The Place of Mechanic Sutures in Medium and Low Rectal Cancer

Abstract

BACKGROUND: For medium and low rectal cancer the most common surgical procedures are: low anterior resection with mechanical or manual colorectal anastomosis and transanal rectosigmiod resection with abdominoendoanal intubation. METHODS: We have conducted an observational, retrospective single-center study on a number of consecutive patients operated between January 1 st and June 31 st , 2011 for malign pathology of the middle and low rectum in The Clinical Emergency Hospital Bucureşti. We included patients with medium and low rectal cancer who had been previously treated by radiotherapy. We practiced rectal resection with mechanical colorectal anastomosis or abdominoendoanal intubation with anal mucous membrane removal. We assessed a number of parameters in relation to surgical procedure, such as: anastomosis dehiscence (AD), anastomotic stenosis (AS), the number of defecations in 24 hours, nocturnal incontinence, delayed bowel movement, flatulence continence, postoperative complications, local tumour recurrence and mortality. RESULTS: The study comprises 53 patients divided into 2 groups: the 1 st group, included 19 patients treated by rectal resection with abdominoendoanal intubation and anal mucous membrane removal, and the 2 nd group, included 34 patients treated by rectal resection with mechanical colorectal anastomosis. AD was found in 5.26% (1/19) in group 1, respectively 20.5% (7/34) in group nr 2. At 6 months follow-up, one patient from the 1 st group experienced AS (5.26%), as for the 2nd group, AS was present in 5 patients (14.7%); at 12 months after the procedure the number of patients with AS increased to 3 in group 1 (15.78%) and to 6 in group 2 (17.64%) respectively. After 12 months, the nocturnal incontinence evaluated between 11.00 pm and 06.00 am: 3 patients from group 1 had 1 night evacuation daily, in all days of the week; 1 patient from group 2 presented 2 night evacuations on week. After 12 months postoperative: 11 patients, (57.89%) from group 1 had complete continence and also 29 patients (85.29%) from group 2. Patients from group 1: 36.36% (4/11) needed evacuation clysters' and also 10.34% (3/29) for the group 2. In the case of group 1 mortality was 5.26% (1/19) and for group 2 was 8.82% (3/34). CONCLUSIONS: The intestinal transit disorders are quite frequent after colonal anastomosis."Achilles heel" of mechanical anastomosis is represented by postanastomotical stenosis.

Surgical Management Analysis of Emergency Colorectal Cancer Surgical Cases - a Retrospective Observational Study

“…At the same time, the time until the gas transit resumption is shorter for mechanical anastomoses. These data do not differ from those in the specialized literature [20].…”