Annals of Coloproctology

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Original Articles

Complications

Incisional hernia risk in intracorporeal anastomosis with Pfannenstiel incision versus extracorporeal anastomosis with midline incision for laparoscopic right hemicolectomy: a multicenter comparison: Francesco Saverio Lucido, Giusiana Nesta, Luigi Brusciano, Claudio Gambardella, Francesco Pizza, Giuseppe Scognamiglio, Gianmattia del Genio, Salvatore Tolone, Federico Maria Mongardini, Massimo Mongardini, Ludovico Docimo, Simona Parisi; Ann Coloproctol. 2025;41(4):287-292. Published online June 18, 2025; DOI: https://doi.org/10.3393/ac.2024.00682.0097

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Abstract PDF: Purpose
Laparoscopic right hemicolectomy can be performed via intracorporeal ileocolic anastomosis (ICA) or extracorporeal ileocolic anastomosis (ECA). Prior studies have emphasized ICA’s advantages in hospital stay and postoperative pain. This multicenter study aimed to compare the 2-year incidence of incisional hernia between ICA (using a suprapubic Pfannenstiel incision) and ECA (using a pararectal incision) and assess perioperative outcomes.
Methods
We retrospectively analyzed patients undergoing laparoscopic right hemicolectomy between 2019 and 2020, divided into 2 groups: ICA with a Pfannenstiel incision and ECA with a pararectal incision.
Results
The mean operative time was longer in the ICA group (190 minutes vs. 170 minutes, P=0.004). Despite requiring advanced surgical skills and prolonged operative time, ICA was associated with superior short-term outcomes and a significantly lower incisional hernia rate compared to ECA (1.2% vs. 14.7%, P=0.044) at 24-month follow-up.
Conclusion
ICA is linked to longer operative times, but shorter hospital stays, fewer wound complications, and reduced incisional hernia rates compared to ECA.

Complications

Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study: Daniela Rega, Ernesto De Giulio, Raffaele De Luca, Andrea Muratore, Marco Milone, Giuseppe Sica, Paolo Millo, Carmela Cervone, Nicola Cillara, Patrizia Marsanic, Brunella Maria Pirozzi, Valeria Grazia Malagnino, Pietro Anoldo, Marcello Calabrò, Giovanni De Palma, Michele Simone, Paolo Delrio; Ann Coloproctol. 2025;41(4):293-302. Published online June 4, 2025; DOI: https://doi.org/10.3393/ac.2024.00899.0128

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Graphical Abstract Abstract PDF: Purpose
Anastomotic leaks (AL) remain a major complication following right colectomy for colon cancer. This multicenter, prospective, observational study evaluated the efficacy of Glubran 2, a cyanoacrylate-based sealant, in reducing the incidence of AL by reinforcing ileocolic anastomoses.
Methods
The study enrolled 380 patients undergoing right colectomy for colon cancer across 7 Italian hospitals. Glubran 2 was applied to reinforce ileocolic anastomoses. The primary endpoint was a 50% reduction in AL incidence from a baseline of 6.18% within 10 days after surgery. Secondary endpoints included examining the correlation between AL and preexisting risk factors and determining the rate of anastomotic bleeding. Statistical analyses employed binomial tests and logistic regression.
Results
The AL rate was reduced to 1.85% compared to the reference rate of 6.18% (P<0.01). Glubran 2 exhibited a protective effect even in patients with preexisting risk factors such as smoking, diabetes, or prior surgeries; none of these factors was significantly associated with AL (P>0.05). Surgical technique (P=0.687), anastomosis technique (P=0.998), and anastomosis type (P=0.998) did not influence AL rates. Operation time was similar across groups (P=0.613), and anastomotic bleeding occurred in 1.3% of cases, with no association with AL (P=0.989).
Conclusion
Glubran 2 was safely applied to ileocolic anastomoses, significantly reducing AL rates and potentially providing a protective effect even in patients with known risk factors. Its hemostatic and bacteriostatic properties support improved postoperative outcomes, highlighting its potential as an effective adjunct in colorectal surgery. Further studies are warranted to confirm these findings and explore broader applications.

Minimally invasive surgery

New double-stapling technique without staple-crossing line in laparoscopic low anterior resection: effort to reduce anastomotic leakage: Nam Seok Kim, Ji Hoon Kim, Yoon Suk Lee, In Kyu Lee, Won Kyung Kang; Ann Coloproctol. 2024;40(6):573-579. Published online November 22, 2024; DOI: https://doi.org/10.3393/ac.2022.00409.0058

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Graphical Abstract Abstract PDF

Purpose
This study aimed to demonstrate the safety of new double-stapling technique (nDST), without a crossing line and dog ears, by comparing with conventional DST (cDST) in laparoscopic low anterior resection (LAR).
Methods
We retrospectively reviewed 98 consecutive patients who underwent laparoscopic LAR for rectal cancer from January 2018 to December 2020. The inclusion criterion was an anastomosis level below the peritoneal reflection and 4 cm above the anal verge. In the nDST group, the staple line of the linear cutter was sutured using barbed sutures to shorten the staple line before firing the circular stapler. Therefore, there were no crossing lines after firing the circular stapler. A 2:1 propensity score matching was performed between the cDST and nDST groups.
Results
After propensity score matching, 39 patients were in the cDST group and 20 were in the nDST group. There were no significant differences in patient demographics between the 2 groups. There was no difference in the total operation time between the cDST and nDST groups (124.0±26.2 minutes vs. 125.2±20.3 minutes, P=0.853). Morbidity rates were similar between the 2 groups (9 cases [23.1%] vs. 5 cases [25.0%], P=0.855). There was no significant difference in leakage rate (4 cases [10.3%] vs. 1 case [5.0%], P=0.847) and anastomotic bleeding rate (1 case [2.6%] vs. 3 cases [15.0%], P=0.211).
Conclusion
The nDST to eliminate the crossing line and dog ears in laparoscopic LAR is technically feasible and safe. However, more attention should be paid to anastomotic bleeding in such cases.

Citations

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The robotic intracorporeal single-stapled anastomosis (RiSSA) technique in robotic left-sided colorectal resection: a technical note
Chih-Chien Wu, Yung-Lin Tan, Chao-Wen Hsu, Hsin-Ping Tseng, Danilo Miskovic, Shih-Feng Huang
Annals of Coloproctology.2025; 41(4): 357. CrossRef
Comparative perioperative outcomes of articulated versus conventional straight devices in laparoscopic low anterior resection: a propensity score–matched analysis
Hayoung Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
Annals of Coloproctology.2025; 41(5): 434. CrossRef

Anorectal benign disease

Proctitis distal to colorectal anastomosis: a retrospective cohort study of an underreported complication after sigmoidectomy: Ajmal Khan, Maziar Nikberg, Kenneth Smedh, Abbas Chabok; Ann Coloproctol. 2024;40(5):498-505. Published online October 22, 2024; DOI: https://doi.org/10.3393/ac.2023.00675.0096

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Abstract PDF: Purpose
Proctitis distal to colorectal anastomosis is rare and infrequently reported. We evaluated the incidence, symptoms, treatment, and potential risk factors associated with this condition.
Methods
We conducted a retrospective population-based cohort study in Västmanland County, Sweden. This investigation included all patients who underwent sigmoidectomy with colorectal anastomosis between 2008 and 2020. We excluded patients without an anastomosis and those with inflammatory bowel disease.
Results
Of the 546 patients identified, 233 fulfilled the inclusion criteria, of whom 26 (11.2%) developed proctitis distal to colorectal anastomosis. The most frequent symptoms included urgency (n=16, 61.5%), increased stool frequency (n=12, 46.2%), and anorectal pain (n=12, 46.2%). Endoscopic balloon dilation was performed in 20 cases (76.9%), with 10 requiring only a single therapeutic procedure. The median number of dilations was 3 (range, 1–8). Multivariable analysis revealed that surgery due to malignancy and emergency surgery were associated with elevated risk of proctitis. A subgroup analysis of patients who underwent surgery due to malignancy indicated that smoking (odds ratio, 3.9; 95% confidence interval, 1.1–14.0) and emergency surgery (odds ratio, 6.5; 95% confidence interval, 1.1–37.1) were also associated with increased proctitis risk.
Conclusion
Proctitis distal to colorectal anastomosis is not uncommon following sigmoidectomy. Patients undergoing emergency surgery or surgery due to malignancy and who had a history of smoking displayed an increased risk of developing proctitis. Due to the paucity of symptoms observed, particularly in patients with a diverting stoma, routine endoscopic rectal examination should be performed during follow-up after sigmoidectomy.

Video

Video clip

Robotic total colectomy and ileorectal anastomosis: Jonathan Yu Jin Chua, Nan Zun Teo, James Chi-Yong Ngu; Ann Coloproctol. 2024;40(2):186-187. Published online April 22, 2024; DOI: https://doi.org/10.3393/ac.2024.00066.0009

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Abstract PDF Supplementary Material

The benefits of minimally invasive approaches in colorectal surgery have been well demonstrated. However, some hesitancy remains with regards to the utilization of the robotic platform for total colectomies, mostly due to the perceived need for multiple re-dockings in multiquadrant surgery. This video aims to demonstrate how the robotic platform can be efficiently utilized in multiquadrant surgery without the need for multiple re-dockings, as well as some tips on how to overcome the potential challenges that may be encountered during this procedure.

Citations

Citations to this article as recorded by

Fully Robotic Total Colectomy in High‐Risk Patients and Review of Literature
Igor Monsellato, Teresa Gatto, Maria Antonietta Alagia, Federico Sangiuolo, Marco Palucci, Celeste del Basso, Martina Girardi, Irene Gandini, Gabriela Del Angel‐Millan, Marco Lodin, Fabio Giannone, Gianluca Cassese, Fabrizio Panaro
The International Journal of Medical Robotics and Computer Assisted Surgery.2025;[Epub] CrossRef

Technical Note

Technical tips

Introduction of extraperitoneal tunneling method: a way to secure the drain tube in the pelvic cavity after proctectomy: Sung Il Kang, Sohyun Kim, Jae Hwang Kim; Ann Coloproctol. 2024;40(2):182-185. Published online March 25, 2024; DOI: https://doi.org/10.3393/ac.2023.00073.0010

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1 Citations

Abstract PDF

The effectiveness of closed drainage tube insertion after low anterior resection has been controversial. We believe that drain tube displacement, which occurs up to 35% in real clinical practice, reduces the effectiveness of the drain tube. We report in this video a simple way to secure the drain tube in the pelvic cavity after low anterior resection and introduce a case that used the drain fixation method and treated anastomotic leakage without interventional procedure.

Citations

Citations to this article as recorded by

Comparison of drain displacement and complications between conventional drain insertion and extraperitoneal tunneling drain insertion following anterior or low anterior resection: a retrospective comparative cohort study
Sung Il Kang, Sohyun Kim
Annals of Surgical Treatment and Research.2025; 109(1): 7. CrossRef

Case Report

Colorectal cancer

Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature: Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim; Ann Coloproctol. 2024;40(Suppl 1):S38-S43. Published online February 8, 2023; DOI: https://doi.org/10.3393/ac.2022.00829.0118

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Abstract PDF

Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform. The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

Citations

Citations to this article as recorded by

International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome
Guglielmo Niccolò Piozzi, Krunal Khobragade, Vusal Aliyev, Oktar Asoglu, Paolo Pietro Bianchi, Vlad‐Olimpiu Butiurca, William Tzu‐Liang Chen, Ju Yong Cheong, Gyu‐Seog Choi, Andrea Coratti, Quentin Denost, Yosuke Fukunaga, Emre Gorgun, Francesco Guerra, Ma
Colorectal Disease.2023; 25(9): 1896. CrossRef

Review

Colorectal cancer

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis: Ricardo Purchio Galletti, Gabriel Andrade Agareno, Lucas de Abreu Sesconetto, Rafael Benjamim Rosa da Silva, Rafael Vaz Pandini, Lucas Soares Gerbasi, Victor Edmond Seid, Sérgio Eduardo Alonso Araujo, Francisco Tustumi; Ann Coloproctol. 2023;39(5):375-384. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00605.0086

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Abstract PDF Supplementary Material

Purpose
This study aimed to review the outcomes of redo procedures for failed colorectal or coloanal anastomoses.
Methods
A systematic review was performed using the PubMed, Embase, Cochrane, and LILACS databases. The inclusion criteria were adult patients undergoing colectomy with primary colorectal or coloanal anastomosis and studies that assessed the postoperative results. The protocol is registered in PROSPERO (No. CRD42021267715).
Results
Eleven articles met the eligibility criteria and were selected. The studied population size ranged from 7 to 78 patients. The overall mortality rate was 0% (95% confidence interval [CI], 0%–0.01%). The postoperative complication rate was 40% (95% CI, 40%–50%). The length of hospital stay was 13.68 days (95% CI, 11.3–16.06 days). After redo surgery, 82% of the patients were free of stoma (95% CI, 75%–90%), and 24% of patients (95% CI, 0%–39%) had fecal incontinence. Neoadjuvant chemoradiotherapy (P=0.002) was associated with a lower probability of being free of stoma in meta-regression.
Conclusion
Redo colorectal and coloanal anastomoses are strategies to restore colonic continuity. The decision to perform a redo operation should be based on a proper evaluation of the morbidity and mortality risks, the probability of remaining free of stoma, the quality of life, and a functional assessment.

