"End-to-end" and "end-to-side” colorectal anastomosis: does the selection of surgical tactics influence insufficiency of the apparatus anastomosis?

Authors

  • D. Yu. Savenkov
  • O. D. Bielosludtsev
  • S. S. Siryi

DOI:

https://doi.org/10.26641/2307-0404.2020.3.214851

Keywords:

colorectal cancer, colorectal anastomosis, complications

Abstract

It is still uncertain whether the choice of “end-to-end” or “end-to-side” anastomosis affects the risk of anastomosis insufficiency, with low anterior resections of the rectum in patients with colorectal cancer. The aim of our work was to determine the influence of choosing the surgical tactics of overlaying colorectal “end-to-end” or “end-to-side” anastomosis on the frequency and severity of the anastomosis leak in patients after rectal resection and postoperative recovery period. A retrospective analysis of the medical documentation of patients after anterior resection of the rectum in relation to rectal cancer was performed. Depending on the type of anastomosis the patients were divided into two groups: group 1 – patients with “end-to-end” anastomosis, group 2 – patients with “end-to-side” anastomosis. Surgical complications including the frequency and severity of intestinal anastomosis leak were analyzed. The total number of postoperative complications among patients in group 1 was by 2 times more frequent than in patients in group 2, and analysis of their severity points on advantage of overlaying “end-to-side” anastomosis. Thus, in 3 (20.0%) patients of group 1 there was a partial failure of anastomosis of the class B, in 2 (13.3%) patients – a partial failure of anastomosis of the class C, in 2 (13.3%) patients there was peritonitis; in 1 (6.7%) patient we found lymphorrhea. While in patients of group 2 there were isolated complications (partial failure of anastomosis of class B was in 2 (14.3%) patients, postoperative seroma was in 2 (14.3%) patients. However, partial failure of anastomosis of class C, peritonitis or lymphorrhea were absent. The number of days from surgery to discharge in patients of group 2 was less (9 [7–13] days compared with 13.0 [9–20] days in patients of group 1). In patients with rectal cancer after anterior rectum resection, the choice of surgical tactics of overlaying of colorectal “end-to-end” or “end-to-side” anastomoses influences the frequency of formation of anastomosis insufficiency; “end-to-side” anastomoses overlay reduces the frequency and severity of the colorectal anastomoses leak, which reduces the postoperative recovery period.

Author Biographies

D. Yu. Savenkov

MI "Clinical Oncology Dispensary" DRC
Gavrilenko str., 1, Dnipro, 49000, Ukraine

O. D. Bielosludtsev

MI "Clinical Oncology Dispensary" DRC
Gavrilenko str., 1, Dnipro, 49000, Ukraine

S. S. Siryi

MI "Clinical Oncology Dispensary" DRC
Gavrilenko str., 1, Dnipro, 49000, Ukraine

References

[Electronic textbook on statistics]. [Internet]. [cited 2019 July 01]. Ukrainian. Available from: http://statsoft.ru/home/textbook/default.htm

[Functions of Excel (by categories)]. [Internet]. [cited 2019 July 01]. Ukrainian. Available from: https://support.office.com/uk-ua/article

Sujatha-Bhaskar S, Jafari MD, Hanna M, Koh CY, et al. An endoscopic mucosal grading system is predictive of leak in stapled rectal anastomoses. Surg Endosc. 2018 Apr;32(4):1769-75. doi: https://doi.org/10.1007/s00464-017-5860-y

Cooper CJ, Morales A, Othman MO. Outcomes of the use of fully covered esophageal self-expandable stent in the management of colorectal anastomotic strictures and leaks. Diagn Ther Endosc. 2014;2014:187541. doi: https://doi.org/10.1155/2014/187541

Pucciarelli S, Del Bianco P, Pace U, Bianco F, et al. Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer. Br J Surg. 2019 Aug;106(9):1147-55. doi: https://doi.org/10.1002/bjs.11222

Sciuto A, Merola G, De Palma G, Sodo M, et al. Pre­dictive factors for anastomotic leakage after laparo­sco­pic co­lorectal surgery. World J Gastroenterol. 2018;24(21):2247-60. doi: https://dx.doi.org/10.3748/wjg.v24.i21.2247

Meyer J, Naiken S, Christou N, Liot E, et el. World J. Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges. Gastroenterol. 2019;25(34):5017-25. doi: https://doi.org/10.3748/wjg.v25.i34.5017

Thomas MS, Margolin DA. Management of Colo­rec­tal Anastomotic Leak. Clin Colon Rectal Surg. 2016;29(2):138-44. doi: https://doi.org/10.1055/s-0036-1580630

Published

2020-10-05

How to Cite

1.
Savenkov DY, Bielosludtsev OD, Siryi SS. "End-to-end" and "end-to-side” colorectal anastomosis: does the selection of surgical tactics influence insufficiency of the apparatus anastomosis?. Med. perspekt. [Internet]. 2020Oct.5 [cited 2024Jun.18];25(3):139-43. Available from: https://journals.uran.ua/index.php/2307-0404/article/view/214851

Issue

Section

CLINICAL MEDICINE