Long-term fecal diverting device for the prevention of sepsis in case of colorectal anastomotic leakage: an animal experiment
Tóm tắt
A new fecal diverting device (FDD) was fabricated for fecal diversion from the proximal colon above the anastomosis to outside the anus for protecting the rectal anastomosis. The aim of the study is to evaluate the safety and effectiveness of the FDD. After a pilot study, a prospective observational trial was performed in 34 mongrel dogs. The experiment comprised of segmental resection and anastomosis of the colon, fixation of the FDD, and observation for 3 weeks (n = 15) and more than 3 weeks (n = 19) without initiation of parenteral nutrition. Four cases of perioperative death unrelated to the FDD were excluded. Twenty-six (87 %) of the 30 dogs survived. Sixteen (53 %) dogs were able to retain the FDD for more than 3 weeks until 82 days. The autopsy findings revealed that four (15 %) dogs showed colonic wall erosions and mucosal scarring respectively at the band fixation area without evidence of serious septic complications. The surviving dogs retained the FDD for more than 6 days. Mortality occurred in four of the five dogs that expelled the FDD within three postoperative days. A closed abscess cavity as the evidence of anastomotic leakage was noted in seven (23 %) of the surviving dogs. The newly designed fecal diverting device can be retained for more than 3 weeks until 82 days without any serious complications. The FDD may prevent sepsis in case of anastomotic leakage if it is retained for more than 6 days.
Tài liệu tham khảo
Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60:461–464
Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jorgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 9:CD001544
Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48:2076–2079
Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I (2010) Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 5:CD006878
Ravo B, Ger R (1984) A preliminary report on the intracolonic bypass as an alternative to a temporary colostomy. Surg Gynecol Obstet 159:541–545
Ravo B, Ger R (1984) Intracolonic bypass by an intraluminal tube. An experimental study. Dis Colon Rectum 27:360–365
Yoon WH, Song IS, Chang ES (1994) Intraluminal bypass technique using a condom for protection of coloanal anastomosis. Dis Colon Rectum 37:1046–1047
Ye F, Wang D, Xu X, Liu F, Lin J (2008) Use of intracolonic bypass secured by a biodegradable anastomotic ring to protect the low rectal anastomosis. Dis Colon Rectum 51:109–115
Kim JH, Shon DH, Kang SH, Jang BI, Chung MK, Kim JH, Shim MC (2005) Complete single-stage management of left colon cancer obstruction with a new device. Surg Endosc 19:1381–1387
Fraser I (1982) An historical perspective on mechanical aids in intestinal anastomosis. Surg Gynecol Obstet 155:566–574
Carpenter D, Bello J, Sokol TP, Sackier J, Carroll B, Wood C, Lugo D, Morgenstern L (1990) The intracolonic bypass tube for left colon and rectal trauma. The avoidance of a colostomy. Am Surg 56:769–773
Keane PF, Ohri SK, Wood CB, Sackier JM (1988) Management of the obstructed left colon by the one-stage intracolonic bypass procedure. Dis Colon Rectum 31:948–951
Falcone RE, Wanamaker SR, Santanello SA, Carey LC (1992) Colorectal trauma: primary repair or anastomosis with intracolonic bypass vs. ostomy. Dis Colon Rectum 35:957–963
Ravo B (1987) The intracolonic bypass procedure. Int J Colorectal Dis 2:38–42
Ravo B, Metwally N, Castera P, Polansky PJ, Ger R (1988) The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakages. An experimental study. Dis Colon Rectum 31:868–871
Ravo B, Mishrick A, Addei K, Castrini G, Pappalardo G, Gross E, Sackier JM, Wood CB, Ger R (1987) The treatment of perforated diverticulitis by one-stage intracolonic bypass procedure. Surgery 102:771–776
Launer DP, Sackier JM (1991) Pouch-anal anastomosis without diverting ileostomy. Dis Colon Rectum 34:993–998
Rosati C, Smith L, Deitel M, Burul CJ, Baida M, Borowy ZJ, Bryden P (1992) Primary colorectal anastomosis with the intracolonic bypass tube. Surgery 112:618–622, discussion 622–613
Ruiz PL, Facciuto EM, Facciuto ME, Rodriguez Otero JC, Pigatto J, Cominelli H (1995) New intraluminal bypass tube for management of acutely obstructed left colon. Dis Colon Rectum 38:1108–1109
Chen TC, Yang MJ, Chen SR, Chang CP, Chi CH (1997) Valtrac-secured intracolonic bypass device: an experimental study. Dis Colon Rectum 40:1063–1067
Egozi L, Sorrento JJ, Golub R, Schultz EH (1993) Complication of the intracolonic bypass. Report of a case. Dis Colon Rectum 36:191–193
Ross H (1987) The effect of an intraluminal tube used as an internal drain on the healing of the rat colon. Dis Colon Rectum 30:591–594
Braskén P, Renvall S, Lehto M (1991) Fibronectin, laminin, and collagen types I, III, IV and V in the healing rat colon anastomosis. Br J Surg 78:1048–1052
Bullard KM, Trudel JL, Baxter NN, Rothenberger DA (2005) Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 48:438–443
Kim J, Shim MC, Choi BY, Ahn SH, Jang SH, Shin HJ (2001) Clinical application of continent anal plug in bedridden patients with intractable diarrhea. Dis Colon Rectum 44:1162–1167
Keshava A, Renwick A, Stewart P, Pilley A (2007) A nonsurgical means of fecal diversion: the Zassi Bowel Management System. Dis Colon Rectum 50:1017–1022
Cherian PT, Goussous G, Ashori F, Sigurdsson A (2010) Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years. Surg Endosc 24:2031–2038
Devesa JM, Rey A, Hervas PL, Halawa KS, Larranaga I, Svidler L, Abraira V, Muriel A (2002) Artificial anal sphincter: complications and functional results of a large personal series. Dis Colon Rectum 45:1154–1163