Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
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SHR Neuro Krebs Kardio Lipid Stoffw Microb
Chopra, SS; Mrak, K; Hünerbein, M.
The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer.
Surgery. 2009; 145(2):182-188
Doi: 10.1016/j.surg.2008.09.012
Web of Science
PubMed
FullText
FullText_MUG
- Co-Autor*innen der Med Uni Graz
- Mrak Karl
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- Abstract:
- BACKGROUND: Despite surgical advances, anastomotic leaks remain a major complication after rectal resection. Endoscopic techniques are increasingly used as an alternative or in addition to conventional operative therapy of anastomotic leakage. We have analyzed the impact of endoscopic treatment on the outcome of patients with leaks after resection of rectal cancer. METHODS: From January 2000 to December 2005, rectal resection was performed in 274 patients with rectal cancer. Anastomotic leakage was observed in 29 patients (11%). Nine of these patients received a protective ileostomy. The remaining 20 patients underwent either conventional operative or endoscopic treatment. Both groups were analyzed regarding complications, necessity of operative reintervention, hospitalization, anastomotic healing time, and stoma reversal rate. RESULTS: The endoscopic group included 13 patients who underwent endoscopic debridement in combination with stenting, endoluminal vacuum therapy, or fibrin injection. The remaining 7 patients underwent reoperation-secondary ileostomy creation (n = 4), Hartmann procedure (n = 2), or anastomotic repair (n = 1). Stoma creation was necessary in 7 of 13 patients (54%) in the endoscopic group and in 6 of 7 patients (86%) in the operative group. There were no significant differences regarding postoperative septicemia (39 vs 43%), duration of intensive care (13 vs 11 days), or time of hospitalization (25 vs 26 days) for endoscopic and conventional therapies. Mean healing time of the anastomotic leak in the endoscopic and conventional group was 105 and 173 days, respectively. The stoma reversal rate was similar in both groups (50 vs 57%), but the overall rate of patients without colostomy was higher in the endoscopic group (77 vs 57%). CONCLUSION: Endoscopic therapy in combination with effective operative drainage may support healing of anastomotic leaks after rectal resection. However, the majority of patients require operative reintervention with bowel diversion despite endoscopic treatment.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Aged -
- Aged, 80 and over -
- Anastomosis, Surgical - adverse effects
- Carcinoma - surgery
- Female -
- Humans -
- Male -
- Middle Aged -
- Postoperative Complications - surgery
- Proctoscopy -
- Rectal Neoplasms - surgery
- Rectum - surgery
- Retrospective Studies -
- Treatment Outcome -