Annals of Coloproctology

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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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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

Citations to this article as recorded by

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

Feasibility and Safety of a Fold-Over Diverting Ileostomy Reversal After Rectal Cancer Surgery: Case-Matched Comparison to the Resection Technique: Jinock Cheong, Jeonghyun Kang, Im-Kyung Kim, Nam Kyu Kim, Seung-Kook Sohn, Kang Young Lee; Ann Coloproctol. 2014;30(3):118-121. Published online June 23, 2014; DOI: https://doi.org/10.3393/ac.2014.30.3.118

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36 Download
7 Web of Science
6 Citations

Abstract PDF

Purpose

Compared to the stapling technique, the fold-over technique (FO) has the benefit of avoiding the sacrifice of the bowel segment. The aim of this study was to compare short-term outcomes between the FO and a conventional resection.

Methods

Between June 2008 and March 2012, a total of 242 patients who underwent a diverting ileostomy reversal after rectal cancer surgery were selected. Among them, 29 patients underwent the FO. Using propensity scores to adjust for body mass index, previous abdominal surgery history, rectal cancer surgery type (open vs. minimally invasive), and reason for ileostomy (protective aim vs. leakage management), we created a well-balanced cohort by matching each patient who underwent the FO, as the study group, with two patients who underwent a stapled or a hand-sewn technique with bowel resection (RE), as the control group (FO : RE = 1 : 2). Morbidity and perioperative recovery were compared between the two groups.

Results

Twenty-four and forty-eight patients were allocated to the FO and the RE groups, respectively. The mean operation time was 91 ± 26 minutes in the FO group and 97 ± 34 minutes in the RE group (P = 0.494). The overall morbidity rates were not different between the two groups (12.5% in FO vs. 14.6% in RE, P = 1.000). The rate of postoperative ileus was similar between the two groups (8.3% in FO vs. 12.5% in RE, P = 0.710). Although time to resumption of soft diet was shorter in the FO group than in the RE group, the lengths of hospital stay were not different.

Conclusion

The FO and the conventional resection have similar short-term clinical outcomes for diverting ileostomy reversal.

Citations

Citations to this article as recorded by

Comparison of hand-sewn anterior repair, resection and hand-sewn anastomosis, resection and stapled anastomosis techniques for the reversal of diverting loop ileostomy after low anterior rectal resection: a randomized clinical trial
Seyed Mostafa Meshkati Yazd, Reza Shahriarirad, Mohammad Reza Keramati, Mehdi Fallahi, Soheila-sadat Nourmohammadi, Alireza Kazemeini, Mohammad Sadegh Fazeli, Amir Keshvari
Techniques in Coloproctology.2024;[Epub] CrossRef
Does the timing of protective ileostomy closure post-low anterior resection have an impact on the outcome? A retrospective study
Fozan Sauri, Ahmad Sakr, Ho Seung Kim, Mohammed Alessa, Radwan Torky, Eman Zakarneh, Seung Yoon Yang, Nam Kyu Kim
Asian Journal of Surgery.2021; 44(1): 374. CrossRef
Modified Colon Leakage Score to Predict Anastomotic Leakage in Patients Who Underwent Left-Sided Colorectal Surgery
Seung Up Yang, Eun Jung Park, Seung Hyuk Baik, Kang Young Lee, Jeonghyun Kang
Journal of Clinical Medicine.2019; 8(9): 1450. CrossRef
Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period
Bojan Krebs, Arpad Ivanecz, Stojan Potrc, Matjaz Horvat
Radiology and Oncology.2019; 53(3): 331. CrossRef
Impact of prior abdominal surgery on postoperative prolonged ileus after ileostomy repair
Im-kyung Kim, Jeonghyun Kang, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim, Seung-Kook Sohn
Asian Journal of Surgery.2018; 41(1): 86. CrossRef
Endless Arguments Over Diversion Stomas
Seung Chul Heo
Annals of Coloproctology.2014; 30(3): 103. CrossRef

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