PURPOSE: This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR). METHODS: Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine. RESULTS: Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis. CONCLUSION: WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.
Abscess ; Anastomotic Leak ; Colorectal Surgery ; Enema* ; Humans ; Rectal Neoplasms*

Anastomotic Leak ; Aorta/surgery* ; Aortic Valve Insufficiency ; Humans

Anastomosis, Surgical ; Anastomotic Leak/surgery* ; Drainage ; Gastrectomy ; Humans ; Suction

Background and Objective: One of the uses of indocyanine green (ICG) in the surgical field is the evaluation of the anastomotic margins in colorectal surgery. This is of particular importance because fluorescence imaging may aid in detecting vascular compromise, allowing the surgeon to change the resection margin thereby decreasing the chance of an anastomotic leak. To date, there has been no study with its use locally. This study aimed to determine whether the use of ICG can safely identify if the margins of resection are well-vascularized in patients undergoing left-sided colon or rectal surgery, which in turn may reduce anastomotic leak rates. Methods: Through a retrospective study design, the investigators gathered data of patients who underwent left-sided colon or rectal surgery. The groups were divided into those with and without the use of ICG and a comparative data on the anastomotic leak rates were analyzed. Results: Eighty-six (86) patients with similar patient characteristics, tumor staging, and surgical approach were compared. Both the leak rates identified during the initial hospital stay and at 30 days post-operatively were lower in those where ICG was used (p=0.035, p=0.047, respectively) than those where ICG was not used. Conclusion ICG fluorescence imaging may reduce the anastomotic leak rates in patients undergoing colorectal surgery.
indocyanine green ; colon ; rectum ; colorectal surgery ; anastomosis, surgical ; anastomotic leak

Anastomotic leakage (AL) is one of the most serious complications after sphincter- preserving surgery for rectal cancer, which can significantly prolong the length of stay of patients, increase perioperative mortality, cause dysfunction, shorten overall survival and recurrence-free survival of patients. In order to reduce the serious consequences caused by AL, prediction of AL through preoperative and intraoperative risk factors are of great importance. However, the influences of neoadjuvant chemoradiotherapy, protective stoma, laparoscopic surgery and some intraoperative manipulations on AL are still controversial. Through the auxiliary judgment of anastomotic blood supply during operation, such as indocyanine green imaging, hemodynamic ultrasound, etc., it is expected to achieve the source control of AL. Early diagnosis of AL can be achieved by attention to clinical manifestations and drainage, examination of peripheral blood, drainage and intestinal flora, identification of high risk factors such as fever, diarrhea and increased infectious indicators, and timely administration of CT with contrast enema.
Humans ; Anastomotic Leak/surgery* ; Rectal Neoplasms/complications* ; Rectum/surgery* ; Risk Factors ; Early Diagnosis

Objective: To evaluate the efficiency and safety of endoscopic trans-fistula drainage (ETFD) for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. Methods: Among 456 esophageal cancer patients receiving esophagectomy between February 2012 and February 2017 in Sir Run Run Shaw Hospital, 15 cases were diagnosed as gastroesophageal anastomotic fistula with para-fistula abscess after surgery. Seven cases received ETFD treatment (ETFD group), and 8 cases received conventional treatment (control group). Recovery of inflammatory markers and fistula, length of hospital stay after esophagectomy and total medical expenses were compared between ETFD group and control group. Results: All patients recovered in ETFD group. Time of white cell count returning to normal and decline of C-reactive protein, time of fistula healing and length of hospital stay after esophagectomy in ETFD group were significantly shorter than those of control group (all P<0.05). And medical expenses in ETFD group was also lower (P<0.05). Conclusion: ETFD is effective and safe for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy.
Abscess ; Anastomotic Leak ; Drainage ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Fistula ; surgery ; Humans ; Retrospective Studies

