Paul H Sugarbaker1. 1. Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA. paul.sugarbaker@medstar.net.
Abstract
BACKGROUND: In performing cytoreductive surgery with hyperthermic perioperative chemotherapy, a rectosigmoid colon resection is frequently required. To reduce the incidence of anastomotic leakage at the colorectal anastomoses, a diverting ileostomy has been recommended in these patients. METHODS: Stripping of mesorectal fat from the rectum up to the peritoneal reflection allows transection of the rectum at the junction of the upper and middle rectum. A suture pulls in the lateral aspects of the rectal staple line so that this staple line is included within the barrel of the stapler. After the circular-stapled anastomoses is complete, a second layer of silk sutures is used to invert the staple line. RESULTS: In 31 stapled colorectal anastomoses, three rectal transections were so low that a layer of sutures was not possible. In the 29 two-layer colorectal anastomoses, no anastomotic leakages were observed. The incidence of diverting ileostomy was reduced from 50 to 7 %. CONCLUSIONS: These results suggest that preservation of a 10-15 cm length of rectum allows a second layer of sutures to be placed over the stapled colorectal anastomoses. This is a safe alternative to a diverting ileostomy in selected patients.
BACKGROUND: In performing cytoreductive surgery with hyperthermic perioperative chemotherapy, a rectosigmoid colon resection is frequently required. To reduce the incidence of anastomotic leakage at the colorectal anastomoses, a diverting ileostomy has been recommended in these patients. METHODS: Stripping of mesorectal fat from the rectum up to the peritoneal reflection allows transection of the rectum at the junction of the upper and middle rectum. A suture pulls in the lateral aspects of the rectal staple line so that this staple line is included within the barrel of the stapler. After the circular-stapled anastomoses is complete, a second layer of silk sutures is used to invert the staple line. RESULTS: In 31 stapled colorectal anastomoses, three rectal transections were so low that a layer of sutures was not possible. In the 29 two-layer colorectal anastomoses, no anastomotic leakages were observed. The incidence of diverting ileostomy was reduced from 50 to 7 %. CONCLUSIONS: These results suggest that preservation of a 10-15 cm length of rectum allows a second layer of sutures to be placed over the stapled colorectal anastomoses. This is a safe alternative to a diverting ileostomy in selected patients.
Authors: Leonidas Chardalias; Antonios Gklavas; Ira Sotirova; Erasmia Vlachou; John Kontis; Ioannis Papaconstantinou Journal: Int J Surg Case Rep Date: 2020-06-13