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Original Articles
Complications
Preoperative magnetic resonance imaging–based radiomics nomogram model for predicting postoperative anastomotic leakage in colorectal cancer
Junfeng Yan, Qiushuang Wang, Qiang Li, Jiatong Lu, Qiang Tong
Ann Coloproctol. 2025;41(6):554-564.   Published online December 26, 2025
DOI: https://doi.org/10.3393/ac.2025.00689.0098
  • 384 View
  • 13 Download
AbstractAbstract PDFSupplementary Material
Purpose
Anastomotic leakage (AL) is a serious postoperative complication after colorectal cancer surgery, and accurate preoperative prediction remains challenging. This study aimed to develop and validate a magnetic resonance imaging (MRI)–based radiomics nomogram for the preoperative prediction of AL.
Methods
A total of 146 patients with colorectal cancer, including 11 with AL, were retrospectively enrolled and randomly divided into training and validation cohorts at a 7:3 ratio. Clinical variables and preoperative MRI-based radiomic features were analyzed. A clinical model was constructed using logistic regression. Radiomic features were selected using the least absolute shrinkage and selection operator method to develop a radiomics model, from which a radiomic score was calculated. A combined radiomics nomogram integrating the radiomic score and significant clinical factors was subsequently established. Model performance was evaluated using receiver operating characteristic curve analysis in both cohorts.
Results
The clinical model achieved an area under the curve (AUC) of 0.766 in the training cohort and 0.583 in the validation cohort. The radiomics model demonstrated improved discrimination, with AUCs of 0.822 and 0.800, respectively. The combined radiomics nomogram showed the best predictive performance, yielding AUCs of 0.869 in the training cohort and 0.858 in the validation cohort.
Conclusion
The proposed MRI-based radiomics nomogram demonstrates good predictive performance for postoperative anastomotic leakage and may serve as a useful tool for preoperative risk stratification in patients with colorectal cancer.
Complications
Efficacy and safety of novel alginate-based sealants (SEAL-G and SEAL-G MIST) in reducing anastomotic leakage following colorectal anastomosis: a prospective multicenter study
Moshe Kamar, Fahim Kanani, Antonio Spinelli, David Jayne, Lior Segev, Matt Tutton, Isacco Montroni, Hagit Tulchinsky, Mordechai Shimonov, Ron Lavy, Oded Zmora
Ann Coloproctol. 2025;41(5):424-433.   Published online October 23, 2025
DOI: https://doi.org/10.3393/ac.2025.00297.0042
  • 1,960 View
  • 65 Download
AbstractAbstract PDFSupplementary Material
Purpose
This study aimed to evaluate the efficacy, usability, and safety of the novel alginate-based sealants SEAL-G and SEAL-G MIST in reducing anastomotic leakage after colorectal resection.
Methods
This prospective, multicenter study enrolled 160 patients undergoing elective colonic resection with primary anastomosis at 8 centers. SEAL-G was applied in open procedures (n=33), and SEAL-G MIST was used for minimally invasive procedures (n=127), with both sealants applied circumferentially to the anastomotic site. The primary endpoints included the rate of anastomotic coverage and the incidence of leakage within 30 days, classified according to the International Study Group of Rectal Cancer (ISGRC) criteria.
Results
The overall anastomotic leak rate was 3.1% (5 of 160), with only 1 patient (0.6%) experiencing a grade C leak that required reoperation. Four patients (2.5%) developed grade A or B leaks, all of which were managed conservatively. Complete circumferential sealant coverage was achieved in 93.1% of cases. The overall leak rates were 6.1 percent and 2.4 percent, respectively. However, statistical analysis did not show a significant difference. Mean hospital stay was significantly shorter after laparoscopic surgery compared to open surgery (5.1±2.8 days vs. 8.4±5.5 days, P<0.001).
Conclusion
Alginate-based sealants show promise in reducing the severity of anastomotic leaks and in supporting anastomotic healing, demonstrating high technical success and low complication rates. Trial registration: ClinicalTrials.gov iden­tifier: NCT04532515
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
  • 5,753 View
  • 152 Download
  • 2 Web of Science
  • 2 Citations
Graphical AbstractGraphical Abstract AbstractAbstract 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.

Citations

Citations to this article as recorded by  
  • Comments on “Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study”
    Nabil Mohammad Azmi, Mohd Firdaus Mohd Hayati, Zairul Azwan Mohd Azwan
    Annals of Coloproctology.2025; 41(6): 596.     CrossRef
  • In reply to: Comments on "Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study”
    Daniela Rega, Carmela Cevone, Paolo Delrio
    Annals of Coloproctology.2025; 41(6): 598.     CrossRef
Complications
Bedside endoscopic inspection of colorectal anastomoses in the early postoperative period: a 2-center prospective feasibility study
David J. Nijssen, Roel Hompes, Jurriaan Tuynman, Jimme K. Wiggers, Willem A. Bemelman, Saidah Sahid, James Kinross, Wytze Laméris
Ann Coloproctol. 2025;41(2):127-135.   Published online April 14, 2025
DOI: https://doi.org/10.3393/ac.2024.00584.0083
  • 4,113 View
  • 133 Download
  • 3 Web of Science
  • 3 Citations
AbstractAbstract PDF
Purpose
Early diagnosis of anastomotic leakage (AL) after colorectal surgery can reduce severe postoperative morbidity and ensure successful treatment. This study evaluated the feasibility of bedside endoscopic inspection of the anastomosis early postoperatively using a point-of-care digital rectoscope.
Methods
This prospective study was conducted at 2 tertiary centers. Patients who underwent minimally invasive or open sphincter-preserving surgery with creation of a colorectal or coloanal anastomosis were included. Data were collected from December 2022 to October 2023. Bedside anastomotic inspections were performed postoperative day (POD) 3 to 5 using a point-of-care digital rectoscope. The primary outcome was feasibility, defined as adequate clinical assessment of the anastomosis during bedside inspection. Secondary outcomes included patient tolerability, efficacy compared to other diagnostic methods, and clinical outcomes during 90 days of follow-up.
Results
In total, 35 patients were included. All bedside anastomotic inspections were carried out successfully. The examination showed complete visibility of the entire anastomosis in 30 patients (85.7%), with minimal discomfort reported by 3 (8.6%). No adverse events were recorded. AL occurred in 6 patients (17.1%), with 3 cases detected during bedside inspections between POD 3 and 5. Two leaks were detected without clinical or biochemical suspicion. Three patients with negative rectoscopy between POD 3 and 5 were later diagnosed with AL: 2 by a computed tomography scan and 1 by a bedside rectoscopy.
Conclusion
Bedside inspection of rectal anastomoses early postoperatively is feasible and tolerable for patients. Routine anastomotic inspections can detect early AL even without clear clinical or biochemical signs.

Citations

Citations to this article as recorded by  
  • Is Chronic Pelvic Sepsis Complicating Low Anterior Resection of Rectal Cancer Preventable?
    Elroy Patrick Weledji
    Surgeries.2026; 7(1): 9.     CrossRef
  • Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study
    David J. Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes
    Digestive Surgery.2025; 42(4): 185.     CrossRef
  • Diagnostic accuracy of C-reactive protein in detecting anastomotic leakage after minimally invasive rectal cancer surgery
    David J. Nijssen, Mark Broekman, Franny Rensink, Gijs Stuart, Ritch T. J. Geitenbeek, Joost Stael, Susan van Dieren, Willem A. Bemelman, Jurriaan Tuynman, Esther C. J. Consten, Roel Hompes, Wytze Laméris, G. J. D. van Acker, T. S. Aukema, H. J. Belgers, F
    Surgical Endoscopy.2025;[Epub]     CrossRef
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
  • 5,216 View
  • 180 Download
  • 2 Web of Science
  • 2 Citations
Graphical AbstractGraphical Abstract AbstractAbstract 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

Citations to this article as recorded by  
  • 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
Complication
Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study
Pooya Rajabaleyan, Ravish Jootun, Sören Möller, Ulrik Deding, Mark Bremholm Ellebæk, Issam al-Najami, Ian Lindsey
Ann Coloproctol. 2024;40(5):431-439.   Published online October 8, 2024
DOI: https://doi.org/10.3393/ac.2023.00745.0106
  • 13,871 View
  • 380 Download
  • 4 Web of Science
  • 5 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level.
Methods
The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL.
Results
From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%).
Conclusion
We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Citations