Anastomotic leak is one of the most severe complications following right hemicolectomy but rarely happens, which should be diagnosed based on clinical manifestations, laboratory and radiographic examinations. Influencing factors of anastomotic leak after right hemicolectomy include bowel preparation, emergency surgery, anastomotic procedure (side-to-side anastomosis vs. end-to-side anastomosis, instrument anastomosis vs. manual technigue and intracorporeal vs. extracorporeal anastomosis), surgical resection range and patient's characteristics. The occurrence of anastomotic leak might be avoided by standardized operations and indocyanine green fluorescence imaging. Active treatment is recommended once anastomotic leak is diagnosed. Most patients can be cured by non-surgical treatments such as adequate drainage and anti-infection therapy. When severe sepsis happens or non-surgical treatment fails, surgical treatment should be carried out in time.
Anastomosis, Surgical/adverse effects* ; Anastomotic Leak/surgery* ; Colectomy ; Colon/surgery* ; Humans ; Indocyanine Green

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.
Anastomotic Leak ; Fistula ; Gastrointestinal Tract* ; Intestinal Perforation ; Natural Orifice Endoscopic Surgery ; Tertiary Care Centers*

PURPOSE: The routine use of postoperative nasogastric decompression after abdominal surgery has been challenged. Furthermore, investigators have recently shown that early postoperative oral feeding is safe and generally well tolerated. This study was aimed to determine whether or not early postoperative feeding is safe after elective colorectal surgery. METHODS: All patients who underwent elective colorectal surgeries between June 1998 and March 1999 were permitted to take oral intake one day after the operations. The patients were compared with other patients, who had underwent elective colorectal surgeries between September 1997 and June 1998 and permitted to have a meal after resolving postoperative ileus. The nasogastric tube was removed from all patients immediately after surgery. The patients were monitored for the time of ileus resolution, nausea/vomiting, abdominal distension, nasogastric tube reinsertion and complications. RESULTS: Fifty-one patients were studied, 24 patients in early feeding group and 27 patients in traditional feeding group. Eighteen patients (75.0%) in the early feeding group tolerated the early oral intake. There were no significant differences between two groups in the time for resolution of ileus (3.46 1.38 days vs 3.56 1.80 days), nausea/vomiting (33.3% vs 29.6%), abdominal distension (16.6% vs 14.8%) and nasogastric tube reinsertion (12.5% vs 7.4%). No significant difference was noted in complications such as wound infection, pulmonary problems, intestinal obstruction and anastomotic leak. CONCLUSIONS: Early oral intake after elective colorectal surgery was safe and most of the patients tolerated it. And it may become a kind of managements after elective colorectal surgery.
Anastomotic Leak ; Colorectal Surgery* ; Decompression ; Humans ; Ileus ; Intestinal Obstruction ; Meals ; Research Personnel ; Wound Infection

PURPOSE: Anastomotic leakage following low anterior resection (LAR) for rectal cancer is a serious complication that increases morbidity and mortality rates. Transanal tube placement may reduce postoperative anastomotic leakage rate by reducing intraluminal pressure and preventing fecal extrusion through the staple line. This meta-analysis evaluated the effectiveness of transanal tube placement to prevent anastomotic leakage after LAR for rectal cancer using a stapling technique. METHODS: A systematic review of the literature was consistent with the recommendations of the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement. Multiple comprehensive databases, including PubMed, Embase, Cochrane Library and KoreaMed, were searched. The main study outcomes were anastomotic leakage. RESULTS: Two randomized clinical trials and 4 nonrandomized studies involving 1,118 patients were included. Subgroup analyses of randomized clinical trials found that transanal tube placement had no effect on study outcomes. Meta-analysis of nonrandomized studies showed that transanal tube placement was associated with a lower incidence of anastomotic leakage (relative risk, 0.32; 95% CI, 0.15-0.67; I2 = 0%). CONCLUSION: Transanal tube placement may be effective in preventing or reducing the occurrence of anastomotic leakage after LAR for rectal cancer using a stapling technique. Randomized clinical trials with sufficient power are needed to confirm the benefit of transanal tube placement.
Anastomotic Leak* ; Colorectal Neoplasms ; Colorectal Surgery ; Humans ; Incidence ; Mortality ; Rectal Neoplasms*