Citations

Citations to this article as recorded by

Abdominoperineal pull-through with delayed coloanal anastomosis for pelvic anastomotic failure—a systematic review
T. J. K. Tan, S.-M. Ng, T. S. Q. Lee, E. K.-W. Tan, I. Seow-En
Techniques in Coloproctology.2025;[Epub] CrossRef
Laparoscopic redo endorectal pull‐through procedure for complex rectovaginal fistula after rectal resection for endometriosis: A Video Vignette
Sergio Eduardo Alonso Araujo, Francisco Tustumi, Ana Sarah Portilho, Lucas de Araujo Horcel, Victor Edmond Seid
Colorectal Disease.2023; 25(11): 2284. CrossRef

Original Articles

Malignant disease,Rectal cancer,Complication,Biomarker & risk factor

Cross-sectional area of psoas muscle as a predictive marker of anastomotic failure in male rectal cancer patients: Japanese single institutional retrospective observational study: Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kohei Nakata, Kenoki Ohuchida, Toru Nakano, Masafumi Nakamura; Ann Coloproctol. 2022;38(5):353-361. Published online April 12, 2022; DOI: https://doi.org/10.3393/ac.2022.00122.0017

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8 Web of Science
9 Citations

Graphical Abstract Abstract PDF Supplementary Material

Purpose
Preoperative sarcopenia worsens postoperative outcomes in various cancer types including colorectal cancer. However, we often experienced postoperative anastomotic leakage in muscular male patients such as Judo players, especially in rectal cancer surgery with lower anastomosis. It is controversial whether the whole skeletal muscle mass impacts the potential for anastomotic failure in male rectal cancer patients. Thus, the purpose of this study was to clarify whether skeletal muscle mass impacts anastomotic leakage in rectal cancer in men.
Methods
We reviewed the medical charts of male patients suffering from rectal cancer who underwent colo-procto anastomosis below the peritoneal reflection without a protective diverting stoma. We measured the psoas muscle area and calculated the psoas muscle index.
Results
One hundred ninety-seven male rectal cancer patients were enrolled in this study. The psoas muscle index was significantly higher in patients with anastomotic leakage (P<0.001). Receiver operating characteristic curve determined the optimal cut-off value of the psoas muscle index for predicting anastomotic leakage as 812.67 cm²/m² (sensitivity of 60% and specificity of 74.3%). Multivariate analysis revealed that high psoas muscle index (risk ratio [RR], 3.933; P<0.001; 95% confidence interval [CI], 1.917–8.070) and super low anastomosis (RR, 2.792; P=0.015; 95% CI, 1.221–6.384) were independent predictive factors of anastomotic leakage.
Conclusion
This study showed that male rectal cancer patients with a large psoas muscle mass who underwent lower anastomosis had a higher rate of postoperative anastomotic leakage.

Citations

Citations to this article as recorded by

Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Unraveling the role of computed tomography derived body composition metrics on anastomotic leakages rates in rectal cancer surgery: A protocol for a systematic review and meta-analysis
Mark Broekman, Charlotte M. S. Genders, Ritchie T. J. Geitenbeek, Klaas Havenga, Schelto Kruijff, Joost M. Klaase, Alain R. Viddeleer, Esther C. J. Consten, Ozlem Boybeyi-Turer
PLOS ONE.2024; 19(7): e0307606. CrossRef
Association of computed tomography‐derived body composition and complications after colorectal cancer surgery: A systematic review and meta‐analysis
Claire P.M. van Helsdingen, Job G.A. van Wijlick, Ralph de Vries, Nicole D. Bouvy, Mariska M.G. Leeflang, Robert Hemke, Joep P.M. Derikx
Journal of Cachexia, Sarcopenia and Muscle.2024; 15(6): 2234. CrossRef
Prognostic Value of Artificial Intelligence-Driven, Computed Tomography-Based, Volumetric Assessment of the Volume and Density of Muscle in Patients With Colon Cancer
Minsung Kim, Sang Min Lee, Il Tae Son, Taeyong Park, Bo Young Oh
Korean Journal of Radiology.2023; 24(9): 849. CrossRef
Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Can the cross-sectional area of the psoas muscle be a predictor of anastomotic failure in male rectal cancer patients?
Myong Hoon Ihn
Annals of Coloproctology.2022; 38(5): 333. CrossRef
Psoas Muscle Index – Could It Be an Indicator of Postoperative Complications in Colorectal Cancer? Case Presentation and Review of the Literature
Georgiana Alexandra Scurtu, Zsolt Zoltán Fülöp, Botond Kiss, Patricia Simu, Diana Burlacu, Tivadar Bara
Journal of Interdisciplinary Medicine.2022; 7(4): 100. CrossRef

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study of anastomotic complications: Jonathan Frigault, Samuel Avoine, Sébastien Drolet, François Letarte, Alexandre Bouchard, Jean-Pierre Gagné, Claude Thibault, Roger C. Grégoire, Naomee Jutras Bouthillette, Maude Gosselin, Philippe Bouchard; Ann Coloproctol. 2023;39(2):147-155. Published online March 29, 2022; DOI: https://doi.org/10.3393/ac.2021.00983.0140

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Abstract PDF

Purpose
Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on perioperative safety and postoperative evolution.
Methods
We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used.
Results
In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160±31 minutes vs. EA, 138±42 minutes; P<0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P=0.049). At 30 days after surgery, there were no differences in the frequency of anastomotic leak (IA, 0% vs. EA, 2.3%; P=0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P>0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P>0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P=0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P=0.06). Anastomosis technique had no influence on recurrence.
Conclusion
For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.

Citations

Citations to this article as recorded by

Short-term outcomes for intracorporeal vs. extracorporeal anastomosis in laparoscopic right hemicolectomy for colonic cancer—a prospective cohort study (ICEA-study)
Emilie Schultz Hougaard, Benedicte Schelde-Olesen, Issam Al-Najami, Thomas Buchbjerg, Benjamin Schnack Brandt Rasmussen, Lasse Bugge, Thomas Kolbro, Sören Möller, Mark Bremholm Ellebæk
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Intracorporeal stapled versus extracorporeal hand-sewn anastomosis in minimal-invasive right hemicolectomy with complete mesocolic excision – a retrospective single center analysis
Maximilian Brunner, Katja Bondartschuk, Axel Denz, Georg F. Weber, Robert Grützmann, Christian Krautz
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Comparison of Robot‐Assisted and Laparoscopic Right Hemicolectomy for Right‐Sided Colon Cancer: A Report on the Short‐Term Perioperative Outcomes Using Propensity Score Matching
Shunsuke Sakuraba, Mizuki Nishiko, Shingo Yamasaki, Kazumasa Nakamura, Kohei Koido, Takeshi Oshima, Hiroyuki Hazama, Kou Ohata, Hideyuki Kanemto
Asian Journal of Endoscopic Surgery.2025;[Epub] CrossRef
Elevating surgical standards: The role of intraperitoneal isoperistaltic side-to-side anastomosis in colon cancer surgery
Sung Uk Bae
World Journal of Gastrointestinal Oncology.2025;[Epub] CrossRef
Revisiting Robotic Right Hemicolectomy: A Critical Appraisal of Perioperative Outcomes and Emerging Complications
Javed Iqbal, Brijesh Sathian, Syed Muhammad Ali
Asian Journal of Endoscopic Surgery.2025;[Epub] CrossRef
Laparoscopic Versus Robotic Completely Intracorporeal Jejunal Pouch Reconstruction After Gastrectomy: A Single-Center Analysis from Germany
Ani K. Stoyanova, Fiona Speichinger, Ioannis Pozios, Katharina Beyer, Ann-Kathrin Berg
Cancers.2025; 17(16): 2690. CrossRef
Comparison of intracorporeal and extracorporeal anastomosis in laparoscopic right colectomy: an updated meta-analysis and trial sequential analysis
Konstantinos Perivoliotis, George Tzovaras, Konstantinos Tepetes, Ioannis Baloyiannis
Updates in Surgery.2024; 76(2): 375. CrossRef
Effectiveness and safety of self-pulling and latter transection reconstruction in totally laparoscopic right hemicolectomy
Fuyu Yang, Fan He, Chenglin Tang, Defei Chen, Junjie Xiong, Yu Zou, Saed Woraikat, Kun Qian, Hui Li
Frontiers in Oncology.2024;[Epub] CrossRef
Single-Center Experiences: A Comparison of Intracorporeal and Extracorporeal Anastomosis Outcomes in Right Hemicolectomy
Audrey Kim, Munyaradzi G Nyandoro, Linda Vu, Ruben Rajan, Abraham Jacob
Cureus.2024;[Epub] CrossRef
Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons
Hye Jung Cho, Jong Woo Kim, Woo Ram Kim
Annals of Surgical Treatment and Research.2024; 107(1): 42. CrossRef
Effect of Specimen Extraction Site on Postoperative Incisional Hernia after Minimally Invasive Right Colectomy
Josh A Johnson, Andrea Mesiti, Margo Herre, Cyrus Farzaneh, Ying Li, Wini Zambare, Joseph Carmichael, Alessio Pigazzi, Mehraneh D Jafari
Journal of the American College of Surgeons.2024; 239(2): 107. CrossRef
Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery
Seong Kyu Baek
Journal of Minimally Invasive Surgery.2022; 25(3): 91. CrossRef

Technical Notes

Benign GI diease,Surgical technique

Double-layered hand-sewn anastomosis: a valuable resource for the colorectal surgeon: Cristopher Varela, Manar Nassr, Azharuddin Razak, Nam Kyu Kim; Ann Coloproctol. 2022;38(3):271-275. Published online March 17, 2022; DOI: https://doi.org/10.3393/ac.2021.00990.0141

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Abstract PDF Supplementary Material

Hand-sewn anastomosis is an essential and fundamental skill for surgeons dealing with any gastrointestinal anastomosis. Despite the advances in minimally invasive surgery and stapling devices, there are still complex surgical circumstances when the surgeon’s surgical know-how are necessary. Therefore, a safe hand-sewn technique for bowel anastomosis is required to establish a tension-free, well-perfused, and sealed anastomosis that allows gastrointestinal continuity with no unexpected complications. We describe a step-by-step procedure for hand-sewn double-layered anastomosis that reflects these principles and is practical for small and large bowel anastomosis.

