 9.5 days. Mean operative time was 90 ± 150 min. Postoperative hospital stay was between 4.5 and 18 days. DISCUSSION AND CONCLUSION Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in "relaparoscopic" management of surgical complications seems to suggest that laparoscopy "second look" is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems.
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Affiliation(s)
- Antonino Agrusa
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giuseppe Frazzetta
- Ospedale "Michele Chiello", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n° 4 Contrada Bellia, 94015, Piazza Armerina, Sicily, Italy. .,Ospedale "Umberto I°", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n°4, Contrada Ferrante, 94100, Enna, Sicily, Italy.
| | - Daniela Chianetta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Silvia Di Giovanni
- Ospedale "Umberto I°", U.O. Medicina e Chirurgia d'Accettazione e d'Urgenza, ASP n°4, Contrada Ferrante, Enna, 94100, Sicily, Italy
| | - Leonardo Gulotta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giuseppe Di Buno
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Vincenzo Sorce
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giorgio Romano
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Gaspare Gulotta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
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