Anastomotic leakage (AL) is one of the most serious complications of anterior resection for rectal cancer with morbidity about 10%. Distance of anastomosis to anal margin, underlying disease, surgical technique and perioperative situations are associated with AL. The transanal drainage tube (TDT) after anastomosis is gradually proved to be useful in prevention of AL. Most of the literatures suggest that TDT is simple and safe, and can reduce the incidence of AL. The materials and the operating process of TDT have been universalized gradually: application of silicone or rubber material, large lumen with several side holes, placement at a distance of 3 to 5 cm above the anastomosis for 5 to 7 days. However, selection bias existed in previous studies, and the main problems were disunity of enrolling standard and exclusion of patients with high AL risk, which would not fully reflect the value of TDT. Defunctioning stoma (or diverting stoma, DS) is a common method to prevent and treat the AL. At present, efficacy comparison between TDT and DS remains controversial. Thus, randomized, double-blind, controlled trials are needed to investigate the value of TDT in prevention of AL after anterior resection, especially for middle and low rectal cancer.
Anal Canal ; Anastomosis, Surgical ; Anastomotic Leak ; prevention & control ; Drainage ; Humans ; Rectal Neoplasms ; surgery ; Surgical Stomas

OBJECTIVETo evaluate the necessity of defunctioning stoma in low anterior resection for rectal cancer below peritoneal reflection.

METHODSThe databases of Medline, Embase, Cochrane Library, Wanfang and CNKI were searched. The eligible studies were identified for pooled analyses.

RESULTSSix randomized controlled trials with 648 cases(332 patients with defunctioning stoma and 316 without stoma) and 25 retrospective controlled trials with 10,722 cases(4,470 patients with defunctioning stoma and 6,252 without stoma) were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage (RR=0.33 and 95% CI:0.21-0.53 for RCTs, OR=0.60 and 95% CI:0.42-0.85 for retrospective studies), reoperation (RR=0.30, 95% CI:0.16-0.53 for RCTs, OR=0.26 and 95% CI:0.21-0.32 for retrospective studies) and mortality(OR=0.41, 95% CI:0.27-0.62 for retrospective studies).

CONCLUSIONDefunctioning stoma should be routinely performed in low anterior resection for high-risk patients.

Anastomotic Leak ; etiology ; prevention & control ; Enterostomy ; methods ; Humans ; Postoperative Complications ; prevention & control ; Randomized Controlled Trials as Topic ; Rectal Neoplasms ; surgery

In recent years, the laparoscopic anterior rectal cancer resection is increasingly applied in clinical practice, however, laparoscopic operations and stapling techniques can bring a series of related complications. The anastomotic bleeding is one of the early complications in laparoscopic anterior rectal cancer resections. If the continuous anastomotic bleeding is not diagnosed or managed in time, it could lead to serious consequences, such as secondary surgery and shock. Therefore, the diagnosis and treatment of anastomotic bleeding is meaningful. This paper investigates the reasons of anastomotic bleeding after laparoscopic anterior resection of rectal cancer, and introduces related preventions and treatments. Conservative treatment can be used first for small or delayed bleeding. As for acute bleeding from low anastomosis, transanal suture hemostasis can be considered. When the bleeding comes from high anastomosis and is massive and active, laparoscopic or open surgery must be performed immediately.
Anastomotic Leak ; prevention & control ; surgery ; Digestive System Surgical Procedures ; adverse effects ; Hemorrhage ; Humans ; Laparoscopy ; Rectal Neoplasms ; surgery

OBJECTIVETo study the efficacy of pedicled greater omentum transposed to mediastinum in prevention against postoperative in-hospital intrathoracic complications after esophagectomy.

METHODSClinical data of 148 consecutive patients with esophageal cancer undergoing Ivor-Lewis surgery in our department from January 2010 to May 2014 were retrospectively reviewed. Among them, 84 patients with omental transposition(transposition group) and 64 patients without omental transposition(non-transposition group) were compared.

RESULTSPostoperative hospital stay was shorter in patients with omental transposition compared to those without omental transposition(P<0.05). Intrathoracic infection rate was significantly lower in transposition group(33/84, 39.3%) than that in non-transposition group(36/64, 56.2%), and as was the combined sepsis rate[19/33, 57.6% vs. 31/36, 86.1%, P<0.05]. No significant differences were found in the morbidity of anastomotic leakage, wound infection, cardiac complication and mortality during hospitalization. The median postoperative hospital stay was significantly shorter in transposition group than that in non-transposition group(13.0 vs. 16.5 days, P<0.05).

CONCLUSIONOmental transposition to mediastinum can reduce the development and severity of intrathoracic infection and shorten hospital stay in patients undergoing esophagectomy.