Citations

Citations to this article as recorded by

Grampeadores mecânicos versus sutura manual em Anastomoses intestinais: uma revisão sistemática
Letícia Meneses Teixeira, Yuri Fleury de Melo Prudente Guimarães, Leonardo de Oliveira Leite Coelho, Leo Ferreira Mattos De Miranda
RCMOS - Revista Científica Multidisciplinar O Saber.2025;[Epub] CrossRef
Fluorescence-guided colorectal surgery: applications, clinical results, and protocols
Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
Annals of Surgical Treatment and Research.2023; 105(5): 252. CrossRef
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef

Original Articles

Colorectal cancer

Outcomes of side-to-end versus end-to-end colorectal anastomosis in nonemergent sigmoid and rectal cancers: a randomized controlled clinical trial: Tamer A.A.M. Habeeb, Hatem Mohammad, Tamer Wasefy, Mohamed Ibrahim Mansour; Ann Coloproctol. 2023;39(3):231-241. Published online March 11, 2022; DOI: https://doi.org/10.3393/ac.2021.00906.0129

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7 Citations

Graphical Abstract Abstract PDF

Purpose
The outcomes of open colorectal anastomosis of side-to-end versus end-to-end in nonemergent sigmoid and rectal cancer surgery in adults were compared.
Methods
A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018.
Results
The mean age was 62.58±12.3 years in the side-to-end anastomotic (SEA) group and 61.03±13.98 years in the end-to-end anastomotic (EEA) group. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were significantly associated with leakage. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (P=0.04). There is a statistically significant difference regarding incontinence for flatus in the SEA group only (P≤0.001). A statistically significant change in both groups regards incontinence for liquid stools (P≤0.001) and clustering of stools (P≤0.001 and P=0.043). The quality of life in the SEA group significantly dropped at 6 months and then returned to baseline as regards to physical well-being (PWB), functional well-being (FWB), and colorectal cancer symptoms (CCS) with no difference as regards SWB and EWB, while in the EEA group, the exact change happened only as regard PWB and FWB, but SWB and CCS percentage did not return to baseline.
Conclusion
The SEA group offers a safe alternative approach to the EEA group.

Citations

Citations to this article as recorded by

Short-term Outcomes of Linear vs. Circular Stapling for Esophagojejunostomy in Gastric Cancer: an Inverse Probability of Treatment Weighting Analysis
Yeojin Boo, Ho-Jung Shin, Jeong Ho Song, Sang-Yong Son, Hoon Hur, Sang-Uk Han
Journal of Gastric Cancer.2025; 25(3): 509. CrossRef
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Complication,Biomarker & risk factor

Intraoperative fluorescence angiography as an independent factor of anastomotic leakage and a nomogram for predicting leak for colorectal anastomoses: Mikhail Alekseev, Evgeny Rybakov, Evgeniy Khomyakov, Irina Zarodnyuk, Yuri Shelygin; Ann Coloproctol. 2022;38(5):380-386. Published online July 22, 2021; DOI: https://doi.org/10.3393/ac.2021.00171.0024

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17 Citations

Abstract PDF

Purpose
Colorectal anastomotic leakage (AL) is a life-threatening complication, which increases morbidity, hospital stay and cost of treatment. The aim of this study is to identify risk factors, including intraoperative indocyanine green fluorescence angiography (ICG FA), associated with the leak of stapled colorectal anastomosis.
Methods
Four hundred twenty-nine consecutive patients underwent surgery between 2017 and 2019 for benign (n=10, 2.3%) or malignant (n=419, 97.7%) and rectal (n=349, 81.4%) or distal sigmoid (n=80, 18.6%) lesions with double-stapling technique reconstruction were included into retrospective study. Univariate analysis and multivariate logistic regression of the tumor-, patient- and treatment-related risk factors of AL was performed.
Results
An AL developed in 52 patients (12.1%). In multivariate analysis following variables were independently associated with AL; male sex (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.9−7.7; P<0.01), anastomosis at ≤6.5 cm from anal verge (OR, 3.1; 95% CI, 1.3−7.5; P=0.01), and age of ≤62.5 years (OR, 2.1; 95% CI, 1.1−4.1; P=0.03). ICG FA was found as independent factor reducing colorectal AL rate (OR, 0.4; 95% CI, 0.2−0.8; P=0.02). A nomogram with high discriminative ability (concordance index, 0.81) was created.
Conclusion
ICG FA is a modifiable surgery-related risk factor associated with a decrease of colorectal AL rate. A suggested nomogram, which takes into consideration ICG FA, might be helpful to identify the individual risk of AL.

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J. R. Gómez-López, A. Balla, E. Licardie, S. Morales-Conde
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SAGES 2025 systematic review and meta-analysis for fluorescence image-guided gastrointestinal surgery using indocyanine green
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Malignant disease, Rectal cancer,Colorectal cancer,Surgical technique

The “reverse air leak test”: a new technique for the assessment of low colorectal anastomosis: Francesco Crafa, Augusto Striano, Francesco Esposito, Amalia Rosaria Rita Rossetti, Mario Baiamonte, Valeria Gianfreda, Antonio Longo; Ann Coloproctol. 2022;38(1):20-27. Published online December 4, 2020; DOI: https://doi.org/10.3393/ac.2020.09.21.1

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16 Citations

Abstract PDF

Purpose
Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution.
Methods
From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis.
Results
The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned.
Conclusion
The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.

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Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
Sami Alahmadi, David L. Berger, Christy E. Cauley, Robert N. Goldstone, William V. Kastrinakis, Marc Rubin, Hiroko Kunitake, Rocco Ricciardi, Grace C. Lee
Journal of Gastrointestinal Surgery.2025; 29(2): 101899. CrossRef
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Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
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Crafa Francesco, Vanella Serafino
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Hyun Gu Lee
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Francesco Crafa, Serafino Vanella, Adele Noviello, Giuseppe Longo, Francesco Longo
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Case Report

Malignant disease

Early Postoperative Anastomotic Obstruction Due to an Intraluminal Blood Clot After Laparoscopic Anterior Resection: A Case Report: Soon Keun Kwon, Jin Soo Han, Jihyun Seo, Yong Sik Yoon; Ann Coloproctol. 2020;36(5):349-352. Published online October 31, 2020; DOI: https://doi.org/10.3393/ac.2020.06.11.2

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Abstract PDF: Early postoperative anastomotic obstruction after colorectal surgery rarely develops. Herein, we present a case of a 50-year-old healthy woman who had an early postoperative anastomotic obstruction which was revealed caused by a blood clot and successfully managed by endoscopic approach. The patient was discharged after laparoscopic anterior resection and visited the emergency department one day after because of abdominal pain. Computed tomography showed that the anastomosis site was obstructed with low-density material. Intraoperative endoscopy was performed under general anesthesia and blood clot filling the lumen were identified. As the scope was advanced to the blood clot with air inflation, the blood clot was evacuated. The anastomosis site could be obstructed by blot clot with mucous debris albeit it is a rare condition. An endoscopic approach seems to be the first option in the diagnosis and treatment of postoperative obstruction at the anastomosis site and it could prevent unnecessary laparotomy.

Original Article

Benign GI diease, IBD, Inflammatory bowel disease,Benign diesease & IBD

Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: An Australian Institution’s Experience: Ming Han Lim, Anton R. Lord, Lisa A. Simms, Katherine Hanigan, Aleksandra Edmundson, Matthew J.F.X. Rickard, Russell Stitz, David A. Clark, Graham L. Radford-Smith; Ann Coloproctol. 2021;37(5):318-325. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.08.26

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13 Citations

Abstract PDF

Purpose
We report outcomes and evaluate patient factors and the impact of surgical evolution on outcomes in consecutive ulcerative colitis patients who had restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) at an Australian institution over 26 years.
Methods
Data including clinical characteristics, preoperative medical therapy, and surgical outcomes were collected. We divided eligible patients into 3 period arms (period 1, 1990 to 1999; period 2, 2000 to 2009; period 3, 2010 to 2016). Outcomes of interest were IPAA leak and pouch failure.
Results
A total of 212 patients were included. Median follow-up was 50 (interquartile range, 17 to 120) months. Rates of early and late complications were 34.9% and 52.0%, respectively. Early complications included wound infection (9.4%), pelvic sepsis (8.0%), and small bowel obstruction (6.6%) while late complications included small bowel obstruction (18.9%), anal stenosis (16.8%), and pouch fistula (13.3%). Overall, IPAA leak rate was 6.1% and pouch failure rate was 4.8%. Eighty-three patients (42.3%) experienced pouchitis. Over time, we observed an increase in patient exposure to thiopurine (P=0.0025), cyclosporin (P=0.0002), and anti-tumor necrosis factor (P<0.00001) coupled with a shift to laparoscopic technique (P<0.00001), stapled IPAA (P<0.00001), J pouch configuration (P<0.00001), a modified 2-stage procedure (P=0.00012), and a decline in defunctioning ileostomy rate at time of IPAA (P=0.00002). Apart from pouchitis, there was no significant difference in surgical and chronic inflammatory pouch outcomes with time.
Conclusion
Despite greater patient exposure to immunomodulatory and biologic therapy before surgery coupled with a significant change in surgical techniques, surgical and chronic inflammatory pouch outcome rates have remained stable.

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Review

Malignant disease

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review: Mohamed Ali Chaouch, Tarek Kellil, Camillia Jeddi, Ahmed Saidani, Faouzi Chebbi, Khadija Zouari; Ann Coloproctol. 2020;36(4):213-222. Published online August 31, 2020; DOI: https://doi.org/10.3393/ac.2020.05.14.2

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31 Citations

Abstract PDF

Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

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Pelvic Surgery and Oncology.2022; 11(3-4): 23. CrossRef
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Young Il Kim, In Ja Park
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Pedro Barrios, Isabel Ramos, Oriol Crusellas, Domenico Sabia, Sergio Mompart, Lana Bijelic
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Mohamed Ali Chaouch, Jim Khan, Talvinder Singh Gill, Arianeb Mehrabi, Christoph Reissfelder, Nuh Rahberi, Hazem Elhadedy, Hani Oweira
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Case Report

Malignant disease

Treatment of a Total Obstructive Anastomosis Stricture Using a Transanal Laparoscopic Approach and Intraoperative Colonoscopic Balloon Dilatation: Jae Young Kwak, Kwan Mo Yang, Hyun Il Seo; Ann Coloproctol. 2020;36(5):353-356. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.02.27

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Abstract PDF: An anastomosis stricture with a total obstruction is rare and treatment options are variable. We describe our experience with a combination of a single port transanal laparoscopic approach and intraoperative colonoscopic balloon dilatation. The patient was a 48-year-old man with rectal cancer. A laparoscopic single port lower anterior resection and diverting ileostomy were performed followed by a colon study and ileostomy takedown. The colon study and sigmoidoscopy revealed total obstruction of the rectum at the anastomosis level. We employed a transanal approach using a single port to correct this. We located the anastomosis stricture site and generated a lumen using a dissector and electocautery method to insert the balloon device. Colonoscopic balloon dilatation was subsequently successful. The patient was discharged with no postoperative complications. A laparoscopic single port transanal approach with an intraoperative colonoscopic balloon dilatation is a viable alternative approach to treating an anastomosis stricture of the rectum.

Original Articles

Benign GI diease,Benign diesease & IBD,Complication,Surgical technique

Triple-Staple Technique Effectively Reduces Operating Time for Rectal Anastomosis: Marie Shella De Robles, Christopher John Young; Ann Coloproctol. 2021;37(1):16-20. Published online February 5, 2020; DOI: https://doi.org/10.3393/ac.2019.06.30

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Abstract PDF

Purpose
Stapled anastomotic techniques to the distal rectum have gained widespread acceptance due to their procedural advantages. Various modifications in the stapling techniques have evolved since their inception. The triple-staple technique utilizing stapled closure of both the proximal colon and distal rectal stump provides a rapid and secure colorectal anastomosis. The aims of this study were to determine the safety and efficacy of the triple-staple technique and to compare the clinical outcomes with a historical control group for which the conventional double-staple technique had been performed.
Methods
One hundred consecutive patients operated on by a single surgeon were included in the study; 50 patients who underwent a double-staple (DSA) procedure and 50 patients undergoing triple-staple anastomosis (TSA).
Results
The most common indication for surgery in both groups was rectal cancer followed by diverticular disease and distal sigmoid cancer. There was no significant difference in number of patients requiring loop ileostomy formation in the groups (TSA, 56.0% vs. DSA, 68.0%; P = 0.621). The mean operating time for the TSA group was significantly shorter compared to that of the DSA group (TSA, 242.8 minutes vs. DSA, 306.1 minutes; P = 0.001). There was no significant difference in complication rate (TSA, 40% vs. DSA, 50%; P = 0.315) or length of hospital stay between the two groups (TSA, 11.3 days vs. DSA, 13.0 days; P = 0.246). Postoperative complications included anastomotic leak, prolonged ileus, bleeding, wound infection, and pelvic collection.
Conclusion
The triple-staple technique is a safe alternative to double-staple anastomosis after anterior resection and effectively shortens operating time.