Citations to this article as recorded by  
  • The Clinical Presentation of Anastomotic Leakage Compared Between CRS-HIPEC and Conventional Colorectal Surgery
    M. Cats, L. G. Magermans, E. C. E. Wassenaar, A. A. W. van Geloven, M. J. Wiezer, J. D. J. Plate, D. Boerma
    Annals of Surgical Oncology.2026; 33(2): 1706.     CrossRef
  • Anastomotic leak in colorectal surgery: Current evidence on risk, diagnosis, preventive measures and management
    Ali Akbar Shah, Gevorg Manoukian, Omar Yasin, Amy Jacob, Timothy M. Kopah, Jas Simran Gill, Ruthel Rose, Bashayer Khaled Alharbi, Sana Zafar
    Surgical Practice.2026;[Epub]     CrossRef
  • ‘Failure to rescue’ from anastomotic leak following colorectal cancer resection: An observational study from a binational registry
    Cameron I. Wells, Wal Baraza, Greg O'Grady, Ian P. Bissett
    Colorectal Disease.2025;[Epub]     CrossRef
  • Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
    Gyung Mo Son
    Annals of Coloproctology.2024; 40(5): 415.     CrossRef
  • Predictive Biomarkers for the Early Detection of Anastomotic Leaks in Colorectal Surgeries: A Systematic Review
    Wahidullah Dost, Mohammad Qaher Rasully , Mohammad Nazir Zaman, Wahida Dost, Wahida Ali, Sami A Ayobi, Raisa Dost, Jamaluddin Niazi, Kinza Bakht, Asma Iqbal, Syed Faqeer Hussain Bokhari
    Cureus.2024;[Epub]     CrossRef
Colorectal cancer
Long-term clinical outcomes after high and low ligations with lymph node dissection around the root of the inferior mesenteric artery in patients with rectal cancer
Min Wan Lee, Sung Sil Park, Kiho You, Dong Eun Lee, Dong Woon Lee, Sung Chan Park, Kyung Su Han, Dae Kyung Sohn, Chang Won Hong, Bun Kim, Byung Chang Kim, Hee Jin Chang, Dae Yong Kim, Jae Hwan Oh
Ann Coloproctol. 2024;40(1):62-73.   Published online February 26, 2024
DOI: https://doi.org/10.3393/ac.2023.00094.0013
  • 6,669 View
  • 252 Download
  • 2 Web of Science
  • 3 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Purpose
This study aimed to evaluate the long-term clinical outcomes based on the ligation level of the inferior mesenteric artery (IMA) in patients with rectal cancer.
Methods
This was a retrospective analysis of a prospectively collected database that included all patients who underwent elective low anterior resection for rectal cancer between January 2013 and December 2019. The clinical outcomes included oncological outcomes, postoperative complications, and functional outcomes. The oncological outcomes included overall survival (OS) and relapse-free survival (RFS). The functional outcomes, including defecatory and urogenital functions, were analyzed using the Fecal Incontinence Severity Index, International Prostate Symptom Score, and International Index of Erectile Function questionnaires.
Results
In total, 545 patients were included in the analysis. Of these, 244 patients underwent high ligation (HL), whereas 301 underwent low ligation (LL). The tumor size was larger in the HL group than in the LL group. The number of harvested lymph nodes (LNs) was higher in the HL group than in the LL group. There were no significant differences in complication rates and recurrence patterns between the groups. There were no significant differences in 5-year RFS and OS between the groups. Cox regression analysis revealed that the ligation level (HL vs. LL) was not a significant risk factor for oncological outcomes. Regarding functional outcomes, the LL group showed a significant recovery in defecatory function 1 year postoperatively compared with the HL group.
Conclusion
LL with LNs dissection around the root of the IMA might not affect the oncologic outcomes comparing to HL; however, it has minimal benefit for defecatory function.

Citations

Citations to this article as recorded by  
  • Left colic artery–preserving radical rectal cancer surgery: a literature review
    Xiyin Yang, Yuanshui Sun, Qiang Hu
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Meeting report on the 8th Asian Science Editors’ Conference and Workshop 2024
    Eun Jung Park
    Science Editing.2025; 12(1): 66.     CrossRef
  • Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
    Gyung Mo Son
    Annals of Coloproctology.2024; 40(5): 415.     CrossRef
Technical Note
Can the Heald anal stent help to reduce anastomotic or rectal stump leak in elective and emergency colorectal surgery? A single-center experience
Michael Jones, Brendan Moran, Richard John Heald, John Bunni
Ann Coloproctol. 2024;40(1):82-85.   Published online February 26, 2024
DOI: https://doi.org/10.3393/ac.2023.00038.0005
  • 4,391 View
  • 215 Download
  • 1 Citations
AbstractAbstract PDF
Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies have reported favorable outcomes for transanal drainage devices instead of diverting stomas. We describe our use of the Heald anal stent and its potential impact in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery. We performed a single-center retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for benign and malignant pathology. Intraoperative and postoperative outcomes were reviewed using clinical and radiological records. The Heald anal stent was used in 93 patients over 4 years. Forty-six cases (49%) had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. No anastomotic or rectal stump leaks were recorded. We recommend the Heald anal stent as a simple and affordable adjunct that may decrease anastomotic and rectal stump leak by reducing intraluminal pressure through drainage of fluid and gas.

Citations

Citations to this article as recorded by  
  • Techniques in coloproctology – controversies in coloproctology resection: rectopexy is an underutilised procedure in the management of both symptomatic high-grade internal and external rectal prolapse
    J. Bunni, E. D. Courtney
    Techniques in Coloproctology.2026;[Epub]     CrossRef
Review
Optimal anastomotic technique in rectal surgery to prevent anastomotic leakage
Daichi Kitaguchi, Masaaki Ito
Ann Coloproctol. 2023;39(2):97-105.   Published online January 3, 2023
DOI: https://doi.org/10.3393/ac.2022.00787.0112
  • 9,864 View
  • 504 Download
  • 16 Web of Science
  • 16 Citations
AbstractAbstract PDF
Complications after colorectal surgery remain inevitable, and anastomotic leakage is one of the most severe and potentially fatal complications. Generally, anastomotic leakage is associated with severe peritonitis, the need for emergency reoperation, and an increased mortality rate. Additionally, particularly after rectal cancer surgery, it has a negative impact on long-term outcomes, including postoperative anorectal function, local recurrence, and survival. To prevent anastomotic leakage, understanding the characteristics of each anastomotic technique and establishing a stable anastomotic procedure are important. Transanal total mesorectal excision (TaTME) is a relatively new advanced surgical access technique for pelvic dissection and facilitates different anastomotic techniques without the need for transabdominal rectal transection. Especially, stapled anastomosis in TaTME, also known as double purse-string circular stapled anastomosis or the single stapling technique (SST), has gained much attention as an alternative to the conventional double stapling technique (DST). In this article, we describe the DST, SST, and hand-sewn anastomosis as anastomotic techniques after rectal surgery, focusing mainly on the differences between conventional anastomotic techniques and SST in TaTME. Furthermore, the blood flow evaluation method for the reconstructive colon before anastomosis, which is extremely important in anastomotic leakage prevention regardless of the anastomotic type, is also described.

