Annals of Coloproctology

Original Articles

Anorectal benign disease

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

944 View
42 Download

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

Colorectal cancer

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

7,539 View
184 Download
3 Web of Science
5 Citations

Graphical Abstract Abstract PDF

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

Citations

Citations to this article as recorded by

Short-term Outcomes of Linear vs. Circular Stapling for Esophagojejunostomy in Gastric Cancer: an Inverse Probability of Treatment Weighting Analysis
Yeojin Boo, Ho-Jung Shin, Jeong Ho Song, Sang-Yong Son, Hoon Hur, Sang-Uk Han
Journal of Gastric Cancer.2025;[Epub] CrossRef
Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation
Xavier Serra-Aracil, Irene Gómez-Torres, Andrea Torrecilla-Portoles, Anna Serracant-Barrera, Albert García-Nalda, Anna Pallisera-Lloveras
Langenbeck's Archives of Surgery.2024;[Epub] 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
Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
Sami Alahmadi, David L. Berger, Christy E. Cauley, Robert N. Goldstone, William V. Kastrinakis, Marc Rubin, Hiroko Kunitake, Rocco Ricciardi, Grace C. Lee
Journal of Gastrointestinal Surgery.2024; : 101899. CrossRef
Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer
Asif Almas Haque, Mir Rasekh Alam Ovi, Mohammad Tanvir Jalal
International Surgery Journal.2024; 12(1): 42. CrossRef

Complication,Biomarker & risk factor

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

4,729 View
169 Download
11 Web of Science
14 Citations

Abstract PDF

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

Citations

Citations to this article as recorded by

Multiple robotic stapler firings to transect the rectum are not associated with anastomotic leakage
Stefano Cardelli, Luca Stocchi, Amit Merchea, Dorin T. Colibaseanu, Michelle F. DeLeon, Nitin Mishra, Kevin J. Hancock, David W. Larson
Colorectal Disease.2025;[Epub] CrossRef
Prospective analysis of factors influencing the change of the section line based on fluorescence angiography with ICG for colorectal anastomosis
J. R. Gómez-López, A. Balla, E. Licardie, S. Morales-Conde
Techniques in Coloproctology.2025;[Epub] CrossRef
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
RISK FACTORS AND PREVENTIVE MEASURES OF SURGICAL COMPLICATIONS IN THE TREATMENT OF RECTAL CANCER
Світлана Віталіївна Маліборська, Y.D. Partykevych, A.E. Kryzhanivska
Art of Medicine.2024; : 282. 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
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
Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?
Christos Tsalikidis, Athanasia Mitsala, Vasileios I. Mentonis, Konstantinos Romanidis, George Pappas-Gogos, Alexandra K. Tsaroucha, Michail Pitiakoudis
Current Oncology.2023; 30(3): 3111. CrossRef
The effect of neoadjuvant treatment on postoperative morbidity in upper rectal cancer
S. N. Lukmonov, Ya. V. Belenkaya, M. S. Lebedko, S. S. Gordeev, Z. Z. Mammadli
Pelvic Surgery and Oncology.2023; 13(2): 46. 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
Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer
Xue-Cong Zheng, Jin-Bo Su, Jin-Jie Zheng
BMC Gastroenterology.2023;[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
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
Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery
Eugenia Claudia Zarnescu, Narcis Octavian Zarnescu, Radu Costea
Diagnostics.2021; 11(12): 2382. CrossRef

Malignant disease, Rectal cancer,Colorectal cancer,Surgical technique

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

6,137 View
225 Download
12 Web of Science
16 Citations

Abstract PDF

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

Citations

Citations to this article as recorded by

Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?
Sami Alahmadi, David L. Berger, Christy E. Cauley, Robert N. Goldstone, William V. Kastrinakis, Marc Rubin, Hiroko Kunitake, Rocco Ricciardi, Grace C. Lee
Journal of Gastrointestinal Surgery.2025; 29(2): 101899. CrossRef
Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
Cureus.2025;[Epub] CrossRef
Laparoscopic discoid rectal resection as surgical treatment for endometrial cancer recurrence
Francesco Cosentino, Alessio Colalillo, Claudia Tucci, Francesco Corbisiero, Daniele Neola, Diego Raimondo, Antonio Raffone
International Journal of Gynecological Cancer.2025; : 101637. CrossRef
Solo surgery for low rectal cancer: trans‐circular anal dilator low rectal dissection associated with laparoscopic total mesorectal excision—A Video Vignette
Crafa Francesco, Vanella Serafino, Emanuele Caruso, Madoka Hamada, Nozomi Ueno
Colorectal Disease.2024; 26(4): 805. CrossRef
Colorectal eversion technique combined with modified single‐stapled double‐purse‐string low colorectal anastomosis
Crafa Francesco, Vanella Serafino
Colorectal Disease.2024; 26(4): 772. CrossRef
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
Treatment of anastomotic leak in colorectal surgery by endoluminal vacuum therapy with the VACStent avoiding a stoma - a pilot study
Markus M. Heiss, Jonas Lange, Judith Knievel, Alexander Yohannes, Ulrich Hügle, Arno J. Dormann, Claus F. Eisenberger
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Propuesta de una técnica quirúrgica modificada para prevenir fugas anastomóticas colorrectales
Malik Takkal, Xavier Delgadillo, Amel Takkal, Sara Al-Maimouni
Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon.2024; 20(1): 12. CrossRef
Risk stratification of anastomotic leakages after colonic resection and reconstructive procedures
A. A. Vaganov, A. Yu. Korol’kov, P. I. Bogdanov, Z. Kh. Osmanov, V. P. Morozov, A. V. Babich
Grekov's Bulletin of Surgery.2023; 181(6): 98. CrossRef
Colorectal eversion technique combined with modified DST (CET‐M‐DST) for low colorectal anastomosis after laparoscopic TME for colorectal cancer – Video correspondence
Crafa Francesco, Vanella Serafino, Baiamonte Mario, Longo Antonio
Colorectal Disease.2023; 25(12): 2473. 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
Laparoscopic PME with colorectal anstomosis with transanal control – A video vignette
Francesco Crafa, Serafino Vanella, Adele Noviello, Giuseppe Longo, Francesco Longo
Colorectal Disease.2022; 24(7): 887. CrossRef
Laparoscopic TME and hepatic resection after total neoadjuvant chemotherapy plus short course radiotherapy for low rectal cancer with single synchronous liver metastases – A video vignette
Francesco Crafa, Serafino Vanella
Colorectal Disease.2022; 24(10): 1264. CrossRef
Initial experience with intraoperative testing and repair of colorectal anastomosis using a TAMIS approach after a positive leak test
J. Valdes-Hernandez, J. Cintas-Catena, F. J. Del Rio-Lafuente, A. Cano-Matias, C. Torres-Arcos, A. Perez-Sanchez, L. Capitan-Morales, F. Oliva-Mompean, J. C. Gomez-Rosado
Techniques in Coloproctology.2022; 26(11): 901. CrossRef
Minimally invasive colorectal surgery learning curve
Serafino Vanella, Enrico Coppola Bottazzi, Giancarlo Farese, Rosa Murano, Adele Noviello, Tommaso Palma, Maria Godas, Francesco Crafa
World Journal of Gastrointestinal Endoscopy.2022; 14(11): 731. CrossRef

First
Prev
Page of 1
Next
Last

Search