J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results

Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gündoğan, Ersin; Gezen, Fazli Cem; Öncel, Mustafa

doi:10.1016/j.ijsu.2017.09.012

Cited by 20 publications

(27 citation statements)

References 27 publications

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“…However, anastomotic leakage occurs significantly more often in coloplasty than in J-pouch anastomosis [8]. Moreover, J-pouch or sideto-end anastomosis results in less anastomotic leakage because of better blood flow to the anastomotic site [9]. A J-pouch anastomosis is technically and anatomically more challenging to perform because it requires a longer segment of colon, a wide pelvis, and an extended operating time [10].…”

Section: Discussionmentioning

confidence: 99%

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

et al. 2021

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Background Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis. Case presentation A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis. Conclusion Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.

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Section: Discussionmentioning

confidence: 99%

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

et al. 2021

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“…However, anastomotic leakage occurs signi cantly more often in coloplasty than in J-pouch anastomosis [8]. Moreover, J-pouch or side-to-end anastomosis results in less anastomotic leakage because of better blood ow to the anastomotic site [9]. A J-pouch anastomosis is technically and anatomically more challenging to perform because it requires a longer segment of colon, a wide pelvis, and an extended operating time [10].…”

Section: Discussionmentioning

confidence: 99%

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Tajima

Hanai

Katsuno

et al. 2020

Preprint

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BackgroundColorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis.Case presentationA 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double-stapling technique or transanal hand-sewn anastomosis but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis.ConclusionPerforming side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.

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“…Most of the studies were performed in Europe and Asia. The interventions of six studies [31][32][33][34][36][37][38] were comparisons between SEA and CJP anastomosis, and the other four studies [35,[39][40][41] were based on three-arm trials. A total of 864 patients were available for this meta-analysis, and the characteristics of the included studies are summarized in Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

“…Of the included studies, four studies [31,34,35,38] reported urgency, three studies [32,34,38] reported the rate of using pads, four studies [31,34,35,38] reported the incomplete defecation, and three studies [31,32,34] reported the number of patients using enemas or other medications at 6 months after surgery. The available data pooled from two studies [31,34] showed that SEA had benefits in terms of completeness of defecation 3 months after surgery (RR = 0.28; 95% CI, 0.09-0.86; P = 0.03).…”

Section: Bowel Functionmentioning

confidence: 99%

Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials

et al. 2021

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Background The application of side-to-end anastomosis (SEA) in sphincter-preserving resection (SPR) is controversial. We performed a meta-analysis to compare the safety and efficacy of SEA with colonic J-pouch (CJP) anastomosis, which had been proven effective in improving postoperative bowel function. Methods The protocol was registered in PROSPERO under number CRD42020206764. PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials databases were searched. The inclusion criteria were randomized controlled trials (RCTs) that evaluated the safety or efficacy of SEA in comparison with CJP anastomosis. The outcomes included the pooled risk ratio (RR) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. All outcomes were calculated with 95% confidence intervals (CI) by STATA software (Stata 14, Stata Corporation, TX, USA). Results A total of 864 patients from 10 RCTs were included in the meta-analysis. Patients undergoing SEA had a higher defecation frequency at 12 months after SPR (WMD = 0.20; 95% CI, 0.14–0.26; P < 0.01) than those undergoing CJP anastomosis with low heterogeneity (I2 = 0%, P = 0.54) and a lower incidence of incomplete defecation at 3 months after surgery (RR = 0.28; 95% CI, 0.09–0.86; P = 0.03). A shorter operating time (WMD = − 17.65; 95% CI, − 23.28 to − 12.02; P < 0.01) was also observed in the SEA group without significant heterogeneity (I2 = 0%, P = 0.54). A higher anorectal resting pressure (WMD = 6.25; 95% CI, 0.17–12.32; P = 0.04) was found in the SEA group but the heterogeneity was high (I2 = 84.5%, P = 0.84). No significant differences were observed between the groups in terms of efficacy outcomes including defecation frequency, the incidence of urgency, incomplete defecation, the use of pads, enema, medications, anorectal squeeze pressure and maximum rectal volume, or safety outcomes including operating time, blood loss, the use of protective stoma, postoperative complications, clinical outcomes, and oncological outcomes. Conclusions The present evidence suggests that SEA is an effective anastomotic strategy to achieve similar postoperative bowel function without increasing the risk of complications compared with CJP anastomosis. The advantages of SEA include a shorter operating time, a lower incidence of incomplete defecation at 3 months after surgery, and better sphincter function. However, close attention should be paid to the long-term defecation frequency after SPR.

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J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results

Cited by 20 publications

References 27 publications

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Safety and efficacy of side-to-end anastomosis versus colonic J-pouch anastomosis in sphincter-preserving resections: an updated meta-analysis of randomized controlled trials

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