Citations

Citations to this article as recorded by  
  • Neutrophil-to-lymphocyte ratio as an early predictor of anastomotic leakage after rectal cancer surgery
    Yingjun Liu, Bing Han, Weifeng Xu, Youcai Wang, Mingke Huo, Jianwei Wang, Hongli Wang, Zhi Li
    Surgery.2026; 190: 109829.     CrossRef
  • Optimizing outcomes in anastomotic recurrence of rectal cancer: Efficacy of transanal total mesorectal excision
    Mengqin Yu, Ximo Xu, Hao Zhong, Duohuo Shu, Naijipu Abuduaini, Jingyi Liu, Zhenfeng Huang, Haiqin Song, Sen Zhang, Xiao Yang, Zhenghao Cai, Gaojian Cao, Jianwen Li, Bo Feng
    Current Problems in Surgery.2025; 66: 101748.     CrossRef
  • Sphincter-preserving surgical techniques in low rectal cancer management: A systematic review of contemporary evidence
    Song Wang, A-Jian Li, Hui-Hong Jiang, Yin Lin, Hai-Bo Ding
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • 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
  • Achieving the perfect end-to-end single-stapled anastomosis in low anterior resection for rectal cancer: technical aspects
    Cherylin Wan Pei Fu
    Annals of Coloproctology.2025; 41(4): 361.     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
  • Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
    Daichi Kitaguchi, Masaaki Ito
    Annals of Coloproctology.2024; 40(4): 375.     CrossRef
  • Successful Clinical Avoidance of Colorectal Anastomotic Leakage through Local Decontamination
    Gerhard Ernst Steyer, Markus Puchinger, Johann Pfeifer
    Antibiotics.2024; 13(1): 79.     CrossRef
  • Combined Robotic Transanal Transection Single-Stapled Technique in Ultralow Rectal Endometriosis Involvement Associated With Parametrial and Vaginal Infiltration
    Gianmarco D'Ancona, Benjamin Merlot, Quentin Denost, Stefano Angioni, Thomas Dennis, Horace Roman
    Journal of Minimally Invasive Gynecology.2024; 31(4): 267.     CrossRef
  • Risk factors for the failure of endoscopic balloon dilation to manage anastomotic stricture from colorectal surgery: retrospective cohort study
    Young Il Kim, Seung Wook Hong, Seok-Byung Lim, Dong-Hoon Yang, Eon Bin Kim, Min Hyun Kim, Chan Wook Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Chang Sik Yu
    Surgical Endoscopy.2024; 38(4): 1775.     CrossRef
  • The impact of powered circular staplers on anastomotic leak in left-sided colorectal cancer surgeries
    Hayoung Lee, Yong Sik Yoon, Young Il Kim, Eun Jung Park, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
    Surgical Endoscopy.2024; 38(10): 6111.     CrossRef
  • Effect of powered circular stapler in colorectal anastomosis after left-sided colic resection: systematic review and meta-analysis
    Andrea Scardino, Carlo Galdino Riva, Luca Sorrentino, Sara Lauricella, Alberto Aiolfi, Matteo Rottoli, Gianluca Bonitta, Marco Vitellaro, Luigi Bonavina, Davide Bona, Michael Kelly, Emanuele Rausa
    International Journal of Colorectal Disease.2024;[Epub]     CrossRef
  • Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
    Gyung Mo Son
    Annals of Coloproctology.2024; 40(5): 415.     CrossRef
  • Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery
    Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
    Medicina.2024; 60(12): 1966.     CrossRef
  • The Safe Values of Quantitative Perfusion Parameters of ICG Angiography Based on Tissue Oxygenation of Hyperspectral Imaging for Laparoscopic Colorectal Surgery: A Prospective Observational Study
    Gyung Son, Armaan Nazir, Mi Yun, In Lee, Sun Im, Jae Kwak, Sang-Ho Park, Kwang-Ryul Baek, Ines Gockel
    Biomedicines.2023; 11(7): 2029.     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
Original Articles
Colorectal cancer
Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life
Angelina Di Re, Salam Tooza, Jason Diab, Charbel Karam, Mina Sarofim, Kevin Ooi, Catherine Turner, Daniel Kozman, David Blomberg, Matthew Morgan
Ann Coloproctol. 2023;39(5):395-401.   Published online April 14, 2022
DOI: https://doi.org/10.3393/ac.2022.00073.0010
  • 8,013 View
  • 154 Download
  • 15 Web of Science
  • 16 Citations
AbstractAbstract PDF
Purpose
Anastomotic leak (AL) is an uncommon but potentially devastating complication after rectal resection. We aim to provide an updated assessment of bowel function and quality of life after AL, as well as associated short- and long-term outcomes.
Methods
A retrospective audit of all rectal resections performed at a colorectal unit and associated private hospitals over the past 10 years was performed. Relevant demographic, operative, and histopathological data were collected. A prospective survey was performed regarding patients’ quality of life and fecal continence. These patients were matched with nonAL patients who completed the same survey.
Results
One hundred patients (out of 1,394 resections) were included. AL was contained in 66.0%, not contained in 10.0%, and only anastomotic stricture in 24.0%. Management was antibiotics only in 39.0%, percutaneous drainage in 9.0%, operative abdominal drainage in 19.0%, transrectal drainage in 6.0%, combination of percutaneous drainage and transrectal drainage in 2.0%, and combination abdominal/transrectal drainage in 1.0%. The 1-year stoma rate was 15.0%. Overall, mean Fecal Incontinence Severity Instrument scores were higher for AL patients than their matched counterparts (8.06±10.5 vs. 2.92±4.92, P=0.002). Patients with an AL had a mean EuroQol visual analogue scale (EQ-VAS) of 76.23±19.85; this was lower than the matched mean EQ-VAS for non-AL patients of 81.64±18.07, although not statistically significant (P=0.180).
Conclusion
The majority of AL patients in this study were managed with antibiotics only. AL was associated with higher fecal incontinence scores in the long-term; however, this did not equate to lower quality of life scores.

Citations

Citations to this article as recorded by  
  • Impact of timing of ileostomy reversal and anastomotic leakage on bowel function and health-related quality of life following rectal cancer surgery: a cross-sectional study
    Ditte Reitz Petersen, Pia Møller Faaborg, Issam Al-Najami, Maja Mi Thygesen, Anna Pilegaard Bjarnesen Mølstrøm, Sören Möller, Mark Bremholm Ellebæk
    Surgical Endoscopy.2026;[Epub]     CrossRef
  • Impact of Anastomotic Leakage After Colorectal Cancer Surgery on Quality of Life: A Systematic Review
    Anke H.C. Gielen, Danique J.I. Heuvelings, Patricia Sylla, Yu-Ting van Loon, Jarno Melenhorst, Nicole D. Bouvy, Merel L. Kimman, Stephanie O. Breukink
    Diseases of the Colon & Rectum.2025; 68(2): 154.     CrossRef
  • Fluorescence angiography with indocyanine green for low anterior resection in patients with rectal cancer: a prospective before and after study
    J. Charbonneau, É. Papillon-Dion, R. Brière, N. Singbo, A. Legault-Dupuis, S. Drolet, F. Rouleau-Fournier, P. Bouchard, A. Bouchard, C. Thibault, F. Letarte
    Techniques in Coloproctology.2025;[Epub]     CrossRef
  • Circular staplers and anastomotic leakage in colorectal surgery: meta-analysis
    Claudio Fiorillo, Vincenzo Tondolo, Beatrice Biffoni, Elisabetta Gambaro, Chiara Lucinato, Davide De Sio, Sergio Alfieri, Giuseppe Quero
    BJS Open.2025;[Epub]     CrossRef
  • Intraoperative fluorescence angiography with indocyanine green to prevent anastomotic leak in rectal cancer surgery (IntAct): an unblinded randomised controlled trial
    David Jayne, Julie Croft, Neil Corrigan, Philip Quirke, Ronan A Cahill, Gemma Ainsworth, David M Meads, Andrew Kirby, Damian Tolan, Katie Gordon, Roel Hompes, Antonino Spinelli, Caterina Foppa, Albert M Wolthuis, André D'Hoore, Andrea Vignali, Henry S Til
    The Lancet Gastroenterology & Hepatology.2025; 10(9): 806.     CrossRef
  • Impact of anastomotic leakage and radiotherapy on long-term quality of life after sphincter-saving rectal resections
    Rasim Khalilov, Steffen Seyfried, Christoph Reissfelder, Julia Hardt, Florian Herrle, Vugar Yagublu
    Langenbeck's Archives of Surgery.2025;[Epub]     CrossRef
  • Risk factors and risk prediction modelling for pelvic sepsis and anastomotic leak following robotic total mesorectal excision with primary anastomosis for rectal cancer
    C. A. Fleming, R. T. J. Geitenbeek, R. Duhoky, A. Moussion, N. Bouazza, J. Khan, E. Cotte, A. Dubois, E. Rullier, R. Hompes, P. Rouanet, E. C. J. Consten, Q. Denost
    Colorectal Disease.2025;[Epub]     CrossRef
  • Association between anastomotic leak after rectal resection and bowel dysfunction, a systematic review, meta‐analysis and meta‐regression
    Sameh Hany Emile, Roberta Lynn Oslin, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Steven D. Wexner, Marylise Boutros
    Colorectal Disease.2025;[Epub]     CrossRef
  • Does robotic circumferential oversewing reduce anastomotic leakage in stapled anastomosis for rectal cancer surgery?
    J.-M. Jung, S. Yang, Y. S. Yoon, Y. I. Kim, M. H. Kim, J. L. Lee, C. W. Kim, I. J. Park, S.-B. Lim, C. S. Yu
    Techniques in Coloproctology.2025;[Epub]     CrossRef
  • Neoadjuvant Chemotherapy Without Radiation for Locally Advanced Rectal Cancer: A Meta-analysis of Surgical Outcomes After Total Mesorectal Excision
    Richard Garfinkle, Saba Balvardi, Marylise Boutros, Dean A. Fergusson
    Diseases of the Colon & Rectum.2025; 68(12): 1383.     CrossRef
  • Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis
    Ruth Walsh, Edward Murphy, Éanna J. Ryan, Ronan A. Cahill
    Colorectal Disease.2025;[Epub]     CrossRef
  • The Effect of Post‐Treatment Combined Lifestyle Interventions on Quality of Life in Colorectal Cancer Patients – A Systematic Review
    Anke H. C. Gielen, Britt J. M. Thomassen, Tim J. Bult, Jarno Melenhorst, Merel L. Kimman, Stephanie O. Breukink
    Lifestyle Medicine.2024;[Epub]     CrossRef
  • Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients
    Paerhati Shayimu, Maitisaidi Awula, Chang-Yong Wang, Rexida Jiapaer, Yi-Peng Pan, Zhi-Min Wu, Yi Chen, Ze-Liang Zhao
    World Journal of Gastrointestinal Surgery.2024; 16(10): 3142.     CrossRef
  • Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
    Gyung Mo Son
    Annals of Coloproctology.2024; 40(5): 415.     CrossRef
  • Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery
    Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
    Medicina.2024; 60(12): 1966.     CrossRef
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    Won Beom Jung
    Annals of Coloproctology.2024; 40(6): 527.     CrossRef
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
  • 7,234 View
  • 176 Download
  • 8 Web of Science
  • 9 Citations
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary 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