Citations

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Abdus Salam Raju, Seyed Mohammad Javad Taghavi, Andrew James Gilmore
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Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
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Chungyeop Lee, In Ja Park
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Double-row staple technology versus triple-row staple technology for colorectal surgery: A systematic review and meta-analysis
Tyler McKechnie, Victoria Shi, Elena Huang, Bright Huo, Aristithes Doumouras, Nalin Amin, Cagla Eskicioglu, Dennis Hong
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Alexander A. Gaidarski III, Marco Ferrara
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Jin-Min Jung, In Ja Park, Eun Jung Park, Gyung Mo Son
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Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
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Sung Il Kang
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Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection: Mostafa Shalaby, Waleed Thabet, Oreste Buonomo, Nicola Di Lorenzo, Mosaad Morshed, Giuseppe Petrella, Mohamed Farid, Pierpaolo Sileri; Ann Coloproctol. 2018;34(6):317-321. Published online December 20, 2018; DOI: https://doi.org/10.3393/ac.2017.10.18

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Abstract PDF

Purpose
We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL).
Methods
Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL.
Results
Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2 ). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation.
Conclusion
These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

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A Review of Postoperative Complications in Colon Cancer Surgery: The Need for Patient-Centered Therapy
Adrian Silaghi, Dragos Serban, Corneliu Tudor, Bogdan Mihai Cristea, Laura Carina Tribus, Irina Shevchenko, Alexandru Florin Motofei, Crenguta Sorina Serboiu, Vlad Denis Constantin
Journal of Mind and Medical Sciences.2025; 12(1): 21. CrossRef
Management of anastomotic leakage after low anterior resection with double-stapling anastomosis
Kenji Kawada, Yoshiro Itatani, Kazutaka Obama
Journal of Gastrointestinal Surgery.2025; 29(10): 102178. CrossRef
Challenges in the interdisciplinary treatment of leakages after left-sided colorectal surgery: endoscopic negative pressure therapy, open-pore film drainage therapy and beyond
Pasquale Scognamiglio, Anja Seeger, Matthias Reeh, Nathaniel Melling, Karl F Karstens, Thomas Rösch, Jakob R Izbicki, Marcus Kantowski, Michael Tachezy
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Significance of information obtained during transanal drainage tube placement after anterior resection of colorectal cancer
Yuki Okazaki, Masatsune Shibutani, Hisashi Nagahara, Tatsunari Fukuoka, Yasuhito Iseki, En Wang, Kiyoshi Maeda, Kosei Hirakawa, Masaichi Ohira, Zubing Mei
PLOS ONE.2022; 17(8): e0271496. CrossRef
The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma
Seok Hyeon Cho, In Kyu Lee, Yoon Suk Lee, Min Ki Kim
Annals of Surgical Treatment and Research.2021; 100(2): 100. CrossRef
Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery
Deborah S. Keller, K. Talboom, C.P.M van Helsdingen, Roel Hompes
Clinics in Colon and Rectal Surgery.2021; 34(06): 431. CrossRef
Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer
Xiaojie Tan, Mei Zhang, Lai Li, He Wang, Xiaodong Liu, Haitao Jiang
Journal of International Medical Research.2021;[Epub] CrossRef
Improved colorectal anastomotic leakage healing by transanal rinsing treatment after endoscopic vacuum therapy using a novel patient-applied rinsing catheter
Marcus Kantowski, Andreas Kunze, Eugen Bellon, Thomas Rösch, Utz Settmacher, Michael Tachezy
International Journal of Colorectal Disease.2020; 35(1): 109. CrossRef
Surgical complications in colorectal cancer patients
Haleh Pak, Leila Haji Maghsoudi, Ali Soltanian, Farshid Gholami
Annals of Medicine and Surgery.2020; 55: 13. CrossRef
Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer
Yun Luo, Chang-Kang Zhu, Ding-Quan Wu, Liang-Bi Zhou, Chong-Shu Wang
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Percutaneous transesophageal gastro-tubing for the management of anastomotic leakage after upper GI surgery: a report of two clinical cases
Yutaka Tamamori, Katsunobu Sakurai, Naoshi Kubo, Ken Yonemitsu, Yasuhiro Fukui, Junya Nishimura, Kiyoshi Maeda, Yukio Nishiguchi
Surgical Case Reports.2020;[Epub] CrossRef
Long-Term Results after Anastomotic Leakage following Rectal Cancer Surgery: A Comparison of Treatment with Endo-Sponge and Transanal Irrigation
Alice Weréen, Martin Dahlberg, Göran Heinius, Emil Pieniowski, Deborah Saraste, Karolina Eklöv, Jonas Nygren, Klas Pekkari, Åsa H. Everhov
Digestive Surgery.2020; 37(6): 456. CrossRef
Preventive strategies for anastomotic leakage after colorectal resections: A review
Mostafa Shalaby, Waleed Thabet, Mosaad Morshed, Mohamed Farid, Pierpaolo Sileri
World Journal of Meta-Analysis.2019; 7(8): 389. CrossRef
Transanal surgery: A tool in colorectal anastomotic leakage
Pere Planellas Giné, Júlia Gil Garcia, Ramon Farrés Coll, Antoni Codina Cazador
Cirugía Española (English Edition).2019; 97(10): 590. CrossRef
La cirugía transanal como herramienta en la dehiscencia de la anastomosis colorrectal
Pere Planellas Giné, Júlia Gil Garcia, Ramon Farrés Coll, Antoni Codina Cazador
Cirugía Española.2019; 97(10): 590. CrossRef

The Usefulness of Intraoperative Colonic Irrigation and Primary Anastomosis in Patients Requiring a Left Colon Resection: Youngki Hong, Soomin Nam, Jung Gu Kang; Ann Coloproctol. 2017;33(3):106-111. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.106

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6 Citations

Abstract PDF

Purpose

The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate.

Methods

This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes.

Results

Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8–39 days).

Conclusion

Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.

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Christine McGough, Samuel Lentz, Laurel Berry
Journal of Gynecologic Surgery.2025;[Epub] CrossRef
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Brian Williams, Abhinav Gupta, Sarah D. Koller, Tanya JT Starr, Maximillian J.H. Star, Darcy D. Shaw, Ali H. Hakim, Jennifer Leinicke, Michael Visenio, Kenneth H. Perrone, Zachary H. Torgerson, Austin D. Person, Charles A. Ternent, Kevin A. Chen, Muneera
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Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study
Shahram Khadem, Jonas Herzberg, Human Honarpisheh, Robert Maximilian Jenner, Salman Yousuf Guraya, Tim Strate
Perioperative Medicine.2023;[Epub] CrossRef
Intraoperative Colonic Irrigation for Low Rectal Resections With Primary Anastomosis: A Fail-Safe Surgical Model
Jonas Herzberg, Shahram Khadem, Salman Yousuf Guraya, Tim Strate, Human Honarpisheh
Frontiers in Surgery.2022;[Epub] CrossRef
Malignant Large Bowel Obstruction
Roberta L. Muldoon
Clinics in Colon and Rectal Surgery.2021; 34(04): 251. CrossRef
Mechanical Bowel Preparation, Do It or Not: When Crossing a River, What Do People Do?
Hungdai Kim
Annals of Coloproctology.2017; 33(3): 84. CrossRef

Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model: Mani Habibi, Osman Zekai Oner, Mehmet Tahir Oruc, Nurullah Bulbuller, Sebahat Ozdem, Sukru Ozdemir, Arsenal Sezgin Alikanooglu, Rojbin Karakoyun, Ugur Dogan, Ayper Ongen, Umit Koc; Ann Coloproctol. 2015;31(6):213-221. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.213

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Abstract PDF

Purpose

Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model.

Methods

Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis.

Results

Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined.

Conclusion

Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.

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Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study
Gang Tang, Feng Pi, Zhengqiang Wei, Xiangshu Li
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Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study
Gang Tang, Feng Pi, Yu-Hao Qiu, Zheng-Qiang Wei
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The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model
Afag Aghayeva, Cigdem Benlice, Ismail Ahmet Bilgin, Pinar Atukeren, Gulen Dogusoy, Figen Demir, Deniz Atasoy, Bilgi Baca
Tumori Journal.2017; 103(3): 307. CrossRef
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Jong-Woo Kim
Annals of Coloproctology.2015; 31(6): 207. CrossRef

Case Report

Colon Stricture After Ischemia Following a Robot-Assisted Ultra-Low Anterior Resection With Coloanal Anastomosis: Dae Ro Lim, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Nam Kyu Kim; Ann Coloproctol. 2015;31(4):157-162. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.157

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Abstract PDF

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.

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Guglielmo Niccolò Piozzi, Seon Hahn Kim
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Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
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Original Articles

Adipose-tissue-derived Stem Cells Enhance the Healing of Ischemic Colonic Anastomoses: An Experimental Study in Rats: Jong Han Yoo, Jae Ho Shin, Min Sung An, Tae Kwun Ha, Kwang Hee Kim, Ki Beom Bae, Tae Hyeon Kim, Chang Soo Choi, Kwan Hee Hong, Jeong Kim, Soo Jin Jung, Sun Hee Kim, Kuk Hwan Rho, Jong Tae Kim, Young Il Yang; J Korean Soc Coloproctol. 2012;28(3):132-139. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.132

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Abstract PDF

Purpose

This experimental study verified the effect of adipose-tissue-derived stem cells (ASCs) on the healing of ischemic colonic anastomoses in rats.

Methods

ASCs were isolated from the subcutaneous fat tissue of rats and identified as mesenchymal stem cells by identification of different potentials. An animal model of colonic ischemic anastomosis was induced by modifying Nagahata's method. Sixty male Sprague-Dawley rats (10-week-old, 370 ± 50 g) were divided into two groups (n = 30 each): a control group in which the anastomosis was sutured in a single layer with 6-0 polypropylene without any treatment and an ASCtreated group (ASC group) in which the anastomosis was sutured as in the control group, but then ASCs were locally transplanted into the bowel wall around the anastomosis. The rats were sacrificed on postoperative day 7. Healing of the anastomoses was assessed by measuring loss of body weight, wound infection, anastomotic leakage, mortality, adhesion formation, ileus, anastomotic stricture, anastomotic bursting pressure, histopathological features, and microvascular density.

Results

No differences in wound infection, anastomotic leakage, or mortality between the two groups were observed. The ASC group had significantly more favorable anastomotic healing, including less body weight lost, less ileus, and fewer ulcers and strictures, than the control group. ASCs augmented bursting pressure and collagen deposition. The histopathological features were significantly more favorable in the ASC group, and microvascular density was significantly higher than it was in the control group.

Conclusion

Locally-transplanted ASCs enhanced healing of ischemic colonic anastomoses by increasing angiogenesis. ASCs could be a novel strategy for accelerating healing of colonic ischemic risk anastomoses.

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Dirk Van de putte, Christelle Demarquay, Elke Van Daele, Lara Moussa, Christian Vanhove, Marc Benderitter, Wim Ceelen, Piet Pattyn, Noëlle Mathieu
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Intestinal Anastomosis by Use of a Memory-shaped Compression Anastomosis Clip (Hand CAC 30): Early Clinical Experience: Hak-Youn Lee, Jin-Hee Woo, Si-Young Park, Nam-Wook Kang, Ki-Jae Park, Hong-Jo Choi; J Korean Soc Coloproctol. 2012;28(2):83-88. Published online April 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.2.83

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Abstract PDF

Purpose

The safety and the efficacy of the compression anastomosis clip (Hand CAC 30) have been demonstrated by animal studies. This study was designed to evaluate the clinical validity of the Hand CAC 30 in enterocolic side-to-side anastomosis after colonic or enteric resections.

