Surgical Considerations in Anastomotic Dehiscence

Edden, Yair; Weiss, Eric G.

doi:10.1007/978-1-84882-413-3_49

Cited by 1 publication

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“…Lindgren et al [9] stated that more than 50% of the patients who were offered a Hartmann procedure were left with a permanent stoma. Edden and Weiss [10] identified a limited and shortened surgical intervention combined with adequate abdominal lavage and proximal diversion as important principles that should be applied no matter the method used for additional intervention. Reoperation is rarely indicated in patients with a defunctioning stoma at the time of initial operation, which is usually the case for an extraperitoneal anastomosis, and nonsurgical treatments include transanal anastomotic tube drainage or percutaneous drainage of the pelvic collection guided by ultrasonography (US) or computed tomography (CT), as well as newer technologies such as endoscopic endoluminal vacuum-assisted therapy, endoscopic stenting, or clip placement [6].…”

Section: Introductionmentioning

confidence: 99%

Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection

et al. 2018

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PurposeWe evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL).MethodsPatients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL.ResultsTwo hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation.ConclusionThese results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

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Section: Introductionmentioning

confidence: 99%