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  • 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
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
  • 15,533 View
  • 277 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract PDFSupplementary 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

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  • How to Do a Continuous Inverting Bowel Anastomosis Employing Counter‐Traction
    Sunil Siri Pathamanathan, Warunika Jayasena, Steven Due, Harjit Singh
    ANZ Journal of Surgery.2026;[Epub]     CrossRef
  • 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
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    Hyun Gu Lee
    The Ewha Medical Journal.2023;[Epub]     CrossRef
Original Articles
Malignant disease, Rectal cancer, Functional outcomes
Introduction of a handmade vacuum-assisted sponge drain for the treatment of anastomotic leakage after low anterior rectal resection
Amir Keshvari, Abolfazl Badripour, Mohammad Reza Keramati, Alireza Kazemeini, Behnam Behboudi, Mohammad Sadegh Fazeli, Ehsan Rahimpour, Parisa Ghaffari, Seyed Mohsen Ahmadi Tafti
Ann Coloproctol. 2022;38(3):230-234.   Published online June 10, 2021
DOI: https://doi.org/10.3393/ac.2021.00059.0008
  • 8,695 View
  • 234 Download
  • 5 Web of Science
  • 6 Citations
AbstractAbstract PDF
Purpose
Anastomotic leakage, a known major postoperative complication, potentially leads to readmission, reoperation, and increased mortality rates in patients, such as rectal cancer patients following a low anterior resection (LAR). Currently, vacuum-assisted closure, as featured by B-Braun (B-Braun Medical B.V.), is already being used for the treatment of gastrointestinal leakages and fistulas. The main aim of this study was to introduce a novel method for creating a vacuum-assisted drain for the treatment of anastomotic leakage after LAR.
Methods
All 10 patients, who underwent LAR surgery from 2018 to 2019, were diagnosed with anastomotic leakage and had received neoadjuvant chemotherapy prior to surgery. Therefore, patients were treated with a handmade vacuum-assisted drain and were revisited every 5 to 7 days for further evaluations and drain replacement until leakage resolution. Physical features of cavity, time of diagnose, and duration of treatment were analyzed correspondingly. The handmade vacuum-assisted sponge drain was prepared for each patient in each session of follow-up.
Results
Eight out of 10 patients experienced complete closure of the defect. The mean delay time from the day of operation to the diagnosis of anastomotic leakage was 61.0±80.4 days while the mean time for leakage closure was 117.6±68.3 days. Eventually, 7 cases underwent ileostomy reversal with no complications during a 3-month follow-up.
Conclusion
In this study, we evaluated the healing process of anastomotic leakage after the usage of a handmade vacuum-assisted sponge drain in a case series method. In our trial, we provided an innovative cost-benefit method easily applicable in the operating room.

Citations

Citations to this article as recorded by  
  • Ghost Ileostomy Versus Protective Ileostomy in Rectal Cancer Followed by Low Anterior Resection: A Randomized Feasibility Trial
    Seyed Mostafa Meshkati Yazd, Mohammad Reza Keramati, Marzieh Ghanbari Ghalerudkhani, Reza Shahriarirad, Amir Parsa, Amir Keshvari
    Health Science Reports.2025;[Epub]     CrossRef
  • Optimal Indocyanine Green Dosage for Repetitive Angiography for Laparoscopic Colorectal Surgery
    Gyung Mo Son, Sang-Ho Park, Nam Su Kim, Mi Sook Yun, In Young Lee, Myeong-Sook Kwon, Tae Kyun Kim, Eun Hwa Lee, Eun Jung Hwang, Kwang-Ryul Baek
    Medicina.2024; 60(12): 1966.     CrossRef
  • Assessment of the efficacy of Handmade Vacuum-Assisted Sponge Drain for Treatment of Anastomotic leakage after Low Anterior Rectal Resection
    Amir Keshvari, Leila mollamohammadi, Mohammad Reza Keramati, Behnam Behboudi, Mohammad Sadegh Fazeli, Alireza Kazemeini, Amirhossein Naseri, Elnaz Shahmohammadi, Laleh Foroutani, Aryan Ayati, Amirhossein Tayebi, Zahra Sajjadian, Alireza Hadizadeh, Seyed-M
    Updates in Surgery.2023; 75(4): 847.     CrossRef
  • Endoscopic vacuum therapy and early surgical closure after pelvic anastomotic leak: meta-analysis of bowel continuity rates
    F. Borja de Lacy, Kevin Talboom, Sapho X. Roodbeen, Robin Blok, Anna Curell, Pieter J. Tanis, Wilhelmus A. Bemelman, Roel Hompes
    British Journal of Surgery.2022;[Epub]     CrossRef
  • Outpatient closure in a late colo-cutaneous postoperative anastomotic leak managed with EVAC in Bucaramanga, Colombia. Case report.
    Jairo Enrique Mendoza Saavedra, Cesar Andrés Torres Carrillo, Gloria Liliana Mendoza Valbuena
    International Journal of Surgery Case Reports.2022; 100: 107737.     CrossRef
  • Neoadjuvant chemoradiotherapy determines the prognostic impact of anastomotic leakage in advanced rectal cancer
    Bo Young Oh, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee
    Annals of Surgical Treatment and Research.2022; 103(4): 235.     CrossRef
Malignant disease, Rectal cancer, Functional outcomes,Colorectal cancer
The Effect of Anastomotic Leakage on the Incidence and Severity of Low Anterior Resection Syndrome in Patients Undergoing Proctectomy: A Propensity Score Matching Analysis
Sungjin Kim, Sung Il Kang, So Hyun Kim, Jae-Hwang Kim
Ann Coloproctol. 2021;37(5):281-290.   Published online June 7, 2021
DOI: https://doi.org/10.3393/ac.2021.03.15
  • 6,540 View
  • 73 Download
  • 23 Web of Science
  • 23 Citations
AbstractAbstract PDF
Purpose
Proctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires.
Methods
We retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints.
Results
Among the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P<0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P<0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score.
Conclusion
This study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.