Anastomotic Leak ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Mediastinum ; surgery ; Omentum ; transplantation ; Postoperative Complications ; prevention & control ; Retrospective Studies

OBJECTIVETo investigate the prevention and management of complications after laparoscopic gastric bypass (LRYGB) operation.

METHODSClinical data of 82 cases (9 cases of simple obesity, 55 of obesity complicated with type 2 diabetes, 18 of non-obesity simple type 2 diabetes) undergoing LRYGB in our hospital between May 2010 to May 2013 were retrospectively analyzed. Cause of complication was explored and experience was summarized in order to provide reference to clinical practice.

RESULTS RESULTSThere was no mortality and re-admission within 30 days after procedures. Nine patients developed complications. Punctural injury occurred in 1 patient(1.2%) and laparotomy surgery was performed to stop bleedind. Hemorrhage was observed in 4 patients(4.9%, one patients had concurrent anastomotic ulcer) and was cured by either gastrolavage with solution of epinephrine and normal saline or cautery under gastroscope. Anastomotic leakage occurred in one patient(1.2%) which was cured by placing nose-gastro tube immediately after diagnosis of leakage and total enteral nutrition for one month. Anastomotic stricture occurred in 1 patient(1.2%), general peritonitis occurred after balloon dilation and laparoscopic repair was performed to repair the perforation due to dilation. Gastroplegia occurred in two patients(2.4%) and was cured after fasting, gastrointestinal decompression, usage of gastrointestinal prokinetic medications and enteral nutrition. All complications were cured at last. BMI of all patients dropped in vary extent after a follow up of 19.0-35.0(29.1±5.4) months.

CONCLUSIONSComplication after LRYGB operation may be prevented by active preoperative preparation, surgical precision, and intensive postoperative care. Even complications occur, the corresponding treatments are effective.

Anastomotic Leak ; Diabetes Mellitus, Type 2 ; Gastric Bypass ; adverse effects ; Humans ; Laparoscopy ; Postoperative Complications ; prevention & control ; therapy ; Retrospective Studies

It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.
Anastomotic Leak ; Constriction, Pathologic ; Gastrectomy ; adverse effects ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; surgery

Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage after rectal cancer surgery. It is of concern that about 1 in 5 defunctioning stomas will not be restored, that is, becoming permanent. And that is usually beyond expectation by physicians and patients, which deserves enough attention. The causes are complex, including anastomotic complications, tumor progression, perioperative death, poor anal function and patient willingness. Possible risk factors include symptomatic anastomotic leakage, age, tumor location, neoadjuvant therapy, anal function, TNM stage, ASA score, hospital factors, etc. Those factors may occur in various stages of patient referral such as before neoadjuvant therapy, prior to surgery, intra or post-operative period, and follow-up. Adequate physician-patient communication and shared decision-making, comprehensive tumor and patient function assessment, rational treatment strategy, careful manipulation during operation and good quality control, and meticulous perioperative management are important steps to reduce the permanent stoma. When shared decision-making, patients' needs should be fully considered while unnecessary expectations of anal preservation should be avoided. The risk of perpetuation of defunctioning stoma should be fully informed. Safe operation, especially anastomosis, is the key to avoid permanent stoma. And attention should be paid to the early detection and intervention of postoperative anastomotic stenosis.
Humans ; Anastomotic Leak/etiology* ; Surgical Stomas/adverse effects* ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Risk Factors ; Postoperative Complications/prevention & control*

The incidence of anastomotic leakage, a common and serious postoperative complication of low rectal cancer, remains high. Clarifying the risk factors for anastomotic leakage in patients with low rectal cancer after surgery can help guide clinical treatment and help patients improve their prognosis. The current literature suggests that the risk factors affecting the occurrence of anastomotic leakage after low rectal cancer include three aspects: (1) individual factors: male gender, high body mass index, malnutrition, smoking, alcoholism, and metabolic diseases; (2) tumor factors: the lower margin of tumor <5 cm from the anal verge, tumor diameter >2.5 cm, late tumor stage, high level of tumor markers and preoperative intestinal obstruction; (3) surgical factors: long operative time (>180 min), intraoperative bleeding (≥70 ml), more than 2 cartridges of stapling for anastomosis, contamination of the operative field, epidural analgesia and intraoperative hypothermia. Notably, the surgical approach (laparoscopic, open and hand-assisted laparoscopic surgery) was not a factor influencing the occurrence of postoperative anastomotic leakage in low rectal cancer. The findings on the effects of receiving neoadjuvant therapy, gut microbiota,intestinal bowel preparation, insufficient time for preoperative antibiotic prophylaxis, left colonic artery dissection, intraoperative blood transfusion, pelvic drainage, transanal drainage and combined organ resection, and postoperative diarrhea on postoperative anastomotic leakage in low rectal cancer are controversial. However, clinical workers can still take measures to reduce the risk of anastomotic leakage according to the above risk factors by making a good assessment before surgery, actively avoiding them during and after surgery, and taking measures for each step, so as to bring maximum benefits to patients.
Humans ; Male ; Anastomotic Leak/prevention & control* ; Rectum/surgery* ; Rectal Neoplasms/complications* ; Anastomosis, Surgical/adverse effects* ; Laparoscopy/adverse effects*

