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Risk Factors and Outcomes for Anastomotic Leakage in Colorectal Surgery: A Single-Institution Analysis of 1576 Patients.
Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, Ho YH.
World J Surg. 2010 Oct 23. [Epub ahead of print]
PMID: 20972678 [PubMed - as supplied by publisher]

CONCLUSION: In this prospective study, advanced tumour stage, distal site, and need for postoperative blood transfusion were associated with increased rates of anastomotic leakage. In addition to their high risk of immediate postoperative morbidity and mortality, both localized and generalized leaks had similarly negative impacts on overall, cancer-related, and disease-free survival.


Real-time Intraoperative Detection of Tissue Hypoxia in Gastrointestinal Surgery by Wireless Pulse Oximetry.
Servais EL, Rizk NP, Oliveira L, Rusch VW, Bikson M, Adusumilli PS.
Surg Endosc. 2010 Oct 23. [Epub ahead of print]
PMID: 20972585 [PubMed - as supplied by publisher]

CONCLUSIONS: We have constructed, validated, and successfully tested a novel wireless pulse oximeter capable of detecting intraoperative tissue hypoxia in open or endoscopic surgery. This device will aid surgeons in detecting anastomotic vascular compromise and facilitate choosing an ideal site for bowel anastomosis by targeting well-perfused tissue with optimal healing capacity.


[Diagnosis and Definition of Anastomotic Leakage from the Radiologist's Perspective.]
Bundy BD, Kauczor HU, Grenacher L.
Chirurg. 2010 Oct 23. [Epub ahead of print] German.
PMID: 20967532 [PubMed - as supplied by publisher]

CONCLUSIONS: Anastomotic leakage is a typical complication in gastrointestinal surgery. The frequency of occurrence and symptoms depend on the location of the intervention in the gastrointestinal tract. Consensus definitions have been published for bile leakage, pancreatic fistulas and colorectal leakage but there is still no overall standard classification for anastomotic leakage after surgical intervention in the gastrointestinal tract. Hence, there are also no standard guidelines for a diagnostic algorithm. Radiological techniques for the diagnosis of an anastomotic leakage include sonography, X-ray, fluoroscopy and computed tomography (CT). Percutaneous transhepatic cholangiography (PTC) could be helpful for the diagnosis of a leakage of a biliary enteric anastomosis. Magnetic resonance imaging (MRI) plays a subordinate role in the diagnosis of anastomotic leakage.


The Ladies Trial: Laparoscopic Peritoneal Lavage or Resection for Purulent Peritonitis and Hartmann's Procedure or Resection with Primary Anastomosis for Purulent or Faecal Peritonitis in Perforated Diverticulitis (NTR2037).
Swank H.A., Vermeulen J, Lange J.F., Mulder I.M., van der Hoeven J.A., Stassen L.P., Crolla R.M., Sosef M.N., Nienhuijs S.W., Bosker R.J., Boom M.J., Kruyt P.M., Swank D.J., Steup W.H., de Graaf E.J., Weidema W.F., Pierik R.E., Prins H.A., Stockmann H.B., Tollenaar R.A., van Wagensveld B.A., Coene P.P., Slooter G.D., Consten E.C., van Duyn E.B., Gerhards M.F., Hoofwijk A.G., Karsten T.M., Neijenhuis P.A., Blanken-Peeters C.F., Cense H.A., Mannaerts G.H., Bruin S.C., Eijsbouts Q.A., Wiezer M.J., Hazebroek E.J., van Geloven A.A., Maring J.K., d'Hoore A., Kartheuser A., Remue C., van Grevenstein W.M., Konsten J.L., van der Peet D.L., Govaert M.J., Engel A.F., Reitsma J.B., Bemelman W.A., 3d TD.
BMC Surg. 2010 Oct 18;10(1):29. [Epub ahead of print]
PMID: 20955571 [PubMed - as supplied by publisher] Free Article

DISCUSSION The Ladies trial is a nationwide multicentre randomised trial on perforated diverticulitis that will provide evidence on the merits of laparoscopic lavage and drainage for purulent generalised peritonitis and on the optimal resectional strategy for both purulent and faecal generalised peritonitis.