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  • Repeated Treatments for Chronic Colorectal and Coloanal Anastomotic Leaks are Associated With a Higher Chance of a Permanent Stoma
    Justin Dourado, Sameh Hany Emile, Anjelli Wignakumar, Brett Weiss, Nir Horesh, Victoria DeTrolio, Rachel Gefen, Zoe Garoufalia, Peter Rogers, Victor Strassmann, Steven D. Wexner
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    Sameh Hany Emile, Roberta Lynn Oslin, Anjelli Wignakumar, Nir Horesh, Zoe Garoufalia, Steven D. Wexner, Marylise Boutros
    Colorectal Disease.2025;[Epub]     CrossRef
  • Adenoma and carcinoma in the anal transitional zone following hand-sewn versus stapled ileal pouch-anal anastomosis in familial adenomatous polyposis
    Jun Yong Han, Min Jung Kim, Sang Hui Moon, Young Jin Kim, Hyun Tae Lim, Jesung Park, Jae Hyun Park, Hyo Jun Kim, Ji Won Park, Seung-Bum Ryoo, Kyu Joo Park, Seung-Yong Jeong
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    Lei Zhang, Chenhao Hu, Jiamian Zhao, Chenxi Wu, Zhe Zhang, Ruizhe Li, Ruihan Liu, Junjun She, Feiyu Shi
    Surgical Endoscopy.2024; 38(4): 1912.     CrossRef
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    Chungyeop Lee, In Ja Park
    The World Journal of Men's Health.2024; 42(2): 304.     CrossRef
  • Innovációk a colorectalis sebészetben
    Balázs Bánky, András Fülöp, Viktória Bencze, Lóránd Lakatos, Petra Rozman, Attila Szijártó
    Orvosi Hetilap.2024; 165(2): 43.     CrossRef
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    Gyung Mo Son
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    Cosmin Vasile Obleagă, Sergiu Marian Cazacu, Tiberiu Ștefăniță Țenea Cojan, Cecil Sorin Mirea, Dan Nicolae Florescu, Cristian Constantin, Mircea-Sebastian Șerbănescu, Mirela Marinela Florescu, Liliana Streba, Dragoș Marian Popescu, Ionică Daniel Vîlcea, M
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  • Low anterior resection syndrome after radical surgical treatment of rectal cancer: interim results of a multicenter interuniversity clinical trial
    A. A. Zakharenko, M. A. Belyaev, A. A. Trushin, A. A. Svechkova, I. A. Paltyshev, A. Kh. Khamid, O. A. Ten, T. V. Kupenskaya, M. V. Zavgorodnyaya, I. A. Filatova, F. Ya. Dzhafarzadeh, K. I. Vladimirova, N. M. Guseinova, L. A. Khamid, Ya. O. Baskova, Z. U.
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  • Outcomes following anastomotic leak from rectal resections, including bowel function and quality of life
    Angelina Di Re, Salam Tooza, Jason Diab, Charbel Karam, Mina Sarofim, Kevin Ooi, Catherine Turner, Daniel Kozman, David Blomberg, Matthew Morgan
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    Jing Su, Qianhui Liu, Dagui Zhou, Xiaofeng Yang, Guiru Jia, Lijun Huang, Xiao Tang, Jiafeng Fang
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    Dong Hyun Kang
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    Kelly C.L.R. Buzatti, Andy Petroianu, Søren Laurberg, Rodrigo G. Silva, Beatriz D.S. Rodrigues, Peter Christensen, Antonio Lacerda-Filho, Therese Juul
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  • 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
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    Jeonghee Han
    The Ewha Medical Journal.2023;[Epub]     CrossRef
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    Gyoung Tae Noh
    The Ewha Medical Journal.2023;[Epub]     CrossRef
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    Hyun Gu Lee
    The Ewha Medical Journal.2023;[Epub]     CrossRef
  • Early vs. standard reversal ileostomy: a systematic review and meta-analysis
    N. J. O’Sullivan, H. C. Temperley, T. S. Nugent, E. Z. Low, D. O. Kavanagh, J. O. Larkin, B. J. Mehigan, P. H. McCormick, M. E. Kelly
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    Mingfang Yan, Zhenmeng Lin, Zhiying Wu, Huizhe Zheng, Meiqin Shi
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  • Recycling of Iron Slag Waste in the Production of Ceramic Roof Tiles
    M. M. Ahmed, K. A. M. El Naggar, M. F. Abadir, W. Abbas, E. M. Abdel Hamid, Ajaya Kumar Singh
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    Seung Mi Yeo, Gyung Mo Son
    The Ewha Medical Journal.2022;[Epub]     CrossRef
  • The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
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    Eun Jung Park, Seung Hyuk Baik
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Benign GI diease,Benign diesease & IBD,Complication,Biomarker & risk factor
A development study of drain fluid gastrografin as a biomarker of anastomotic leak
David A. Clark, Edward Yeoh, Aleksandra Edmundson, Craig Harris, Andrew Stevenson, Daniel Steffens, Michael Solomon
Ann Coloproctol. 2022;38(2):124-132.   Published online January 11, 2021
DOI: https://doi.org/10.3393/ac.2020.12.24
  • 6,019 View
  • 182 Download
  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT).
Methods
This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG.
Results
Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT.
Conclusion
This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.

Citations

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  • Drain fluid iodine as a biomarker of anastomotic leak after low anterior resection in patients undergoing Gastrografin rectal tube flushes and omission of a diverting ileostomy: The GUSH study
    David A. Clark, Karen Dobeli, Darren Allen, Brett McWhinney, Michael Lonne, Aleksandra Edmundson
    Colorectal Disease.2025;[Epub]     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
  • Successful colorectal anastomotic leakage management: a two oncological centres' 12-year experience
    Kiril G. KIROV, Tsvetomir M. IVANOV, Nadya S. IVANOVA
    Chirurgia.2022;[Epub]     CrossRef
  • Neoadjuvant chemoradiotherapy determines the prognostic impact of anastomotic leakage in advanced rectal cancer
    Bo Young Oh, Yoon Ah Park, Jung Wook Huh, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee
    Annals of Surgical Treatment and Research.2022; 103(4): 235.     CrossRef
  • Does an ileostomy cover the surgeon or the anastomosis?
    David A. Clark, Andrew Stevenson, John Lumley, Damien Petersen, Craig Harris, Daniel Steffens, Michael Solomon
    ANZ Journal of Surgery.2022; 92(1-2): 19.     CrossRef
Benign GI diease,Benign diesease & IBD,Rare disease & stoma
Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons
David A. Clark, Bree Stephensen, Aleksandra Edmundson, Daniel Steffens, Michael Solomon
Ann Coloproctol. 2021;37(5):337-345.   Published online September 18, 2020
DOI: https://doi.org/10.3393/ac.2020.09.14.1
  • 4,790 View
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  • 8 Web of Science
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AbstractAbstract PDF
Purpose
Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary diverting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons.
Methods
A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon’s preference for the use of diverting stomas, rectal tubes, and pelvic drains.
Results
There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouches
Conclusion
There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.

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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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AbstractAbstract 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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Original Articles
Benign GI diease
Early Metabolic and Inflammatory Intraperitoneal Changes After Rectum Perforation
Ioannis Oikonomakis, Tal M. Horer, Per Skoog, Kristofer F. Nilsson, Kjell Jansson
Ann Coloproctol. 2020;36(6):374-381.   Published online February 25, 2020
DOI: https://doi.org/10.3393/ac.2019.09.30.1
  • 4,955 View
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AbstractAbstract PDF
Purpose
Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an AL.
Methods
Twelve pigs were randomized into 2 groups. In the experimental group, an iatrogenic rectal perforation was performed, with the control group having a sham operation. The 2 groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines interleukin (IL) 1, IL6, and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol, and pyruvate were performed and the lactate/pyruvate ratio was calculated.
Results
Glucose levels were lower in the experimental group after 4 hours. After 7 hours, lactate and lactate/pyruvate ratio was higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group. Blood samples showed higher IL6 after 7 hours in the experimental group. Conclusion: In this study, several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an AL.
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
  • 7,023 View
  • 166 Download
  • 11 Web of Science
  • 11 Citations
AbstractAbstract 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.