Methods

A non-randomized prospective data collection was performed for patients undergoing a side-to-side anastomosis using the Hand CAC 30. Eligibility criteria for the use of the Hand CAC 30 were for anastomoses between the colon and the ileum or between two small bowels. The primary short-term endpoint was the rate of anastomotic leakage. Other clinical outcomes, including intra- and postoperative complications, length of operation time and hospital stay, and the clip elimination time were recorded.

Results

A total of 63 patients (male, 36) underwent an enteric or right-sided colonic resection followed by a side-to-side anastomosis using the Hand CAC 30. Laparoscopic surgery was performed in 36 patients, in whom one patient who underwent a laparoscopic right hemicolectomy was converted to an open procedure (1/32, 3.1%). One patient with ascending colon cancer showed postoperative anastomotic leakage and died of co-morbid ischemic heart disease. There were no other surgical mortalities. The exact date of expulsion of the clip could not be recorded because most patients were not aware of clip elimination. No patients manifested clinical symptoms of anastomotic stricture.

Conclusion

Short-term evaluation of the Hand CAC 30 anastomosis in patients undergoing enterocolic surgery proved it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.

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Cirugía y Cirujanos (English Edition).2016; 84(6): 482. CrossRef
Long term results of the use of compression anastomosis clips (CAC) in gastrointestinal surgery – the first report
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Case Report

Efficacy of Imatinib Mesylate Neoadjuvant Treatment for a Locally Advanced Rectal Gastrointestinal Stromal Tumor: Kyu Jong Yoon, Nam Kyu Kim, Kang Young Lee, Byung Soh Min, Hyuk Hur, Jeonghyun Kang, Sarah Lee; J Korean Soc Coloproctol. 2011;27(3):147-152. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.147

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Abstract PDF

Surgery is the standard treatment for a primary gastrointestinal stromal tumor (GIST); however, surgical resection is often not curative, particularly for large GISTs. In the past decade, with imatinib mesylate (IM), management strategies for GISTs have evolved significantly, and now IM is the standard care for patients with locally advanced, recurrent or metastatic GISTs. Adjuvant therapy with imatinib was recently approved for use, and preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. IM neoadjuvant therapy for primary GISTs has been reported, but there is no consensus on the dose of the drug, the duration of treatment and the optimal time of surgery. These are critical because drug resistance or tumor progression can develop with a prolonged treatment. This report describes two cases of large rectal malignant GISTs, for which a abdominoperineal resection was initially anticipated. The two patients received IM preoperative treatment; we followed-up with CT or magnetic resonance imaging to access the response. After 9 months of treatment, a multi-disciplinary consensus that maximal benefit from imatinib had been achieved was reached. We determined the best time for surgical intervention and successfully performed sphincter-preserving surgery before resistance to imatinib or tumor progression occurred. We believe that a multidisciplinary team approach, considerating the optimal duration of therapy and the timing of surgery, is required to optimize treatment outcome.

Citations

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Xiangfei Sun, Xiaohan Lin, Qiang Zhang, Chao Li, Ping Shu, Xiaodong Gao, Kuntang Shen
Cancer Medicine.2024;[Epub] CrossRef
Clinicopathological and Immunohistochemical Characterization of Gastrointestinal Stromal Tumour at Four Tertiary Health Centers in Nigeria Using CD117, DOG1, and Human Epidermal Growth Factor Receptor-2 Biomarkers
Mumini Wemimo Rasheed, Afolayan Enoch Abiodun, Uchechukwu Brian Eziagu, Najeem Adedamola Idowu, Abdullahi Kabiru, Taiwo Adeyemi Adegboye, Waheed Akanni Oluogun, Adekunle Adebayo Ayoade
Annals of African Medicine.2023; 22(4): 501. CrossRef
Open transanal resection of low rectal stromal tumor following neoadjuvant therapy of imatinib mesylate: Report of 11 cases and review of literature
Qiang Sun, Ning Su, Xinxing Li, Zhiqian Hu, Weijun Wang
Asia-Pacific Journal of Clinical Oncology.2020; 16(3): 123. CrossRef
Using endoscopy to minimize the extent of resection in the management of giant GISTs of the stomach
Hishaam Ismael, Yury Ragoza, Steven Cox
International Journal of Surgery Case Reports.2017; 36: 26. CrossRef
Combined Therapy of Gastrointestinal Stromal Tumors
Piotr Rutkowski, Daphne Hompes
Surgical Oncology Clinics of North America.2016; 25(4): 735. CrossRef
Indications for surgery in advanced/metastatic GIST
Samuel J. Ford, Alessandro Gronchi
European Journal of Cancer.2016; 63: 154. CrossRef
Surgical treatment of gastrointestinal stromal tumour of the rectum in the era of imatinib
M J Wilkinson, J E F Fitzgerald, D C Strauss, A J Hayes, J M Thomas, C Messiou, C Fisher, C Benson, P P Tekkis, I Judson
British Journal of Surgery.2015; 102(8): 965. CrossRef
Intolerance to Imatinib in Gastrointestinal Stromal Tumors: A Case Report and a Review of Literature
Yousra Akasbi, Samia Arifi, Sami Aziz Brahmi, Fatima Zahra El Mrabet, Nawfel Mellas, Fatima Zahra Mernisi, Omar El Mesbahi
Journal of Gastrointestinal Cancer.2014; 45(S1): 71. CrossRef
Primary localized rectal/pararectal gastrointestinal stromal tumors: results of surgical and multimodal therapy from the French Sarcoma group
Thanh-Khoa Huynh, Pierre Meeus, Philippe Cassier, Olivier Bouché, Sophie Lardière-Deguelte, Antoine Adenis, Thierry André, Julien Mancini, Olivier Collard, Michael Montemurro, Emmanuelle Bompas, Maria Rios, Nicolas Isambert, Didier Cupissol, Jean-Yves Bla
BMC Cancer.2014;[Epub] CrossRef
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Piotr Rutkowski, Alessandro Gronchi, Peter Hohenberger, Sylvie Bonvalot, Patrick Schöffski, Sebastian Bauer, Elena Fumagalli, Pawel Nyckowski, Buu-Phuc Nguyen, Jan Martijn Kerst, Marco Fiore, Elzbieta Bylina, Mathias Hoiczyk, Annemieke Cats, Paolo G. Casa
Annals of Surgical Oncology.2013; 20(9): 2937. CrossRef

Review

Controversies in Pouch Surgery for Ulcerative Colitis.: Yu, Chang Sik; J Korean Soc Coloproctol. 2009;25(3):207-211.; DOI: https://doi.org/10.3393/jksc.2009.25.3.207

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Abstract PDF: Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn's disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn's disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

Original Article

Comparison of a Straight, a Coloplasty, and a Colonic J-pouch Anastomosis after a Proctectomy for Rectal Cancer.: Choi, Sang Hong , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2009;25(2):88-93.; DOI: https://doi.org/10.3393/jksc.2009.25.2.88

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Abstract PDF

PURPOSE
Colonic pouches have been used to improve the reservoir function of the neorectrum after a ultra-low anterior resection for treatment of rectal cancer. The purpose of this study was to compare the safety and the functional outcome between a straight anastomosis, an anastomosis using coloplasty, and that using a colonic J-pouch in patients who had undergone an ultralow anterior resection. METHODS: From 2004 through 2006, 60 patients underwent a coloanal straight (straight group: n=23), coloplasty (coloplasty group: n=19), or colonic J-pouch (J-pouch group: n=18) anastomosis to the anal canal after a total mesorectal excision of the rectal cancer. We retrospectively reviewed the medical records of those patients for clinical outcomes according to the reservoir type. The median follow-up interval was 23.7 (4.4-40.9) mo.
RESULTS
The anastomotic leakage rate was higher in the coloplasty group (21.1%) than in the straight group (8.7%) or in the J-pouch group (0%), but the difference was not significant (P=0.1). The mean number of bowel movements per day was significantly lower in the coloplasty group (3.6) and in the pouch group (3.1) than in the straight group (6.2) (P=0.015). No statistically significant differences were found among the three groups regarding other functional outcomes, including use of antidiarrheal drugs (P=0.971), gas incontinence (P=0.256), fecal incontinence (P=0.544), use of pads (P=0.782), difficulty of evacuation (P=0.496), and use of enemas (P=0.712). CONCLUSION: Reconstruction with a coloplasty or a colonic J-pouch in patients undergoing a low colorectal or coloanal anastomosis after rectal cancer surgery seems to decrease the number of daily bowel movements compared to a straight anastomosis. However, the anastomotic leakage rate of coloplasty group was higher than that of the straight-anastomosis group.

Citations

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End-to-end anastomosis provides similar quality-of-life, compared with other reconstructive techniques six months following total mesorectal excision: Systematic review and meta-analysis
Sarolta Beáta Kávási, Diana - Elena Iov, Anett Rancz, Ádám Zolcsák, Dániel Sándor Veres, Katalin Lenti, Pál Miheller, Péter Hegyi, Szabolcs Ábrahám
European Journal of Surgical Oncology.2024; 50(10): 108599. CrossRef
A Case Study of Rectal Cancer Patient Treated with Dokhwaljihwang-tang
Anna Song, Ji-Hye An, Seong-Heun Choi, Eun-Hee Kim, So-Jeong Park, Kyung-Suk Kim, Soo-Kyung Lee
Journal of Sasang Constitutional Medicine.2013; 25(1): 62. CrossRef

Case Reports

Rectal Involvement of Klippel-Trenaunay Syndrome.: Cheon, Seong Hui , Lee, Suk Hwan , Park, Eung Bum; J Korean Soc Coloproctol. 2009;25(1):52-55.; DOI: https://doi.org/10.3393/jksc.2009.25.1.52

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Abstract PDF

Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder and is essentially a disorder of capillary, venous, and lymphatic malformations. Hematochezia is the most common symptom associated with intestinal hemangiomatosis and remains one of the life-threatening emergencies in KTS. We reported one patient of KTS presented with rectal bleeding and severe anemia who was successfully managed by sphincter-saving operation.

Citations

Citations to this article as recorded by

Isolated Colorectal Involvement in Klippel-Trenaunay Syndrome: A Case of Extensive Vascular Malformation
Nurbek Ilyassov, Yerzhan Shayakhmetov, Anuar Abdikarimov, Erlan Nurgaliev, Saken Saberbekov, Rakymzhan Aralbayev, Aiman Tokusheva, Vitaliy Kalina
International Medical Case Reports Journal.2025; Volume 18: 997. CrossRef
A case report of multiple renal aneurysms due to Klippel-Trenaunay syndrome requiring laparoscopic nephrectomy
Mayur Gami, Syed Rahman, Gerald Rix, Adam Howard, Sam Datta
International Journal of Surgery Case Reports.2023; 106: 108070. CrossRef
Rectal and Splenic Vascular Malformation in Klippel-Trenaunay-Weber Syndrome: A Case Report
Ha Youn Kim, Yun Woo Chang, Dong Hwan Lee
Journal of the Korean Society of Radiology.2012; 67(4): 289. CrossRef

Re-anastomosis above a Preceding Anastomosis Made by a Low Anterior Resection.: Shin, Milljae , Yun, Haeran , Lee, Wonseok , Yun, Seonghyeon , Lee, Wooyong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2008;24(4):287-291.; DOI: https://doi.org/10.3393/jksc.2008.24.4.287

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Abstract PDF: Periodic colonoscopic checkup is needed for patients suffering from colorectal cancer, based on the property that a colorectal neoplasm often recurs synchronously or metachronously. Surgical management appropriate to the occasion should be taken in recurrent colorectal cancer. Particularly, recurring colorectal cancer closely above the prior anastomosis for a low anterior resection should be eliminated by using an abdomino-perineal resection, including the preceding anastomotic site or a new anastomotic creation. Under the latter instance, ample possibility exists for postoperative anastomotic stenosis or leakage by reason of insufficient blood supply to the segment between the earlier anastomosis and the later one. The authors report two cases of re-anastomosis for colorectal cancer just above a previous anastomosis taken by a low anterior resection for rectal cancer. In a 52-year-old male with a history of neoadjuvant concomitant chemo-radiotherapy (CCRT) and low anterior resection for rectal cancer located at 6 cm from the anal verge, a new adenocarcinoma was detected 7 cm from the previous anastomotic site and 3 cm from the anal verge. Considering anal sphincter preservation, the re-anastomosis was made at the upper part of the preceding anastomosis. The patient experienced no surgical complications, such as anastomotic stenosis or leakage and functional defecation difficulty. In another patient, a 50-year-old male with a low anterior resection and adjuvant CCRT for rectal cancer 8 cm from anal verge, a new adenocarcinoma was detected in the colon. The new adenocarcinoma was located 10 cm from the anal verge and 8 cm from the previous anastomosis. The same surgical management was applied to this case, with the same postoperative result.

