Use of Intracolonic Bypass Secured by a Biodegradable Anastomotic Ring to Protect the Low Rectal Anastomosis
Tóm tắt
Because of the relatively high morbidity and mortality of anastomotic leakage in patients with low rectal cancer who receive an anterior resection, many fecal diverting methods have been introduced. This study was designed to assess the efficacy and safety of the Valtrac™-secured intracolonic bypass in protecting low rectal anastomosis and to compare the efficacy and complications of Valtrac™-secured intracolonic bypass with those of loop ileostomy. From January 2002 to April 2006, 83 patients with rectal cancer who underwent elective low anterior resection received intracolonic bypass or ileostomy. Demographics, clinical features, and operative data were recorded. Forty-four patients (53 percent) received a Valtrac™-secured intracolonic bypass and 39 patients (47 percent) a loop ileostomy. The demographics and clinical features of the groups were similar. None of the patients developed clinical anastomotic leakage. Longer overall postoperative hospital stay (21.3 ± 5.8 days) and higher costs incurred (3.1 ± 0.9 × $1,000 U.S. dollars) were observed in the ileostomy group than in the intracolonic bypass group (12.5 ± 6.3 days, 4.4 ± 1.2 × $1,000 U.S. dollars; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (12.8 percent), bleeding (2.6 percent), and intestinal obstruction after stoma closure (5.1 percent). No complications were observed in the intracolonic bypass group except for the Valtrac™ ring discharging en bloc, which compromised fecal evacuation in two cases (4.5 percent). The Valtrac™-secured intracolonic bypass procedure is a safe, effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis. Valtrac™-secured intracolonic bypass, in contrast to loop ileostomy, avoids stoma-related complications or readmission for closure and is associated with decreased hospital time and cost.
Tài liệu tham khảo
Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 1998;85:1114–7.
Arbman G, Nilsson E, Hallbook, O, Sjodahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375–9.
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355–8.
Laxamana A, Solomon MJ, Cohen Z. Long-term results of anterior resection using the double-stapling technique. Dis Colon Rectum 1995;38:1246–50.
Scott N, Jackson P, al Jaberi T. Total mesorectal excision and local recurrence: a study of tumor spread in the mesorectum distal to rectal cancer. Br J Surg 1995;82:1031–3.
Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision of the rectum. Br J Surg 1994;81:224–6.
Lowry A, Simmang C, Boulos P. Consensus statement of definitions for anorectal physiology and rectal cancer. Dis Colon Rectum 2001;44:915–9.
Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 2003;5:478–82.
Poon PT, Chu KW, Ho JW, Chan CW, Law WL, Wong J. Prospective evaluation of selective defunctioning stoma for low anterior resection with mesorectal excision. World J Surg 1999;23:463–7.
Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 2004;6:462–9.
Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 1999;86:927–31.
Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000;179:92–6.
Fawcett A, Shembekar M, Vashisht R, Springall RG, Nott DM. Colonic microvascular disease and anastomotic dehiscence. Br J Surg 1995;82:1544–73.
Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003;46:653–60.
Meade B, Moran B. Reducing the incidence and managing the consequences of anastomotic leakage after rectal resection. Acta Chir Iugosl 2004;51:19–23.
Marusch F, Koch A, Schmidt U, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 2002;45:1164–71.
Kanellos I, Zacharakis E, Christoforidis E, Demetriades H, Betsis D. Low anterior resection without defunctioning stoma. Tech Coloproctol 2002;6:153–7.
Tschmelitsch J, Wykypiel H, Prommegger R, Bodner E. Colostomy vs. tube cecostomy for protection of a low anastomosis in rectal cancer. Arch Surg 1999;134:1385–8.
Tocchi A, Mazzoni G, Lepre L, et al. Prospective evaluation of omentoplasty in preventing leakage of colorectal anastomosis. Dis Colon Rectum 2000;43:951–5.
Dunn CJ, Goa KL. Fibrin sealant: a review of its use in surgery and endoscopy. Drugs 1999;58:863–86.
Castrini G, Ger R, Pappalardo G, Ravo B, Trentino P, Pisapia M. Intracolonic by-pass: a new technique to prevent anastomotic complications in colon and rectal surgery. Ital J Surg Sci 1984;14:189–93.
Ravo B, Ger R. Intracolonic bypass by an intraluminal tube: an experimental study. Dis Colon Rectum 1984;27:360–5.
Yoon WH, Song IS, Chang ES. Intraluminal bypass technique using a condom for protection of coloanal anastomosis. Dis Colon Rectum 1994;37:1046–7.
Egozi L, Sorrento JJ, Golub R, Schultz EH. Complication of the intracolonic bypass. Report of a case. Dis Colon Rectum 1993;36:191–3.
Ross H. The effect of an intraluminal tube used as an internal drain on the healing of the rat colon. Dis Colon Rectum 1987;30:591–4.
Chen TC, Yang MJ, Chen SR, Chang CP, Chi CH. Valtrac-secured intracolonic bypass device: an experimental study. Dis Colon Rectum 1997;40:1063–7
Kasperk R, Schumpelick V. Sphincter preserving techniques: from anterior resection to coloanal anastomosis. Langenbecks Arch Surg 1998;383:397–401.
Rudinskaite G, Pavalkis D. Coloanal anastomosis in rectal cancer surgery. Medicina (Kaunas) 2002;38:624–30.
Bulow S, Moesgoaard FA, Billesbolle P, Harling H. Anastomotic leakage after low anterior resection for rectal cancer. Ugeskr Leager 1997;159:297–301.
Hallbook O, Sjodahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 1996;83:60–2.
Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 2001;88:400–4.
Merkel S, Wang WY, Schmidt O, et al. Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Colorectal Dis 2001;3:154–60.
Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004;240:255–9.
Chang SC, Lin JK, Yang SH, Jiang JK, Chen WC, Lin TC. Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer. Hepatogastroenterology 2003;50:1898–902.
Ghitulescu GA, Morin N, Jetty P, Belliveau P. Revisiting the biofragmentable anastomotic ring: is it safe in colonic surgery? Can J Surg 2003;46:92–8.
De Fina S, Franciosi C, Codecasa G, et al. The use of the biofragmentable ring (BAR-Valtrac) in colon surgery. Minerva Chir 2000;55:133–7.
Wang SM, Lai IR, Liang JT, Chang KJ. Colorectal surgery using a biofragmentable anastomotic ring. J Formos Med Assoc 1996;95:798–801.
Ye F, Lin JJ. Clinical application of biofragmentable anastomosis ring for intestinal anastomosis. J Zhejiang Univ Med Sci 2006;35:668–72.
Luukkonen P, Jarvinen HJ, Haapiainen R. Early experience with biofragmentable anastomosis ring in colon surgery. Acta Chir Scand 1990;156:795–9.
Valle M, Biancari F, Caviglia A, D’Andrea V, Baselice PF. The biofragmentable anastomosis ring in elective colon resections. Int Surg 1998;83:58–9.
Corman ML, Prager ED, Hardy TG Jr, Bubrick MP. Comparison of the Valtrac biofragmentable anastomosis ring with conventional suture and stapled anastomosis in colon surgery. Results of a prospective, randomized, clinical trial. Dis Colon Rectum 1989;32:183–7.
Machado M, Hallbook O, Goldman S, Nystrom PO, Jarhult J, Sjodahl R. Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: a comparison between two hospitals with a different policy. Dis Colon Rectum 2002;45:940–5.