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Original article
Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage after Low Anterior Resection in Rectal Cancer Patients
Byoung Chul Lee, Seok-Byung Lim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Chang Sik Yu, Jin Cheon Kim
Received October 22, 2019  Accepted November 19, 2019  Published online January 16, 2020  
DOI: https://doi.org/10.3393/ac.2019.11.19.1
  • 6,806 View
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  • 20 Citations
AbstractAbstract PDF
PURPOSE
This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.
METHODS
This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.
RESULTS
Diverting stomas significantly reduced the rate of anastomotic leakage [HR 0.334, 95% CI 0.212

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  • Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis
    VINÍCIUS EVANGELISTA DIAS, PEDRO ALVES SOARES VAZ DE CASTRO, HOMERO TERRA PADILHA, LARA VICENTE PILLAR, LAURA BOTELHO RAMOS GODINHO, AUGUSTO CLAUDIO DE ALMEIDA TINOCO, RODRIGO DA COSTA AMIL, ALEIDA NAZARETH SOARES, GERALDO MAGELA GOMES DA CRUZ, JULIANA MA
    Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub]     CrossRef
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    VINÍCIUS EVANGELISTA DIAS, PEDRO ALVES SOARES VAZ DE CASTRO, HOMERO TERRA PADILHA, LARA VICENTE PILLAR, LAURA BOTELHO RAMOS GODINHO, AUGUSTO CLAUDIO DE ALMEIDA TINOCO, RODRIGO DA COSTA AMIL, ALEIDA NAZARETH SOARES, GERALDO MAGELA GOMES DA CRUZ, JULIANA MA
    Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub]     CrossRef
  • Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients
    Xiang-nan Yu, Lu-ming Xu, Ya-wen Bin, Ye Yuan, Shao-bo Tian, Bo Cai, Kai-xiong Tao, Lin Wang, Guo-bin Wang, Zheng Wang
    Current Medical Science.2022; 42(6): 1256.     CrossRef
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    Ho Yung Lee, Sung Il Kang, So Hyun Kim, Jae-Hwang Kim
    Journal of Minimally Invasive Surgery.2021; 24(3): 158.     CrossRef
  • Preoperative chemoradiotherapy versus surgery alone for advanced low rectal cancer: a large multicenter cohort study in Japan
    Tomonori Akagi, Masafumi Inomata, Hajime Fujishima, Meiki Fukuda, Tsuyoshi Konishi, Shunsuke Tsukamoto, Fuminori Teraishi, Heita Ozawa, Keitaro Tanaka, Koya Hida, Yoshiharu Sakai, Masahiko Watanabe
    Surgery Today.2020; 50(11): 1507.     CrossRef
Original Articles
Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus?
Chris Tae-Young Chung, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim
Ann Coloproctol. 2019;35(1):30-35.   Published online January 25, 2019
DOI: https://doi.org/10.3393/ac.2018.08.13
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  • 5 Web of Science
  • 5 Citations
AbstractAbstract PDF
Purpose
The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus.
Methods
The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus.
Results
Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture.
Conclusion
Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Citations

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  • Management of Low-Rectal Anastomotic Sinus With Transanal Minimally Invasive Septotomy
    Nirvana B. Saraswat, Scott A. Brill, William E. Wise
    The American Surgeon™.2023; 89(2): 322.     CrossRef
  • The management of asymptomatic radiological anastomotic leakage following anterior resection
    Mohamed Rabie, Laura Parry, Iannish Sadien, Sandeep Kapur, Adam Stearns, Irshad Shaikh
    ANZ Journal of Surgery.2022; 92(4): 801.     CrossRef
  • Chronische Anastomoseninsuffizienz nach tiefer Rektumresektion – ein ungelöstes Problem?
    Peter Kienle, Jörn Richard Magdeburg
    Der Chirurg.2021; 92(7): 605.     CrossRef
  • Response to Dioscoridi et al.
    G. I. Popivanov, V. M. Mutafchiyski, R. Cirocchi, S. D. Chipeva, V. V. Vasilev, K. T. Kjossev, M. S. Tabakov
    Colorectal Disease.2020; 22(7): 841.     CrossRef
  • Anastomotic Sinus Developed From Leakage in Rectal Cancer Resection: When Can We Reverse the Defunctioning Stoma?
    Chang Hyun Kim
    Annals of Coloproctology.2019; 35(1): 1.     CrossRef
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
  • 8,090 View
  • 184 Download
  • 12 Web of Science
  • 15 Citations
AbstractAbstract 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.

Citations

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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
    BMC Surgery.2020;[Epub]     CrossRef
  • 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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  • 63 Download
  • 8 Web of Science
  • 8 Citations
AbstractAbstract 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.

Citations

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  • Use of Intraoperative Bowel Preparation in Gynecological Surgery—A Technical Summary
    Christine McGough, Samuel Lentz, Laurel Berry
    Journal of Gynecologic Surgery.2025;[Epub]     CrossRef
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    Nianzhao Yang, Dafei Dai, Jun Liu, Jun Zhao
    Asian Journal of Surgery.2025;[Epub]     CrossRef
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    Silvia Strambi, Francesco Giudice, Camilla Cremonini, Francesco Arces, Filippo Vagelli, Federico Coccolini, Massimo Chiarugi, Dario Tartaglia
    BMC Surgery.2025;[Epub]     CrossRef
  • Emergency Colon and Rectal Surgery, What Every Surgeon Needs to Know
    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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    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
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    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
  • 12,453 View
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  • 4 Web of Science
  • 4 Citations
AbstractAbstract 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.

Citations

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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
    Nutrition and Cancer.2023; 75(4): 1254.     CrossRef
  • 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
    Frontiers in Nutrition.2023;[Epub]     CrossRef
  • 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
  • Topical Effect of Glutamine for Colorectal Anastomosis
    Jong-Woo Kim
    Annals of Coloproctology.2015; 31(6): 207.     CrossRef
Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery
Seok In Seo, Jong Lyul Lee, Seong Ho Park, Hyun Kwon Ha, Jin Cheon Kim
Ann Coloproctol. 2015;31(4):131-137.   Published online August 31, 2015
DOI: https://doi.org/10.3393/ac.2015.31.4.131
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  • 11 Citations
AbstractAbstract PDF
Purpose

This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR).

Methods

Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine.

Results

Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis.

Conclusion

WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.