Original Articles

Intersphincteric Resection versus Stapled Coloanal Anastomosis for Low Rectal Cancer.: Lee, Bong Hwa , Kim, Jong Wan , Chang, Mi Young , Park, Hyoung Chul , Lee, Hae Wan; J Korean Soc Coloproctol. 2008;24(2):113-120.; DOI: https://doi.org/10.3393/jksc.2008.24.2.113

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Abstract PDF: PURPOSE
Local control and functional results of an intersphincteric resection are controversial in Asian, low BMI patients, even though it might a provide a chance to avoid a permanent colostomy. We tried to evaluate the potential risk of an intersphincteric resection, compared with a stapled coloanal anastomosis, in patients with low rectal cancer. METHODS: Patients with low rectal cancer, who underwent a intersphincteric resection with a hand-sewn anastomosis (ISR) or a coloanal anstomosis with staples (stapled CAA), were analyzed. RESULTS: From 1999 to 2006, 85 patients were enrolled. The distance between the anal verge and the lower margin of the tumor was 3.4+/-0.8 cm (range: 2~5 cm) in the ISR group and 4.9+/-0.8 cm (range: 3~7 cm) in the stapled CAA. The mean body mass index was 23 (range: 18~32). The patients complained postoperatively of intolerable anal incontinence (Kirwan's class > 2) in 35% of the ISR group and in 9% as the stapled CAA group, (P<0.02). The local recurrence rate was greater in the ISR group (15%) than in the stapled CAA group (2%, P<0.04). There was no significant difference in distant metastasis between the two groups. The disease-free survival rates were 80.8% and 91.2% at three years in the ISR group and the stapled CAA group, respectively. Complications, such as urinary incontinence and sexual dysfunction in male patients, were not significantly different between the two groups. CONCLUSIONS: An intersphincteric resection with hand-sewn anastomosis could be worse than a stapled coloanal anastomosis in function and local recurrence. This may indicate that careful selection is required for a intersphincteric resection even when a stapled anastomosis cannot be applied due to a narrow margin.

Complications, Mortality and Functional Outcome following a Total Colectomy and Ileo-rectal Anastomosis.: Kim, Do Yoon , Oh, Seung Yeop , Lee, Jae Man , Suh, Kwang Wook; J Korean Soc Coloproctol. 2007;23(6):448-453.; DOI: https://doi.org/10.3393/jksc.2007.23.6.448

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Abstract PDF

PURPOSE
This study reviews the feasibility of a total colectomy with ileo-rectal anastomosis (TCIRA) and the functional outcome following the operation.
METHODS
The cases of a total of 50 patients (31 men and 19 women) with a median age of 61 who underwent a TCIRA were reviewed retrospectively. The median follow-up time was 28 months (4~72). The clinical records were reviewed to analyze the postoperative complications and bowel function. The clinical outcomes were examined directly from patients' scoring.
RESULTS
The indications of TCIRA were metachronous or synchronous colorectal cancer (34 percent), multiple polypoid lesions (22 percent), malignant colon obstruction (24 percent), ischemic colitis (2 percent), Crohn's disease (6 percent), and tuberculosis colitis (2 percent). The overall mortality and morbidity rates were 0 and 31 percent, respectively. The morbidity included postoperative bleeding, obstruction, intra-abdominal abscess formation, pneumonia, and wound complications. We used the CCIS index to evaluate postoperative functional bowel habit change. The CCIS index evaluation revealed perfect continence in 57 percent of the patients with short-term follow up (<6 months) and in 83 percent of the patients who had undergone a TCIRA more than 2 years ago.
CONCLUSIONS
Most patients were satisfied with their bowel function on long-term follow up, and we think the TCIRA is a safe operation, and the clinical outcomes are relatively satisfactory.

Citations

Citations to this article as recorded by

Treatment of Multiple Colorectal Cancers
Ok Joo Paek, Seung Yeop Oh, Kwang Wook Suh
Journal of the Korean Society of Coloproctology.2009; 25(1): 34. CrossRef

Anastomosis Protection with Mallecot in Low Rectal Anastomosis.: Jang, Young Soo , Lim, Kyoung Hoon , Kang, Byung Mo , Choi, Gyu Seog , Jun, Soo Han; J Korean Soc Coloproctol. 2007;23(6):420-423.; DOI: https://doi.org/10.3393/jksc.2007.23.6.420

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Abstract PDF

PURPOSE
Anastomotic leakage following surgery is one of the most significant causes of morbidity and mortality. Therefore, prevention of anastomotic leakage is crucial for safe rectal surgery. The aim of this study is to determine the effect of Mallecot(R) insertion on the prevention of anastomotic leakage after low rectal anastomosis.
METHODS
From January 2002 to December 2006, 264 rectal cancer surgeries were performed in one center and by one surgeon. Among them, 110 cases whose anastomosis was located below 6 cm from the anal verge were collected and reviewed retrospectively. We made a diverting stoma on 6 out of 20 patients with high risk of anastomotic leakage, and inserted Mallecot(R) on the remaining 14 patients transanally. Removal of Mallecot(R) was done at the 7th postoperative day after a digital rectal examination to identify the completeness of anastomosis had been performed.
RESULTS
Totally, anastomotic leakage occurred in 8 of 110 patients (73%). Among the 90 patients without any preventive measures, 7 incidents of anastomotic leakage were observed; on the other hand, 1 of 14 patients with Mallecot(R) insertion suffered anastomotic leakage. In two of the patients with leakage, including 1 in the Mallecot(R) group, the leakage was resolved via percutaneous drainage; in the other 6 patients were reoperated.
CONCLUSIONS
The importance of preventing an anastomotic leakage after low rectal surgery cannot be overemphasized to reduce morbidity and to improve the prognosis. In addition, Mallecot(R) insertion may be an alternative method for diverting stoma formation.

Citations

Citations to this article as recorded by

Transanal tube placement for prevention of anastomotic leakage following low anterior resection for rectal cancer: a systematic review and meta-analysis
Gi Won Ha, Hyun Jung Kim, Min Ro Lee
Annals of Surgical Treatment and Research.2015; 89(6): 313. CrossRef

The P-pouch: a New Ileal Reservoir Used in Restorative Proctocolectomy.: Lee, Joobong , Yun, Sungpil , Oh, Nahmgun; J Korean Soc Coloproctol. 2006;22(6):363-370.

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Abstract PDF: PURPOSE
To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy.
METHODS
There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15+/-0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3+/-4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit.
RESULTS
In the patient group, daily stool frequency and volume were 5.2+/-0.3 and 423.5+/-23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P>0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0+/-127.8 pmol/l vs. 1146.0+/-150.0 pmol/l, P>0.05). Small intestinal transit time for healthy controls and the patient group averaged 89+/-21 and 117+/-12 minutes (P>0.05). The capacity of the ileal pouch was 372+/-22 ml, and the efficiency of ileal reservoir evacuation was 76 %.
CONCLUSIONS
The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler.

Sphincter Preserving Operation by Coloanal Anastomosis: Long Term Survival.: Lee, Sun Il , Park, Yoon Ah , Sohn, Seung Kook; J Korean Soc Coloproctol. 2006;22(3):177-183.

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Abstract PDF: PURPOSE
Abdominoperineal resection (APR) was the conventional operation for the last 100 years, however it decreased recently for the improvement of sphincter preserving operations, especially of hand-sewn coloanal anastomosis (CAA). The aim of this study is to evaluate oncological results for the CAA.
METHODS
From January 1992 to August 2000, 107 consecutive patients with rectal cancer within 7 cm from anal verge who underwent a curative resection were evaluated retrospectively by operations (APR, CAA, and stapled low anterior resection, LAR). No temporary stoma was made for CAA and LAR.
RESULTS
The mean age is 57.4 and the distance from the anal verge was 4.12 cm (+/-1.55) for 65 males and 4.13 cm (+/-1.67) for 42 females (p>0.05). The age, gender, tumor location, size, resection margin, and stage were not statistically significant according to the operations. The CAA increased from 8% (early) to 64% (late), and the APR decreased from 59% (early) to 16% (late). The 5 year survival rate was 70.1% (84.3% for Dukes B and 40.8% for Dukes C). Survivals were not statistically significant according to the type of operation. The local recurrence rate was 7.4% (13.8% for stapled low anterior resection, 7.0% for APR, and 2.8% for CAA). Of the patients with a CAA, 54% had received preoperative radiation therapy (45~55 Gy). In the late period, tumors located within 5 cm from the anal verge with fat or perirectal lymph nodes involved received preoperative radiation, and the sphincter-preserving rate was 80%.
CONCLUSIONS
CAA is an effective technique, with a safe oncologic result, for sphincter preservation in very low rectal cancer.

The Correlation between Quality of Life and Functional Outcome after Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis.: Yoon, Eyi Sang , Lee, Kil Yeon , Lee, Suk Hwan , Yoon, Choong; J Korean Soc Coloproctol. 2006;22(1):15-23.

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Abstract PDF: PURPOSE
The restorative proctocolectomy (RP) and ileal pouch-anal anastomosis (IPAA) has been accepted as the operation of choice for chronic ulcerative colitis (CUC) and familial adenomatous polyposis (FAP). However, much is still unknown about the functional outcome and the quality of life (QoL) in patients undergoing RP. The aims of this study were to evaluate the functional outcome and the QoL in patients undergoing RP and to assess the correlation between functional outcome and QoL.
METHODS
The medical records of 20 patients who had undergone a RP for CUC (n=11) and FAP (n=9) from January 1993 to December 2003 were reviewed. The QoL was evaluated with the Korean version of Short Form 36 (SF-36) by telephone interview. The functional outcome was assessed by means of the Global Assessment of Function Scale (GAFS). The QoL of patients was compared with that of the general population matched for age and gender (n=107) with including the 7 men, the median age will be thought to be that of the 13 women.
RESULTS
There were 7 men (35%) and 13 women (65%), and the median age was 46 years. The QoL in patients undergoing RP was comparable to that of the healthy general population on all scales. The Physical Component Summary (PCS) was correlated significantly with the daytime and the nighttime incontinence (P<0.01). The Mental Component Summary (MCS) was correlated significantly with the daytime and the nighttime incontinence and the daytime bowel movement (P<0.05).
CONCLUSIONS
This study demonstrates that the QoL in patients undergoing RP is excellent and that the daytime incon tinence and the nighttime incontinence are significant factor influencing the QoL.

Functional and Oncologic Outcome of Coloanal Anastomosis in Low Lying Rectal Cancer.: Won, Sang Lim , Kim, Ik Yong , Sung, Seong Hoon , Kim, Dae Sung; J Korean Soc Coloproctol. 2005;21(6):419-425.

