Treatment of colorectal and ileoanal anastomotic sinuses

Abstract

When used in conjunction with fecal diversion, sinus unroofing by division of the common wall between the sinus and bowel lumen treats low pelvic sinuses.

Long-Term Results of Salvage Surgery for Septic Complications After Restorative Proctocolectomy

“…Others have taken this approach with similar results. 3,17,31 Transanal revisions when performed as unique procedures involved significantly fewer hospital days than combined modalities. In many cases, this surgery was performed on an ambulatory or overnight basis.…”

“…Other large series have made similar observations. 12,17,26,31 In the present study, more aggressive abdominoperineal revisions were reserved for cases in which pouch or anodermal advancement was not technically possible. Advancement flaps were not feasible because of large anastomotic gaps or severe perianastomotic fibrosis.…”

Use of the endostapler for the treatment of non-healing sinus secondary to a dehisced colorectal anastomosis

“…Pagni [1] reported on the use of the surgical stapler to treat a strictured rectal anastomosis and not a chronic posterior sinus. Whitlow [2] reported on the use of the laparoscopic cautery scissors in the treatment of such sinuses in patients who had an ileoanal anastomosis. All the patients in this series had fecal diversion and the sinus resolved in 1 month except in one case when it needed 12 months to heal.…”

The fate of anastomotic sinuses after total mesorectal excision for rectal cancer

“…A significant number will, however, go clinically unnoticed and only become radiologically apparent at a later stage or on routine assessment of anastomotic integrity prior to stoma closure. Once the leak has matured into a paraanastomotic sinus, therapeutic options are (1) expectant with delayed stoma closure; (2) excision and reanastomosis; (3) takedown of anastomosis and formation of permanaent colostomy; (4) laying open into neorectum as described by Whitlow et al [5]; and (5) occlusive agents, e.g. fibrin glue as described by Swain and Ellis [6].…”