Citations

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  • Preoperative anastomotic evaluation prior to ileostomy closure: A 5‐year UK survey, systematic review, and meta‐analysis
    D. Atraszkiewicz, T. Shakir, C. Harrington, P. Bassett, B. Soile, H. Mukhtar
    Colorectal Disease.2025;[Epub]     CrossRef
  • Technical considerations in stoma reversal
    Reece K. DeHaan, Jeremy Lipman
    Seminars in Colon and Rectal Surgery.2023; 34(2): 100957.     CrossRef
  • Pictorial review: radiological diagnosis of anastomotic leakage with water-soluble contrast enema after anterior resection of the rectum
    Piero Boraschi, Gaia Tarantini, Giuseppe Mercogliano, Luigi Giugliano, Francescamaria Donati
    Japanese Journal of Radiology.2022; 40(12): 1235.     CrossRef
  • Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal
    S. Lindner, K. von Rudno, J. Gawlitza, J. Hardt, F. Sandra-Petrescu, S. Seyfried, P. Kienle, C. Reissfelder, A. Bogner, F. Herrle
    International Journal of Colorectal Disease.2021; 36(2): 413.     CrossRef
  • Out of the Loop: The Value of a Preoperative Loopogram for Colostomy Reversal in Trauma
    Nolitha Makapi Tisetso Morare, Meshack Nkosinaye Motha, Maeyane Stephens Moeng
    World Journal of Surgery.2021; 45(7): 2009.     CrossRef
  • Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal
    Simon Lindner, Steffen Eitelbuss, Svetlana Hetjens, Joshua Gawlitza, Julia Hardt, Steffen Seyfried, Christian Galata, Christoph Reissfelder, Flavius Sandra-Petrescu, Florian Herrle
    International Journal of Colorectal Disease.2021; 36(11): 2387.     CrossRef
  • Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma
    Henrik Jutesten, Marie-Louise Lydrup, Axel Landberg, Daniel Risberg, Olle Ekberg, Sophia Zackrisson, Pamela Buchwald
    Acta Radiologica Open.2020;[Epub]     CrossRef
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    Georgios Exarchos, Linda Metaxa, Antonios Gklavas, Vassilis Koutoulidis, Ioannis Papaconstantinou
    European Radiology.2019; 29(4): 1754.     CrossRef
  • Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery
    Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
    World Journal of Gastroenterology.2018; 24(1): 104.     CrossRef
  • Imaging of the Postoperative Colon
    Eugene Huo, Laura Eisenmenger, Stefanie Weinstein
    Radiologic Clinics of North America.2018; 56(5): 835.     CrossRef
  • Should a Contrast Enema Be Performed Before Reversal of a Diverting Stoma in Lower Rectal Surgery?
    Ji Yeon Kim
    Annals of Coloproctology.2015; 31(4): 117.     CrossRef
Niti CAR 27 Versus a Conventional End-to-End Anastomosis Stapler in a Laparoscopic Anterior Resection for Sigmoid Colon Cancer
Seung-Jin Kwag, Jun-Gi Kim, Won-Kyung Kang, Jin-Kwon Lee, Seong-Taek Oh
Ann Coloproctol. 2014;30(2):77-82.   Published online April 25, 2014
DOI: https://doi.org/10.3393/ac.2014.30.2.77
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  • 6 Citations
AbstractAbstract PDF
Purpose

The Niti CAR 27 (ColonRing) uses compression to create an anastomosis. This study aimed to investigate the safety and the effectiveness of the anastomosis created with the Niti CAR 27 in a laparoscopic anterior resection for sigmoid colon cancer.

Methods

In a single-center study, 157 consecutive patients who received an operation between March 2010 and December 2011 were retrospectively assessed. The Niti CAR 27 (CAR group, 63 patients) colorectal anastomoses were compared with the conventional double-stapled (CDS group, 94 patients) colorectal anastomoses. Intraoperative, immediate postoperative and 6-month follow-up data were recorded.

Results

There were no statistically significant differences between the two groups in terms of age, gender, tumor location and other clinical characteristics. One patient (1.6%) in the CAR group and 2 patients (2.1%) in the CDS group experienced complications of anastomotic leakage (P = 0.647). These three patients underwent a diverting loop ileostomy. There were 2 cases (2.1%) of bleeding at the anastomosis site in the CDS group. All patients underwent a follow-up colonoscopy (median, 6 months). One patient in the CAR group experienced anastomotic stricture (1.6% vs. 0%; P = 0.401). This complication was solved by using balloon dilatation.

Conclusion

Anastomosis using the Niti CAR 27 device in a laparoscopic anterior resection for sigmoid colon cancer is safe and feasible. Its use is equivalent to that of the conventional double-stapler.

Citations

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  • New alternative colorectal anastomotic devices: A systematic review and meta-analysis
    T. Shakir, T. Pampiglione, M. Hassouna, P. Rogers, J. Dourado, S. Emile, R. Kokelaar, S. Wexner
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    R. Tabola, R. Cirocchi, A. Fingerhut, A. Arezzo, J. Randolph, V. Grassi, G. A. Binda, V. D’Andrea, I. Abraha, G. Popivanov, S. Di Saverio, A. Zbar
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    Ning-Ning Li, Wen-Tao Zhao, Xiao-Ting Wu
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  • Efficacy and safety of a NiTi CAR 27 compression ring for end-to-end anastomosis compared with conventional staplers: A real-world analysis in Chinese colorectal cancer patients
    Zhenhai Lu, Jianhong Peng, Cong Li, Fulong Wang, Wu Jiang, Wenhua Fan, Junzhong Lin, Xiaojun Wu, Desen Wan, Zhizhong Pan
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    Young Wan Kim, Ik Yong Kim
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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
  • 6,416 View
  • 36 Download
  • 8 Citations
AbstractAbstract 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.

Citations

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Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection
Dong Hyun Choi, Jae Kwan Hwang, Yong Tak Ko, Han Jeong Jang, Hyeon Keun Shin, Young Chan Lee, Cheong Ho Lim, Seung Kyu Jeong, Hyung Kyu Yang
J Korean Soc Coloproctol. 2010;26(4):265-273.   Published online August 31, 2010
DOI: https://doi.org/10.3393/jksc.2010.26.4.265
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AbstractAbstract PDF
Purpose

The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection.

Methods

Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage.

Results

The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage.

Conclusion

The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.

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Analysis of Anastomotic Leakage after an Anterior Resection for Rectal Cancer.
Park, Hey Won , Kim, Chang Nam , Park, Jin Seok , Kang, Yoon Jung , Cho, Byung Sun , Lee, Min Koo , Choi, Young Jin , Park, Joo Seung
J Korean Soc Coloproctol. 2009;25(5):340-346.
DOI: https://doi.org/10.3393/jksc.2009.25.5.340
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AbstractAbstract PDF
PURPOSE
The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer.
METHODS
Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients.
RESULTS
AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P<0.001, EAL: P<0.001) and tumor level from the anal verge < or =8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors.
CONCLUSION
AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.

Citations

Citations to this article as recorded by  
  • Distribution of Lymph Node Metastases Is an Independent Predictor of Survival for Sigmoid Colon and Rectal Cancer
    Jung Wook Huh, Young Jin Kim, Hyeong Rok Kim
    Annals of Surgery.2012; 255(1): 70.     CrossRef
Analysis of Results after Percutaneous Catheter Drainage for Anastomotic Leakage.
Hwang, Sang Il , Kim, Hungdai , Han, Won Kon
J Korean Soc Coloproctol. 2008;24(4):260-264.
DOI: https://doi.org/10.3393/jksc.2008.24.4.260
  • 2,095 View
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AbstractAbstract PDF
PURPOSE
Anastomotic leakage is a serious and life- threatening complication after colorectal surgery. The management of clinical anastomotic leakage remains largely operative. The aim of this study was to analyze the clinical characteristics and the natural history of percutaneous catheter drainage (PCD) for anastomotic leakage after colorectal surgery.
METHODS
Twenty patients who were managed by PCD after anastomotic leakage between January 2002 and December 2006 were studied. Charts were reviewed for information on clinical characteristics and biolologic finding prePCD and postPCD.
RESULTS
Anastomotic leakage was managed by using only PCD in 16 of 20 patients (80%), and twenty percent of patients (4/20) were managed by using a loop ileostomy after PCD. Nine patients (45%) had peritoneal drains left in place at diagnosis. Before PCD, the mean of the peak white blood cell (WBC) was 12,800/mm3, and the mean period of fever (>38degrees C) was 3.4 (2~5) days. After PCD, the mean time until the body temperature dropped below 37oC was 3.1 (1~5) days, the mean time until the WBC count dropped below 10,000/mm3 was 3.2 (0~6) days, the mean duration of ileus and diarrhea was 3.3 (0~6) days, the mean total amount of drainage during 6 days was 880 cc, and the mean length of stay after PCD was 14.9 days.
CONCLUSIONS
PCD is a safe and effective method for treating anastomtic leakage in patients without sepsis or diffuse peritonitis and with CT scans that reveal no diffuse fluid collection.
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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AbstractAbstract 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
Risk Factors for Anastomotic Leakage after a Low Anterior Resection for Rectal Cancer.
Yoon, Seok jun , Kim, Jin soo , Min, Byung so , Kim, Nam Kyu , Baik, Seung Hyuk , Lee, Kang Young , Sohn, Seung Kook , Cho, Jang Hwan
J Korean Soc Coloproctol. 2007;23(5):365-373.
DOI: https://doi.org/10.3393/jksc.2007.23.5.365
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  • 16 Download
  • 4 Citations
AbstractAbstract PDF
PURPOSE
Clinical anastomotic leakage remains a major problem after a low anterior resection for rectal cancer, so indentifing risk factors influencing anastomotic leakage is important. The aim of this study was to assess the association between risk factors and anastomotic leakage.
RESULTS
One thousand two hundred eight patients underwent a primary resection for rectal cancer from June 1993 to March 2007. We used hospital records and the colorectal cancer registry to analyze retrospectively the case histories of those patients. The operations were performed using a low anterior resection with the double stapling method. All patients underwent a tumor-specific mesorectal excision. Of the total, thirty-eight patients showed anastomotic leakage. Univariate and multivariate analyses were performed to assess the risk factors affecting to the anastomotic leakage.
RESULTS
The rate of anastomotic leakage was 3.2% (38 of 1,208 patients) with a mortality rate of 7.9% (3 of 38 patients). The overall mortality rate was 0.3% (3 of 1,208 patients). Males accounted for 28 of the 38 patients with leakage, and female accounted for the the account for the remnant 10. The mean age was 53.7 years (33~74 years). The mean leakage day was 11.8th day (3~37th day) after the operation, and the mean hospital day was 39.2 days (7~131 days). The mean body mass index (BMI) was 22.7 kg/m2 (15.7~30.8 kg/m2). The mean operation time was 230.5 minutes (90~425 minutes), and the mean bleeding loss was 519.5 cc (0~3,500 cc).
CONCLUSIONS
Significant risk factors for anastomotic leakage after primary resection for rectal cancer were the transfusion amount during surgery, a preliminary colostomy, and nodal stage.