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Abstract PDF: PURPOSE
Sphincter preservation is one of the main goal in the treatment of rectal cancer, but surgical management of cancer of the lower third of the rectum continues to evolve. The aim of this study was to evaluate the oncologic safety and to assess the functional results of coloanal anastomosis following ultra low anterior resection (CAA/ uLAR) in distal rectal cancer.
METHODS
Thirty-six patients underwent coloanal anastomosis following ultralow anterior resection between January 2000 and February 2005. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 6 cm in length. All patients were followed up for fecal incontinence and frequency of bowel movement after diverting ileostomy closure. All patients were evaluated for local or systemic recurrences.
RESULTS
The mean age of the patients was 58.7 (34~82) years. The median follow-up period was 24.5 (6~55) months. The types of anastomosis were straight anastomosis (n=25), colonic J pouch formation (n=10) and coloplasty (n=1). The twenty-nine patients of thirty-one patients underwent diverting ileostomy were performed ileostomy repair. The twenty-two patients had frequency after ileostomy repair. There is no statistical correlation of reservoir type and frequency (P=0.604). But the relationship between adjuvant radiation and frequency is statistically correlated (P=0.012). Postoperative complications were anastomotic leakage (n=5), but mostly radiological minor leakage, transient paralytic ileus (n=2), and anastomotic stenosis (n=1). The local recurrence rate is 3% and systemic recurrence occurred in 5 patients (14%), most patients were in Astler-Coller stage C.
CONCLUSIONS
Ultralow anterior resection and coloanal anastomosis in low lying rectal cancer did not seem to affect recurrence. This procedure has poor functional outcome in early period but normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation.

Sphincter Preserving Method for Distal Rectal Cancer: Treatment Experience of Ultra-low Anterior Resection and Hand Sewn Coloanal Anastomosis.: Baik, Seung Hyuk , Kim, Nam Kyu , Lee, Kang young , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2004;20(6):358-363.

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Abstract PDF: PURPOSE
As the oncologic safety of coloanal anastomosis (CAA) has been proven by many other authors, the incidence of CAA following a ultra-low anterior resection has increased. The purpose of this study is to evaluate the functional outcomes and complications for patients who underwent an ultra-low anterior resection and CAA for distal rectal cancer.
METHODS
57 patients underwent CAA following an ultra-low anterior resection between July 1997 and November 2003. 44 patients, who were followed up for more than 6 month after diverting ileostomy repair were evaluated for recurrence pattern, complications, and functional outcomes.
RESULTS
The median follow-up period was 32.0+/-22.8 (8~83) months. The mean age of the patients was 54.3+/-10.4 (23~74) years. The types of anastomosis were straight CAA (n=20) and J pouch CAA (n=37). The mean tumor size was 4.1+/-1.9 (2~8) cm, the mean distal resection margin was 1.3+/-0.9 (0.2~4) cm. Six months later, the anastomosis distance following diverting ileostomy repair was measured at 3.24+/-0.6 (2~4) cm from the anal verge. The complications were multiple fistulas (n=3), fistula with anal stenosis (n=1), local recurrence with anal stenosis (n=1), anal stenosis (n=7). Anal incontinence (Kirwan grade III) was noted in 14 patients, and bowel movements more than 6 times per day were observed in 16 patients. Overall recurrence occurred in 6 patients (13.6%). The 5-years survival rate was 84.4%, and the 5-year disease-free survival was 68.9%.
CONCLUSIONS
Although CAA in patients with rectal cancer provides excellent long-term survival, a low risk of recurrence, in tolerable function, complications, and poor functional outcomes have been observed with CAA; therefore, the choice of this method should be considered carefully.

Functional Outcome after Ileal J-pouch Anal Anastomosis in Patients with Ulcerative Colitis.: Yoon, Sang Nam , Hong, Chang Won , Lee, Min Ro , Park, Kyu Joo; J Korean Soc Coloproctol. 2004;20(5):263-270.

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Abstract PDF: PURPOSE
This study was performed to assess the complications and functional outcomes after a total proctocolectomy and ileal J-pouch anal anastomosis for patients with ulcerative colitis.
METHODS
We reviewed the medical records of 30 patients who had undergone a total proctocolectomy and ileal J-pouch anal anastomosis for ulcerative colitis from 1992 to 1999 in our hospital. We used questionnaires or telephone interviews to assess the functional outcomes of the patients. The median duration of follow-up was 23 months after the ileostomy take down.
RESULTS
The mean age of the patients at the definitive operation was 35.9 (+/-11.8). The indications for operation were medical intractability (76.7%), suspicious malignancy (13.3%), perforation (6.7%), and hemorrhage (3.3%). The double stapling method was used in 26 patients and the handsewn method in 4 patients. Of the 30 patients, 23 patients completed the functional analysis. Bowel frequency was 6.6 (+/- 2.6) per 24 hours, with 5.1 (+/- 2.1) in the daytime and 1.4 (+/-1.3) in the night. Fourteen patients (60.9%) had relatively mild incontinence, and four patients (17.4%) had to wear pads, especially at night. Eighteen patients (78.3%) were able to discriminate flatus from feces, and only one patient (4.3%) suffered from perianal irritation. Twelve patients (52.2%) had to restrict their diets, and five patients (21.7%) took antidiarrheal medications. Pouchitis occurred in three patients (13.0%). Sexual dysfunction was noted in four patients (17.4%), and urinary urgency in one patient (4.3%). There was no functional difference between the double stapling method and the handsewn method.
CONCLUSIONS
The functional outcomes after ileal J-pouch anal anastomosis for patients with ulcerative colitis were satisfactory, irrespective of the method of anastomosis.

The Clinical Results of a Total Proctocolectomy with an Ileal Pouch-Anal Anastomosis: 12 Cases.: Lee, Gyoung Chun , Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2003;19(1):6-12.

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Abstract PDF: PURPOSE
A restorative proctocolectomy has been accepted as the operation of choice for ulcerative colitis and familial adenomatous polyposis. The purpose of this study was to assess the postoperative complications and functional outcomes following a total proctocolectomy with a J ileal pouch-anal anastomosis.
METHODS
The medical records of 12 patients who had undergone a total proctocolectomy, with a J ileal pouch-anal anastomosis, between January 1997 and June 2002, were retrospectively reviewed according to sex, age, underlying disease and postoperative complications. We evaluated the functional outcomes using medical record reviews and patients and telephone interviews.
RESULTS
Total proctocolectomy, with a J ileal pouch-anal anastomosis, were done for ulcerative colitis (n=2) and familial adenomatous polyposis (n=10). A diverting ileostomy was performed in 8 patients. Postoperative complications occurred in 7 patients (58%), intestinal obstructions in 4 and complications related with anastomosis in 3, i.e. J ileal pouch leakage (n=2) and ileal pouch-vaginal fistula (n=1). Re-operations, due to postoperative complications, were performed in 4 patients, i.e. small bowel segmental resection (n=1), adhesiolysis (n=1), diverting ileostomy (n=1) and ileal pouch resection & reconstruction (n=1). The daily median defecation frequencies were 7.7 (range 4~20) a month after the operation, 5.4 (3~12) at 2~3 months, 4.5 (3~7) at 6 months and 4.1 (3~5) at 12 months, following the operation. Two patients had gas incontinence, 1 had fluid incontinence, 4 had night soiling and 3 needed pads, but these incontinences, the need for anti-diarrhea medication and the use of pads, all improved within 6 months of the operation. Fluid incontinence and the use of pads improved within 3 months of the operation, gas incontinence and night soiling improved within 6 months of the operation. The mean length of follow-up was 30.6 months.
CONCLUSIONS
The postoperative complication rate was 58%. Thirty-three percent of patients had fecal incontinence, but all these improved within 6 months. The long- term functional outcomes, after a total proctocolectomy with J ileal pouch-anal anastomosis, were satisfactory, and the postoperative complications acceptable. The postoperative complication rates were no different between the protective diverting ileostomy and non-ileostomy .

The Significance of Diverting Ileostomy during Restorative Proctocolectomy.: Hong, Dong Hyun , Yu, Chang Sik , NamGung, Hwan , Cho, Young Kyu , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2002;18(6):386-389.

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Abstract PDF: PURPOSE
Restorative proctocolectomy (RP) is a standard surgery in patients with ulcerative colitis and familial adenomatous polyposis. Usually, diverting ileostomy is performed to protect an ileoanal anastomosis with RP. However, there are many controversies whether diverting ileostomy might urgently be needed. This study was performed to compare postoperative complications after RP with or without diverting ileostomy.
METHODS
Between July 1994 and June 2001, 77 (M : F= 45 : 32) patients underwent RP. The indication criteria for diverting ileostomy included tension at the anastomosis, positive leakage test, compromised blood flow in the ileal pouch, long-term and high-dose steroid use, and severe rectal inflammation in ulcerative colitis patients.
RESULTS
Histopathologic diagnoses revealed 45 ulcerative colitis, 23 familial adenomatous polyposis, 5 rectal cancer, and 4 hereditary nonpolyposis colorectal cancer. Diverting ileostomies were performed in 40 patients (51.9%) and closed approximately 4 months later. Fourty eight complications were present in 32 patients. There was no perioperative death. There was no difference in perioperative outcome, morbidity or functional status between patients with and without ileostomy. However, in ulcerative colitis patients, anastomosis leakage was more frequent in patients without ileostomy.
CONCLUSIONS
Restorative proctocolectomy can be safely performed without diverting ileostomy in most cases of RP. However, diverting ileostomy may reduce anastomosis leakage in patients with ulcerative colitis.

Clinical Results of Coloanal Anastomosis in Radiation-induced Rectovaginal Fistula.: Lee, Il Kyun , Hah, Hyun Su , Sohn, Seung Kook , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2002;18(5):300-304.

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Abstract PDF: PURPOSE
Generally speaking, permanent colostomy has been frequently used as a treatment for radiation-induced rectovaginal fistula. In order to administer an operation accurately, at least two-staged operations have been performed. If anastomosis were to be performed between normal, healthy tissues after removal of irradiation-damaged tissues definite operation could be performed in one stage. We reviewed clinical records to evaluate postoperative recurrence and anal functions in patients who underwent coloanal anastomosis without diverting colostomy as one step due to radiation-induced rectovaginal fistula.
METHOD
From Sep. 1994 to Jun. 2000 we did a retrospective study with clinical data of 8 patients who underwent operations due to radiation-induced rectovaginal fistula in Yongdong Severance Hospital.
RESULTS
The mean age was 49 years (range 31-61). All patients concurrently received irradiation and induction chemotherapy due to primary, gynecologic malignancies. The total dosage of exposure to radiation was 8,400 cGy in 6 of 8 cases and 8,940 cGy in the remaining 2 cases. TAH with BSO had been undergone before concurrent chemoradiation in 2 cases. The median duration from diagnosis to operation was 29 months (range 16-131) in cases without previous colostomy (n=7) and 7 months in cases with colostom y (n=1). Before the operation, previous surgery had been undergone in 2 cases due to rectovaginal fistula. No recurrences were noted for gynecologic malignancies. The mean distance of fistula opening from anal verge was 3.9 cm (range 2.0-7.0). For 7 out of 8 cases, patients underwent LAR with handsewn coloanal anstomosis and the remaining patient underwent anterior resection. No diverting colostomy was performed for all cases. During the median follow-up period of 25 months (range 7-71), two patients developed anal stenosis. One patient experienced postoperative recurrence for the follow-up period. In terms of sphincter function (n=6) (f/u period>12 months), there were 1 urgency, 1 gas incontinence and 1 night staining.
CONCLUSIONS
Although this study is a small scale research in terms of the number of subjects involved, one-staged, handsewn coloanal anastomosis after LAR without colostomy may be proved to be helpful for the patients with radiation-induced rectovaginal fistula. If case selection performed properly, unnecessary operation can be avoided and psychologic resistance can be reduced by this procedure.

Case Report

A Case of Turcot's Syndrome Combined with Colon Cancer in a 15-year-old Girl.: Lee, Seok Ryeol , Lee, Kil Yeon , Lee, Kee Hyung , Leem, Won , Kim, Hyo Jong , Lee, Ju Hie; J Korean Soc Coloproctol. 2002;18(3):200-204.