Anastomotic leak is a common and serious complication after anterior rectal resection. Despite the continuous advancement of anastomotic instruments and surgical techniques, the incidence of anastomotic leak has not decreased significantly compared with the past. As more studies on the early diagnosis of anastomotic leak are published, postoperative risk factors of anastomotic leak, such as fever, time to first bowel movement, CT, C-reactive protein (CRP) and procalcitonin (PCT), matrix metalloproteinase-9, and other cytokines and biomarkers (IL-6, TNF-α, lactate, pH, urinary neopterin/creatinine ratio), provide a reference for surgeons to assess the risk and increase the possibility of early diagnosis of anastomotic leak. Nevertheless, preventing the occurrence of anastomotic leak is still the ultimate goal. For the prevention of anastomotic leak, intraoperative ICG fluorescence imaging technology provides a simple and safe objective method for surgeons to evaluate anastomotic perfusion. The diversion stoma may reduce the incidence of anastomotic leak. More and more evidence shows that drainage through the anal canal can reduce the incidence of anastomotic leak after rectal cancer, but whether different types of drainage catheters can clearly reduce the incidence of anastomotic leak still needs more evidence. In addition, there has not yet been a unified opinion on the retention time and location of the drainage catheter. At present, the research of anastomotic leak has not adopted a unified definition and the heterogeneity among related studies is still great. We still look forward to more high-quality multi-center large prospective and randomized controlled studies.
Anastomosis, Surgical ; Anastomotic Leak/prevention & control* ; Early Detection of Cancer ; Humans ; Prospective Studies ; Rectal Neoplasms/surgery* ; Rectum/surgery*

OBJECTIVETo compare the efficacy between continuous negative pressure-flush through extraperitoneal dual tube and conventional drainage in the treatment and prevention for anastomotic leakage after low anterior resection in patients with rectal cancer.

METHODSClinical data of 627 rectal cancer patients undergoing low anterior resection by the same surgical team from January 2007 to March 2012 were reviewed retrospectively. Of 627 patients, 370 received self-made easy extraperitoneal dual tube which was placed in the dorsal site of an anastomosis for drainage (dual tube group), and the other 257 received conventional drainage tube from abdominal cavity (convention group) prophylactically. The incidence of postoperative anastomotic leakage, reoperation rate, drainage tube indwelling duration, hospitalization duration, hospitalization expense, quality of life score, incidence of anastomotic stricture within 6 months after operation were compared between the two groups.

RESULTSAnastomotic leakage after low Dixon operation was found in 25 cases (4.0%, 25/627), including 14 cases (3.8%, 14/370) in dual tube group, and 11 cases (4.3%, 11/257) in convention group, and the difference was not statistically significant. After anastomotic leakage occurrence, all the patients in dual tube group were managed by continuous negative pressure (50 mmHg)-flush through another self-made easy intra-rectal dual tube without reoperation, while 5 patients in conventional group underwent operation again because of treatment failure with continuous negative pressure-flush through intra-rectal dual tube for half a month. Drainage tube indwelling duration was (9.7±2.7) d and (16.4±3.6) d, hospitalization duration was (15.7±4.3) d and (21.5±6.4) d, hospitalization expenses was (42 470±3190) Yuan and (53 480±5630) Yuan in dual tube group and conventional group respectively, the differences were all statistically significant (all P<0.05). Quality of life on the 15th day of anastomotic leakage treatment was significantly better in dual tube group as compared to conventional group (P<0.05).

CONCLUSIONThough continuous negative pressure-flush through extraperitoneal dual tube can not decrease the incidence of anastomotic leakage in rectal cancer patients after low anterior resection, it may increase the successful rate of conservative therapy, decrease the reoperation rate, and improve the quality of life when combined with the use of an intra-rectal dual tube.

Aged ; Anastomotic Leak ; etiology ; prevention & control ; Humans ; Middle Aged ; Postoperative Complications ; prevention & control ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Therapeutic Irrigation ; methods ; Treatment Outcome