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  • Cyanoacrylate in Colorectal Surgery: Is It Safe?
    Anna D’Amore, Pietro Anoldo, Michele Manigrasso, Giovanni Aprea, Giovanni Domenico De Palma, Marco Milone
    Journal of Clinical Medicine.2023; 12(15): 5152.     CrossRef
  • New Hope for Wound Healing after Bowel Resection
    Ryung-Ah Lee
    Journal of the Korean Society of Coloproctology.2012; 28(3): 117.     CrossRef
  • Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection
    Dong Hyun Choi, Jae Kwan Hwang, Yong Tak Ko, Han Jeong Jang, Hyeon Keun Shin, Young Chan Lee, Cheong Ho Lim, Seung Kyu Jeong, Hyung Kyu Yang
    Journal of the Korean Society of Coloproctology.2010; 26(4): 265.     CrossRef
  • Cyanoacrylate for colonic anastomosis; is it safe?
    Ki-Beom Bae, Sun-Hee Kim, Soo-Jin Jung, Kwan-Hee Hong
    International Journal of Colorectal Disease.2010; 25(5): 601.     CrossRef
Anastomotic Leakage after Laparoscopic versus Open Resection for Rectal Cancer: A Retrospective Study.
Lee, Doo Seok , Youk, Eui Gon , Choi, Sung Il , Lee, Doo Han , Kim, Do Sun , Moon, Hong Young
J Korean Soc Coloproctol. 2007;23(5):350-357.
DOI: https://doi.org/10.3393/jksc.2007.23.5.350
  • 2,628 View
  • 14 Download
  • 5 Citations
AbstractAbstract PDF
PURPOSE
This study is to compare the rate and pattern of anastomotic leakage (AL) for rectal cancer after laparoscopic vs. conventional open surgery at high and low rectal anastomosis and to evaluate whether the number of linear staples used for distal rectal resection is related to AL in laparoscopic group.
RESULTS
One hundred ninety-seven patients who underwent a curative resection for rectal cancer between March 2002 and February 2006 were studied retrospectively (107 laparoscopic, 90 open). The proportions of patients with anastomosis above vs. below 5 cm from AV were not different between the laparoscopic and the open groups; (above/below: 54/53 and 41/49, respectively, P=0.57). The protective stoma rate, the overall rate of AL, the rate of AL according to the height of the anastomosis, and the number of distal linear staples were evaluated for both groups.
RESULTS
Clinical AL occurred in 11 of 107 patients (10.3%) for the laparoscopic group and in 5 of 90 patients (5.6%) for the open group. The rates of AL in patients without protective stoma were not significantly different for high rectal anastomosis (6.0% for laparoscopic vs. 2.6% for open, P= 0.63) and for low rectal anastomosis (25.8% for laparoscopic vs. 12.1% for open, P=0.21). The risk of AL was 4.9 times higher when 3 linear staples were used than when 2 linear staples were used in the laparoscopic group.
CONCLUSIONS
There was no statistical difference in AL between the laparoscopic group and the open group. The rate of AL could be reduced by using fewer linear staples for distal rectal resection in the laparoscopic group.

Citations

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  • OF RECONSTRUCTIVE SURGERY IN PATIENTS WITH COLOSTOMY
    V. V. Boyko, D. O. Yevtushenko, S. O. Nemenko, I. G. Fursov
    Kharkiv Surgical School.2022; (2): 75.     CrossRef
  • PREVENTION OF COLORECTAL ANASTOMOTIC LEAK
    Andrii Klymenko, Igor Kononenko
    Kharkiv Surgical School.2019; (5-6): 21.     CrossRef
  • Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: A narrative review and outcomes study from an expert tertiary center
    S. AL Asari, M.S. Cho, N.K. Kim
    European Journal of Surgical Oncology (EJSO).2015; 41(2): 175.     CrossRef
  • Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection
    Dong Hyun Choi, Jae Kwan Hwang, Yong Tak Ko, Han Jeong Jang, Hyeon Keun Shin, Young Chan Lee, Cheong Ho Lim, Seung Kyu Jeong, Hyung Kyu Yang
    Journal of the Korean Society of Coloproctology.2010; 26(4): 265.     CrossRef
  • Risk Factors for Anastomotic Leakage after Laparoscopic Intracorporeal Colorectal Anastomosis with a Double Stapling Technique
    Jin Soo Kim, Sun Yeon Cho, Byung Soh Min, Nam Kyu Kim
    Journal of the American College of Surgeons.2009; 209(6): 694.     CrossRef
Risk Factors for Anastomotic Leakage after Laparoscopic Rectal Resection in Rectal Cancer: Does Laparoscopic Rectal Resection Increase Anastomotic Leakage Rate?.
Lee, Ho Suk , Kim, Min Ghwon , Park, Chang Kyun , Cho, Yoo Jin , Hwang, Duk Won , Noh, Sang Ik
J Korean Soc Coloproctol. 2007;23(2):101-109.
DOI: https://doi.org/10.3393/jksc.2007.23.2.101
  • 1,936 View
  • 8 Download
AbstractAbstract PDF
PURPOSE
The purpose of this study is to evaluate the risk factors for clinical anastomotic leakage after laparoscopic resection for rectal cancer.
METHODS
From March 2001 and February 2006 in Seoul Veterans' Hospital, the prospective laparoscopic colorectal resection database identified 101 patients who a had laparoscopic rectal resection with colorectal or coloanal anastomosis. The associations between clinical anastomotic leakage and patient-, tumor-, surgery- and laparoscopic-related variables were studied.
RESULTS
The rate of clinical anastomotic leakage was 4 percent (4 of 101). The patient-related variable significantly associated with clinical anastomotic leakage was preoperative radiotherapy. The surgery-related factor that turned out to be significant was anastomosis situated less than 5 cm from the anal verge. No tumor- or laparoscopic-related variables were significantly associated with clinical anastomotic leakage. CONSLUSIONS: A protective ileostomy should be considered after a laparoscopic rectal resection for an rectal cancer for anastomosis situated less than 5 cm from the anal verge, particularly when preoperative radiotherapy is being used.
Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery.
Jung, Sang Hun , Yu, Chang Sik , Choi, Pyong Wha , Kim, Dae Dong , Hong, Dong Hyun , Kim, Hee Cheol , Kim, Jin Cheon
J Korean Soc Coloproctol. 2006;22(6):371-379.
  • 1,360 View
  • 13 Download
AbstractAbstract PDF
PURPOSE
Anastomotic leakage (AL) is a serious and life-threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery.
METHODS
We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2~96 months).
RESULTS
AL rate was 2.5% (n=35). Gender (male), age (>60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18~7.22; HR: 2.42, 95% CI: 1.12~7.83; HR: 2.68, 95% CI: 1.08~7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P<0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P<0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05).
CONCLUSIONS
Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival.
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