Blood flow in colon anastomotic stricture formation

Orsay, Charles P.; Bass, E. M.; Firfer, B.; Ramakrishnan, Venkat; Abcarian, Herand

doi:10.1007/bf02052452

Cited by 39 publications

(28 citation statements)

References 28 publications

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“…Next, as far as the anastomotic strictures are concerned, although the results of univariate analysis indicate that the anastomotic intestine (colo-colostomy) was the only significant independent factor, four of the five cases of the stricture were anastomosed by TRI. Regarding the absence of anastomotic stricture after colo-coloctomy with extension of the anastomotic diameter, although many previous reports link anastomotic stricture to ischemia, anastomotic leakage, radiation therapy and stapled anastomosis (17)(18)(19), our experience indicates that the diameter of the anastomosis in colo-colostomy is also important. As far as the treatment of anastomotic stricture in this study is concerned, endoscopic balloon dilatation to allow passage of the endoscope with a diameter of 12 mm appears successful.…”

Section: Discussionmentioning

confidence: 76%

Which Is the Safer Anastomotic Method for Colon Surgery? – Ten-year Results

Kosuge

Eto

Hashizume

et al. 2017

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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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Section: Discussionmentioning

confidence: 76%

Which Is the Safer Anastomotic Method for Colon Surgery? – Ten-year Results

Kosuge

Eto

Hashizume

et al. 2017

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“…Blood flow is always reduced in the suture line compared with the normal mucosa. Of all the anastomoses studied, the blood flow of the suture line decreased from the single-layered manual to the two-layered manual to the stapled suture (17,18).…”

Section: Discussionmentioning

confidence: 97%

“…Stapling devices may decrease surgery time, surgical trauma and anastomotic complications (13)(14)(15)(16). However, improper handling of the stapler may lead to a partial tear of the anastomosis and leakage (17,18), whereas irregular suturing of the mucosa may lead to hyperplasia, granulation tissue and scar formation, which may cause a stricture (19,20). Furthermore, there was no reported difference in the morbidity and mortality rates between the hand-sewn and stapled techniques (21,22).…”

Section: Introductionmentioning

confidence: 99%

Single-layer continuous suture contributes to the reduction of surgical complications in digestive tract anastomosis involving special anatomical locations

Zhang

et al. 2013

Molecular and Clinical Oncology

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“…In our study (Shimada et al, 1996), however, compared with non-stricture group, there were no significant relationships of sex, age, tumor stage, EEA size, distance of anastomosis from the anal verge, or timing of postoperative diet in the stricture group (Table 2). For one instance of evaluation of blood supply to the anastomosis (Orsay et al, 1995), we compared the incidence of stenosis between devasculization and preservation of the inferior mesenteric artery. However there was no relationship between them.…”

Section: Incidence and Risk Factors Of Stricture After Circular Staplmentioning

confidence: 99%