Detail
Article
Online article
FT
Medvik - BMC
  • Something wrong with this record ?

Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis

J. Kalvach, O. Ryska, J. Martinek, T. Hucl, J. Pazin, J. Hadac, O. Foltan, H. Kristianova, J. Ptacnik, J. Juhasova, M. Ryska, S. Juhas

. 2022 ; 36 (6) : 4050-4056. [pub] 20210908

Language English Country Germany

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc22018270

Grant support
NV16-31806A Agentura Pro Zdravotnický Výzkum České Republiky

BACKGROUND: Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS: A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS: Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION: In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.

References provided by Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc22018270
003      
CZ-PrNML
005      
20240807102502.0
007      
ta
008      
220720s2022 gw f 000 0|eng||
009      
AR
024    7_
$a 10.1007/s00464-021-08726-1 $2 doi
035    __
$a (PubMed)34495386
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a gw
100    1_
$a Kalvach, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic. Jaroslav.Kalvach@uvn.cz $u Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic. Jaroslav.Kalvach@uvn.cz $1 https://orcid.org/0000000335419939
245    10
$a Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis / $c J. Kalvach, O. Ryska, J. Martinek, T. Hucl, J. Pazin, J. Hadac, O. Foltan, H. Kristianova, J. Ptacnik, J. Juhasova, M. Ryska, S. Juhas
520    9_
$a BACKGROUND: Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS: A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS: Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION: In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.
650    _2
$a anastomóza chirurgická $x metody $7 D000714
650    _2
$a netěsnost anastomózy $x etiologie $x chirurgie $7 D057868
650    _2
$a zvířata $7 D000818
650    _2
$a ženské pohlaví $7 D005260
650    _2
$a lidé $7 D006801
650    _2
$a mužské pohlaví $7 D008297
650    12
$a nádory rekta $x chirurgie $7 D012004
650    _2
$a rektum $x chirurgie $7 D012007
650    12
$a sepse $7 D018805
650    _2
$a prasata $7 D013552
655    _2
$a časopisecké články $7 D016428
700    1_
$a Ryska, O $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, UK
700    1_
$a Martinek, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
700    1_
$a Hucl, T $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
700    1_
$a Pazin, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
700    1_
$a Hadac, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
700    1_
$a Foltán, Ondřej $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u 1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic $7 xx0321133
700    1_
$a Kristianova, H $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u 1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
700    1_
$a Ptacnik, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic $u 1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
700    1_
$a Juhasova, J $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
700    1_
$a Ryska, M $u Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
700    1_
$a Juhas, S $u Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
773    0_
$w MED00004464 $t Surgical endoscopy $x 1432-2218 $g Roč. 36, č. 6 (2022), s. 4050-4056
856    41
$u https://pubmed.ncbi.nlm.nih.gov/34495386 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y p $z 0
990    __
$a 20220720 $b ABA008
991    __
$a 20240807102457 $b ABA008
999    __
$a ok $b bmc $g 1822053 $s 1169513
BAS    __
$a 3
BAS    __
$a PreBMC
BMC    __
$a 2022 $b 36 $c 6 $d 4050-4056 $e 20210908 $i 1432-2218 $m Surgical endoscopy $n Surg Endosc $x MED00004464
GRA    __
$a NV16-31806A $p Agentura Pro Zdravotnický Výzkum České Republiky
LZP    __
$a Pubmed-20220720

Find record

Citation metrics

Archiving options