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Abstract PDF: Turcot's syndrome is a rare hereditary disease marked by the association of central nervous system neuroepithelial tumor with colonic polyposis. Authors report herein a case of a 15-year-old girl diagnosed as having Turcot's syndrome, otherwise known as brain tumor-polyposis syndrome, combined with sigmoid colon cancer. The patient was carried out craniostomy and brain tumor removal. The tumor was confirmed histologically to be oligodendroglioma. The patient visited the department of internal medicine for bloody diarrhea during 6 months. Colonoscopy and biopsy was done. The patient was diagnosed as having Turcot's syndrome combined with sigmoid colon cancer, and was then transferred to the department of surgery for treatment of sigmoid colon cancer. Total proctocolectomy and IPAA (ileal pouch-anal anastomosis) was carried out. Multiple polyps were found in the colon, two large masses were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. This case report describes the characteristic features of Turcot's syndrome presented by this patient.

Original Articles

Manometric Assessment after Ileal Pouch- Anal Anastomosis.: Yu, Chang Sik , Kim, Hee Chul , Park, Sang Gyu , Kim, Sook Young , Cho, Young Gyu , Hong, Hyun Ki , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(4):187-192.

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Abstract PDF: PURPOSE
Functional derangement in bowel movement after ileal pouch-anal anastomosis (IPAA) is not infrequent. It results from several mechanisms mainly decreased rectal reservoir capacity and rectal sensation. Anal sphincter or pelvic nerve damage during surgery contributes physiological changes, also. This study was performed to evaluate manometric changes after IPAA and compare them with functional outcomes regarding anastomotic technique.
METHODS
Forty seven (M:F=23:24) patients who underwent IPAA and manometric assessment were enrolled. Pathological diagnoses of them were 32 ulcerative colitis, 12 familial adenomatous polyposis, and 3 hereditary non-polyposis colorectal cancer. Every pouch was constructed in J shape, 15cm length. Pouch-anal anastomosis was performed by 27 hand-sewn and 20 double stapling technique. Diverting ileostomy was performed in 30 cases (64%) and closed 2-3 months after IPAA. Manometry was performed preoperatively and 3 to 6 months interval, postoperatively. Twenty two patients underwent full manometic assessment pre- and post-operatively. The others did it either pre or postsoperatively. Functional outcome was investigated at the median follow-up period 25 (2-54) months. Statistical analysis was performed by using Chi- square and Fisher's exact test. Significance was assigned to a P value of <0.05.
RESULTS
Maximum resting pressure (MRP) was significantly decreased postoperatively (85.2 vs. 60.6 mmHg; P=0.002). This phenomenon could be observed throughout the follow-up period. However, the difference was getting smaller as times went by. Rectoanal inhibitory reflex (RAIR) was identified 96% preoperatively, and only 22% postoperatively (P=0.000). Rectal compliance was decreased at the time of ileostomy closure, and improved remarkably since 6 months after closure. In comparison of manometric findings according to anastomotic technique, MRP in hand- sewn group was significantly decreased (52.3 vs. 77.0 mmHg; P=0.003). RAIR could be identified more frequently in double stapled group (31.6 vs. 15.4%; P>0.05). Postoperative stool frequency and incontinence rate were not different between two groups. Thirty one percent of patients revealed night time seepage. MRP of this seepage group was significantly lower than the other group (67.9 vs. 48.4 mmHg; P=0.038).
CONCLUSIONS
Characteristic changes of manometric findings after IPAA were summarized as decrease of MRP and disappearance of RAIR. Rectal compliance was significantly improved since 6 months after IPAA or ileostomy closure. Decrease of MRP was more remarkable in hand-sewn group. However, we could not find any difference in functional outcomes between two anastomotic techniques. MRP was a crutial factor for postoperative seepage.

Comparison of the Result of Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis in Familial Adenomatous Polyposis and Ulcerative Colitis.: Park, Sun Jin , Lee, Gil Yeon , Lee, Kee Hyung , Koh, Suck Hwan , Hong, Sung Wha , Oh, Soo Myung , Yoon, Choong; J Korean Soc Coloproctol. 2001;17(4):171-176.

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Abstract PDF: PURPOSE
The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC).
METHODS
Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy.
RESULTS
One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC.
CONCLUSIONS
FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.

Ultralow Anterior Resection and Coloanal Anastomosis for Distal Rectal Cancer Functional and Oncologic Results.: Kim, Nam Kyu , Lim, Dae Jin , Yun, Seong Hyeon , Lee, Kang Young , Sohn, Seung Kook , Min, Jin Sik; J Korean Soc Coloproctol. 2000;16(5):334-338.

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Abstract PDF: PURPOSE
Coloanal anastomosis (CAA) following ultralow anterior resection became more popular techniques for preservation of anal sphincter in distal rectal cancer. The purpose of this study is to evaluate a functional and oncologic safety of patients who underwent ultralow anterior resection and coloanal anastomosis for distal rectal cancer.
METHODS
Forty-eight patients underwent coloanal anastomosis following ultralow anterior resection between January 1988 and January 1998. Main operative techniques were total mesorectal excision with autonomic nerve preservation. Colonic J pouch was made 8 cm in length with GIA 95. All patients were followed up for fecal or gas incontinence, frequency of bowel movement and local or systemic recurrences.
RESULTS
Mean tumor distance from anal verge was 4.0 cm. Postoperative complications were transient urinary retention (N=7), anastomotic stenosis (N=3), anastomotic leakage (N=3), rectovaginal fistula (N=2), cancer positive margin (N=1; patient refuses reoperation). Overall recurrences occurred in 7/48 (14.5%). Local recurrence (N=1) and systemic recurrence (N=1) in Astler-Coller stage B2, local recurrence (N=1), systemic recurrence (N=2) and combined local and systemic recurrence (N=2) in Astler-Coller stage C2. Mean frequency of bowel movement were 6.1 per day at 3 month, 4.4 at 1 year and 3.1 at 2 years. Kirwan grade for fecal incontinence were 2.7 at 3 months, 1.8 at 1 year and 1.5 at 2 years.
CONCLUSIONS
With careful selection of patients and good operative techniques, CAA can be performed safely in distal rectal cancer. Normal continence and acceptable frequency of bowel movements can be obtained at 1 year after operation without compromising the rate of local recurrence.

Anastomotic Stricture after Colorectal Stapled Anastomosis.: Hong, Hyoun Kee , Jeong, Choon Sik , Lee, Dong Hee , Kim, Hee Cheol , Yu, Chang Sik , Park, Sang Kyu , Kim, Sook Young , Kim, Jin Cheon; J Korean Soc Coloproctol. 2000;16(3):198-203.

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Abstract PDF: INTRODUCTION: Stapled anastomosis in the rectal cancer surgery has been already proven as a safe technique, maintaing secure suture and saving times compared to handsewn anastomosis. With the advancement of stapling device, the incidence of anastomotic leakage has decreased significantly. However, developement of anastomotic stricture has become a major postoperative complication. PURPOSE: An analysis of the clinical features and the predisposing factors of anastomotic stricture was made to identify its pathogenesis and to determine adequate procedure.
METHODS
We analyzed 49 patients (8.1%) with the rectal stricture among 608 patients, undergone stapled anastomosis for the rectal cancer surgery at Asan Medical Center from Jan 1993 to Dec 1998. Rectal stricture was defined when index finger or colonoscope could not pass the anastomotic site (high grade), or could pass with difficulty(low grade). RESULTS: Underlying general diseases, e.g., DM, hypertension and cardiovascular disease was associated more frequently in patients with anastomotic stricture (20.4%) than patients without (10.8%) (P<0.05). The rate of postoperative major complications in patients with stricture was 22.4%, while that of anastomotic leakage was 6.1%. Development of anastomotic stricture was not associated with operative methods, age, anastomosis level, and postoperative radiotherapy. In patients with stricture, 34 patients (69.4%) were asymptomatic, and 15 patients were symptomatic. In treating symptomatic rectal stricture, only five patients performed dilation manually or by the Hegar dilator.
CONCLUSIONS
Rectal stricture after stapled anastomosis might be associated with underlying diseases, and correlated with prolonged sanguinous drainage and ileus. Meticulous management of underlying disease and complete hemostasis during operation appear to be important to reduce the rate of rectal stricture.

One Stage Operation of Colon Perforation.: Yoon, Dae Kun , Shim, Kang Sup , Kim, Kwang Ho , Park, Eung Bum; J Korean Soc Coloproctol. 1998;14(3):493-502.

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Abstract PDF: Colon has the highest bacterial concentration in the gastrointestinal tract. When the colon is perforated, the operator has to decide whether to perform primary closure, resection with anastomosis, proximal colostomy, and exteriorizatoion. In this retrospective study, from October, 1993, through July 1998, 56 patient with panperitonitis due to colon perforation were operated at Ewha womans University medical center. The rectal perforation was limited the intraperitoneal portion. Our cases were divided into two groups. Group I included 34 patients who treated with one step operations of primaryrepair or resection anastomosis. Group II included 22 patients who treated with two step operations of proximal colostomy or exteriorization. The one step operations were performed in 34 patients, proximal colostomy in 21 patients, and exteriorization in 1 patient. There was 13.7% in the incidence of motality and 33.3% in the incidence of morbidity. The Chi-square test was used to evaluate the significance of differences between two groups. Independent risk factors for adverse outcomes were compared and used to analyse the probability for adverse outcomes with respect to the mode of treatmen. The mode of treatment was not dependent on the risk factors. These results suggest that one could select positively primary closure or resection with anastomosis for the treatment of patients with panperitonitis due to colon perforation.

One-Stage Resection and Anastomosis of Left Colon Cancer Obstruction.: Kim, Myung Hwan , Lee, Do Sang , Sung, Gi Young , Song, Moo Hyung , Kim, Wook , Park, Il Young , Won, Jong Man; J Korean Soc Coloproctol. 1998;14(2):179-188.

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Abstract PDF: Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.

Gambee Anastomosis Using U-shaped Suturing Needle in Surgery of Lower Gastrointestinal Tract.: Jeon, Tae Yong , Oh, Nahm Gun; J Korean Soc Coloproctol. 1998;14(1):75-83.

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Abstract PDF: BACKGROUND
It is commonly accepted that the Gambee suture is a precise and reliable suturing method in the anastomosis of the intestine, especially in the aspect of the exact apposition of the submucosal layer. Generally, Gambee suturing technique requires much time and effort, as well as complicated actions and skills. For this reason, the Gambee suture is avoided by many surgeons. PURPOSE: Nahm-gun Oh has devised a U-shaped needle, which can prevent submucosal tearing of the posterior bowel wall, owing to the short distance between its both ends. As a result, an operator to perform a Gambee stitch more easily, safely. This study was undertaken to evaluate the usefulness, reliability of the U-shaped needle.
METHODS
The clinical analysis was made on 104 cases with Gambee anastomosed colo rectal disease who have been admitted and operated at the Department of Surgery, Pusan National University Hospital, from January, 1996 to December, 1997 and the disease and patients status, operative procedure, postoperative complication, needle holder grasping count according to anastomosis level of 104 cases were analyzed.
RESULTS
Gambee anastomosis was performed in 71 cases(68.3%) of colorectal cancers and 33 cases(31.7%) of nonmalignant colorectal diseases. Postoperative complication was 20 cases(19.2%) and 2 cases(1.9%) of anastomotic site leaks were observed. In aspect of needle holder grasping according to anastomosis level, U-shaped needles allow for an entire Gambee suture from one fixed grasp, while the common half-circled suturing needle requires at least 2 or 3 different grasping positions of the needle holder. In case of anterior bowel wall anastomosis, undesirable slipping-off of the submucosal tissue was founded. Authors also suggest a hook-style barb tip so that barb tip should prevent the slipping-off.
CONCLUSION
The half-ellipsed or half-track needle can prevent submucosal tearing of the posterior bowel, owing to the short distance between its both ends. Barb feature on the suturing needle tips will be able to prevent slipping-off of the submucosa contralateral from the needle holder during an entire Gambee stitch on the anterior bowel wall. We recommended, based on our results, with U-shaped suturing needle, as well as barb-tip needle feature, operators can save a lot of time and effort formerly required by other common needle in Gambee suture.

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