Background/Aim: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. Materials and Methods: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two-or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. Results: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. Conclusion: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.
Primary adenosquamous cell carcinoma (ASCC) arising from the ileum is an exceptionally rare malignant neoplasm exhibiting mixed glandular and squamous differentiation. The clinicopathological characteristics of ASCC have not been clearly determined due to its rarity. We herein report a case of a 74-year-old man with a successfully treated ASCC of the ileum. The patient visited a medical clinic due to abdominal pain. Abdominal computed tomography imaging revealed an intestinal tumor in the ileum. Prior to undergoing capsule endoscopy, the patient complained of severe abdominal pain due to intestinal obstruction from the patency capsule and the tumor. Thus, the patient was referred to our hospital for emergency surgery. Upon relieving the obstruction by partial resection of the ileum, an impacted patency capsule with a tumor with ulceration was identified. On histological examination, the tumor consisted of malignant glandular and squamous cell elements. The postoperative course was uneventful, without complications. The patient subsequently received adjuvant chemotherapy with oxaliplatin and capecitabine for 6 months. The patient has no evidence of recurrence 20 months after surgery. To the best of our knowledge, only 8 cases of ASCC have been reported in the English literature to date. This case serves as an important reminder to consider small intestinal carcinoma, including ASCC, in the differential diagnosis of intestinal obstruction.
Abstract. Background Several types of intestinal anastomoses following colonic resection have been devised in the past. While the types of intestinal anastomoses can be classified into hand-sewn (HS) and stapled anastomosis, the latter has been the mainstream in recent years due to simplicity and being less timeconsuming (1-3) of which functional end-to-end anastomosis (FEEA) has been used widely (4). This technique has been proven especially useful for intestinal anastomosis with discrepancy in diameter (5), with a number of studies reporting that FEEA is an easy and safe technique compared with the conventional HS procedure (6, 7). On the other hand, Venkatesh et al., in 1993, reported a stapled intestinal anastomosis called triangulating anastomosis (TRI) (8). For colon surgery, TRI is a simple end-to-end anastomosis and more physiological than FEEA for which only a few studies have been undertaken (9, 10). In colon surgery, there is no golden standard of anastomotic techniques, which is generally selected by surgeon's preferences or by local conditions. In this study, we retrospectively conducted a comparative analysis to report the outcome of colon resection to evaluate the safety of anastomotic techniques. Patients and MethodsPatients. From July 2003 to June 2013, 1,324 patients underwent colorectal surgery with primary intestinal reconstruction at the Jikei University Hospital, Tokyo, Japan. A retrospective comparative investigation was carried out to study the influence of the methods of intestinal anastomosis on anastomotic complications using the data from 684 cases, after exclusion of the following cases, some with multiple overlaps: emergency surgery (29 cases), rectal anastomosis (594 cases), use of a circular stapler (627 cases) and creation of a defunctioning stoma (113 cases). The patients were classified into three groups by the type of anastomosis as follows: HS (n=93), FEEA (n=255) and TRI (n=336) ( Table I). Methods of intestinal anastomoses were selected by the preference of each surgeon. The diagnosis of anastomotic leakage was defined based on imaging studies and clinical signs, such as fever >38.5˚C, leukocytosis, elevated serum C-reactive protein, drainage of intestinal content from the drain or computed tomography findings of abscess formation around the anastomosis. The diagnosis of anastomotic stricture was defined based on imaging studies demonstrating intestinal distension starting from oral side of the anastomotic site. Anastomotic bleeding was defined by melena or endoscopic findings within seven days after surgery.As patient's factors, we classified tumor locations into two groups: right-sided colon (cecum, ascending colon and right transverse colon) vs. left-sided colon (left transverse colon, descending colon and sigmoid colon).We investigated the relation between anastomotic complications (anastomotic leakage, stricture and bleeding) and clinical factors, such as age, gender, etiology (benign or malignant), location (right-sided colon or left-sided colon), anastomosis (ileo-co...
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