Single Incision Laparoscopic Total Colectomy and Proctocolectomy for Benign Disease - Initial Experience.
Leblanc F, Makhija R, Champagne B.J., Delaney C.P.
Colorectal Dis. 2010 Oct 19. doi: 10.1111/j.1463-1318.2010.02448.x. [Epub ahead of print]
PMID: 20955513 [PubMed - as supplied by publisher]

CONCLUSION: Single incision laparoscopic total colectomy or proctocolectomy is feasible for benign disease in selected patients.


Ghost Ileostomy: Real and Potential Advantages.
Miccini M, Amore Bonapasta S, Gregori M, Barillari P, Tocchi A.
Am J Surg. 2010 Oct;200(4):e55-7.
PMID: 20887836 [PubMed - indexed for MEDLINE]

CONCLUSIONS: We describe a simple technique (ghost ileostomy) to combine all the advantages of a disposable ileostomy without entailing its complications in patients submitted to low rectal resection.


A Clinical Risk Score to Predict 3-, 5- and 10-year Survival in Patients Undergoing Surgery for Dukes B Colorectal Cancer.
McMillan D.C., McArdle C.S., Morrison D.S.
Br J Cancer. 2010 Sep 28;103(7):970-4. Epub 2010 Aug 31.
PMID: 20808311 [PubMed - indexed for MEDLINE]

CONCLUSION: The results of this study, in a mature cohort, introduce a new simple clinical risk score for patients undergoing surgery for Dukes B colon cancer. This provides a solid foundation for the examination of the impact of additional factors and treatment on prediction of 3-, 5- and 10-year cancer-specific survival.


Influence of Anastomotic Leakage on Oncological Outcome in Patients with Rectal Cancer.
Park I.J.
J Gastrointest Surg. 2010 Jul;14(7):1190-6. Epub 2010 Jan 22. Review.
PMID: 20094811 [PubMed - indexed for MEDLINE]

OUTCOME: The rates of anastomotic leakage are reported to range between 0.6% and 17.4%, depending on the definitions used. Here, we review the available information on anastomotic leakage and its association with oncological outcome.

Updated October 26, 2010

The sutureless compression anastomosis CAR 27 in colon and rectum.
Results in 46 patients.

Abstract No: 625

Title: The sutureless compression anastomosis CAR 27 in colon and rectum. Results in 46 patients.

Affiliations: (1) Asklepios Klinik Barmbek, Hamburg, Germany

Authors: Eberhard Gross (1)

Abstract:
Because of advantages of sutureless anastomosis in animal and compression anastomosis AKA2 in over 400 patients the new compression anastomotic technique CAR 27 was applied in consecutive patients. Endpoint of the trial was the leakage rate. Patients and method: The 46 elective indications were sigmoid diverticulitis(22), Cancer of the sigmoid (12), rectosigmoid (2) desc. colon (3), rectum (4). The mean age was 61.4 y. The procedures, 19 of them laparoscopic operations, included 33 sigmoid resections, 10 low anterior resections, 3 left  colectomies. A CT scan was performed in symptomatic patients only. The anastomosis was done in a double stapling fashion. The essential part of the CAR 27 cartridge are leaves consisting of nitinol, which provide continuous pressure due to the properties of shape memory and superelasticity. Results: 1 anastomotic leakage occurred after LAR and reoperation for bleeding. 4 patients were re-operated for reasons not related to the CAR 27 anastomosis. No patient died.

Conclusion: The CAR 27 device is safe. The low leakage rate in this study supports the advantages of sutureless and compression anastomoses, which were demonstrated in clinical and animal studies.