Annals of Coloproctology

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Original Article

Anorectal benign disease

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

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

Video

Video clip

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

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2 Web of Science
1 Citations

Abstract PDF Supplementary Material

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

Citations

Citations to this article as recorded by

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

Original Articles

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

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

6,741 View
176 Download
8 Web of Science
9 Citations

Graphical Abstract Abstract PDF Supplementary Material

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

Citations

Citations to this article as recorded by

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

Colorectal cancer

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

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199 Download
6 Web of Science
7 Citations

Graphical Abstract Abstract PDF

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

Citations

Citations to this article as recorded by

Short-term Outcomes of Linear vs. Circular Stapling for Esophagojejunostomy in Gastric Cancer: an Inverse Probability of Treatment Weighting Analysis
Yeojin Boo, Ho-Jung Shin, Jeong Ho Song, Sang-Yong Son, Hoon Hur, Sang-Uk Han
Journal of Gastric Cancer.2025; 25(3): 509. CrossRef
Risk Factors for Sigmoid Colonic Anastomosis: A Comparative and Cross-Sectional Analysis
Tutkun Talih, Gokhan Sonmez, Erdogan Sozuer, Sevket Tombul, Mahmut Kulturoglu, Dogan Islam, Hızır Akyıldız, Abdullah Demirtas, Mustafa Karaagac, Fatih Dal
Therapeutics and Clinical Risk Management.2025; Volume 21: 1219. CrossRef
Updates in surgery for colorectal cancer: incidence and risk factors for acute anastomotic leak—a retrospective study
Tamer A. A. M. Habeeb, Abdulzahra Hussain, Massimo Chiaretti, Igor A. Kryvoruchko, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adsam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel A
Updates in Surgery.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

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179 Download
12 Web of Science
17 Citations

Abstract PDF

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

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
Perfil epidemiológico de pacientes submetidos a cirurgias colorretais e análise da incidência de fístulas anastomóticas em hospital secundário - de 2019 a 2024
Davidson Anthony Aragão Freire, Carla Camila Bezerra Rocha, Matthaus Rabelo da Costa, Bruno Gadelha Bezerra, Cid Gerardo Paracampos Liberato, Neto Lorena Cavalcante de Lemos
Revista Científica do Hospital e Maternidade José Martiniano Alencar.2025; 4(2): 20. CrossRef
Risk factors for anastomotic fistula after total mesorectal excision: A monocentric retrospective study of 78 patients
Amine Majdoubi, Anass El Aachi, Mohammed El Hammouti, Haïtam Aabalou, Ayoub Kharkhach, Tariq Bouhout, Badr Serji
Clinical Surgical Oncology.2025; 4(3): 100096. CrossRef
SAGES 2025 systematic review and meta-analysis for fluorescence image-guided gastrointestinal surgery using indocyanine green
Panagiotis Kapsampelis, Elisa C. Calabrese, Sunjay S. Kumar, Dena Shehata, Varun Bansal, Katie Carsky, Austin Eason, Himsikhar Khataniar, Stefan Scholz, María Rita Rodríguez-Luna, Nisha Narula, Jeffrey Chiu, Subhashini Ayloo, Farah Husain, Ahmed Abou-Sett
Surgical Endoscopy.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

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235 Download
14 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

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

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

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166 Download
10 Web of Science
10 Citations

Abstract PDF

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

Citations

Citations to this article as recorded by

Single versus double stapled anastomosis in natural orifice specimen extraction (NOSE) laparoscopic anterior resection
Abdus Salam Raju, Seyed Mohammad Javad Taghavi, Andrew James Gilmore
ANZ Journal of Surgery.2025; 95(6): 1198. 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
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
Double-row staple technology versus triple-row staple technology for colorectal surgery: A systematic review and meta-analysis
Tyler McKechnie, Victoria Shi, Elena Huang, Bright Huo, Aristithes Doumouras, Nalin Amin, Cagla Eskicioglu, Dennis Hong
Surgery.2024; 176(3): 633. CrossRef
The Colorectal Anastomosis: A Timeless Challenge
Alexander A. Gaidarski III, Marco Ferrara
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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
Preventing Anastomotic Leakage, a Devastating Complication of Colorectal Surgery
Hyun Gu Lee
The Ewha Medical Journal.2023;[Epub] CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
Effort to Improve Rectal Anastomosis: the Triple-Stapled Technique for Rectal Anastomosis
Sung Il Kang
Annals of Coloproctology.2021; 37(1): 1. CrossRef

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

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

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

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

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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.

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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

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