The incidence of anastomotic leakage after anterior resection of the rectum for rectal cancer is relatively low. It remains however the most serious complication following rectal resection for cancer.

The immediate postoperative, intraperitoneal administration of 5-FU inhibited wound healing. However, when the colonic anastomoses were covered with fibrin glue, the injection of 5-FU had no adverse effects on the healing of the anastomoses.

Cytologic examination of peritoneal lavage at the time of surgery could be a useful prognostic indicator for local and peritoneal recurrence rate. However, it was not found to be a predictor of survival.

The aim of the present study was to evaluate the effect of glue tissue on the healing of colonic anastomosis in rats. Two groups of 20 Wistar rats each were used. Following laparotomy, a segment of 1 cm of the colon was resected, 10 cm from the ileocecal valve. In the control group, the anastomosis was sutured in a single layer with 6-0 polypropylene interrupted extramucosal sutures. In the glue group, the anastomosis was performed by using 2-octyl cyanoacrylate (Dermabond, Ethicon). Rats were sacrificed on day 7 following operation. Integrity of the anastomoses, existence of perianastomotic abscess or peritonitis, and adhesion formation were recorded. Anastomoses were resected including a 2.5-cm of bowel on either side. Bursting pressures were measured and the specimens were sent for histological examination. Anastomotic dehiscence occured in 20% of the animals in each group. Adhesion formation was more extensive in the glue group compared to the control group, but this difference was not statistically significant (p=0.074). Bursting pressures of the anastomoses between the two groups were not statistically significant (p=0.897). The wound healing process, as assessed by inflammatory cell infiltration, blood vessel neodevelopment, collagen deposition and fibroblast activity, did not differ statistically between the two groups (p>0.05). In conclusion, 2-octyl cyanoacrylate provides, under experimental conditions, a sutureless anastomosis equal in healing to the conventionally sutured one. The outcome may differ under demanding clinical situations.

BackgroundFournier’s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p < 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality.ConclusionEarly diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality.