Short-term results of LAPRA-TY® suture reinforcement for double stapling technique anastomotic reconstruction in left-sided colorectal cancer
EAES Academy. Toshinori K. 07/05/22; 362995; P038
Dr. Kobayashi Toshinori
Contributions
Contributions
Abstract
Aims:
Suture failure is a serious complication in colorectal cancer surgery, with a reported incidence of 1-30%, increasing as the anastomosis becomes more distal. The cause is associated with various factors, including surgical technique and instruments, and patient factors. Recently, tissue perfusion assessment using indocyanine green (ICG) has improved safety. However, suture failure due to diarrhea in the early postoperative period still arises. In this study, we present a surgical technique preventing suture failure after double stapling technique (DST) anastomosis using horizontal mattress suture reinforcement and LAPRA-TY® Suture Clip at four points on the left and right anterior and posterior walls.
Methods:
From December 2019 to August 2021, 24 patients underwent laparoscopic resection and reconstruction at our institution for primary left-sided colon and rectal cancer stage 1-3 without temporary colostomy placement and DST anastomosis. The following were the patients’ characteristics (median [range]): sex: male 17/female 7; age: 70.5 years [4789]; BMI: 25.2 kg/m2 [18.8-45.7]; ASA: 1/2/3:3/17/4; distance from anal verge: 23 cm [15-40]; tumor size: 40 mm [0-90]; pT1b/2/3/ 4: 4/3/14/3; pN0/N1/N2: 18/4/2; and two combined resection (large reticulum, partial cystectomy) and simultaneous resection cases (right hemicolectomy). Surgical technique: Following DST anastomosis, the reconstructed intestine was clamped, and the leak test was performed using transanal air delivery (50 mL catheter tipped syringe); air leak cases were considered positive. After the test, the positive left and right staple intersections, and the anterior and posterior walls, were sutured and reinforced with horizontal mattress sutures and LAPRA-TY® Suture Clip in the serous muscle layer, respectively, a transanal decompression round tube was placed after.
Results:
Operative time: 215min [123-514], blood loss: 15.5 [0-113], three cases underwent splenic flexure, intraoperative ICG evaluation: 11 cases (46%), DST staple: 60mm in 21 cases/60+45mm in three cases, circular autoanastomosis: 25mm in 20 cases/28mm in four cases, and post anastomosis leak test was positive in two cases, with 3-days postoperative time to resume eating [2-6]. On a postoperative day 2-3, the patients were evaluated for radiological leakage (RL) with rectal fluoroscopy study and CT scan, no RL cases were found. Duration of stay was 7 days [639], Clavien-Dindo 0/2:23/1 with bleeding balloon injury in the urethra, while one patient required blood transfusion.
Conclusion:
Suture reinforcement of the DST anastomosis after ICG assessment can result in safer surgical outcomes by assessing blood flow and anastomotic strength.
Suture failure is a serious complication in colorectal cancer surgery, with a reported incidence of 1-30%, increasing as the anastomosis becomes more distal. The cause is associated with various factors, including surgical technique and instruments, and patient factors. Recently, tissue perfusion assessment using indocyanine green (ICG) has improved safety. However, suture failure due to diarrhea in the early postoperative period still arises. In this study, we present a surgical technique preventing suture failure after double stapling technique (DST) anastomosis using horizontal mattress suture reinforcement and LAPRA-TY® Suture Clip at four points on the left and right anterior and posterior walls.
Methods:
From December 2019 to August 2021, 24 patients underwent laparoscopic resection and reconstruction at our institution for primary left-sided colon and rectal cancer stage 1-3 without temporary colostomy placement and DST anastomosis. The following were the patients’ characteristics (median [range]): sex: male 17/female 7; age: 70.5 years [4789]; BMI: 25.2 kg/m2 [18.8-45.7]; ASA: 1/2/3:3/17/4; distance from anal verge: 23 cm [15-40]; tumor size: 40 mm [0-90]; pT1b/2/3/ 4: 4/3/14/3; pN0/N1/N2: 18/4/2; and two combined resection (large reticulum, partial cystectomy) and simultaneous resection cases (right hemicolectomy). Surgical technique: Following DST anastomosis, the reconstructed intestine was clamped, and the leak test was performed using transanal air delivery (50 mL catheter tipped syringe); air leak cases were considered positive. After the test, the positive left and right staple intersections, and the anterior and posterior walls, were sutured and reinforced with horizontal mattress sutures and LAPRA-TY® Suture Clip in the serous muscle layer, respectively, a transanal decompression round tube was placed after.
Results:
Operative time: 215min [123-514], blood loss: 15.5 [0-113], three cases underwent splenic flexure, intraoperative ICG evaluation: 11 cases (46%), DST staple: 60mm in 21 cases/60+45mm in three cases, circular autoanastomosis: 25mm in 20 cases/28mm in four cases, and post anastomosis leak test was positive in two cases, with 3-days postoperative time to resume eating [2-6]. On a postoperative day 2-3, the patients were evaluated for radiological leakage (RL) with rectal fluoroscopy study and CT scan, no RL cases were found. Duration of stay was 7 days [639], Clavien-Dindo 0/2:23/1 with bleeding balloon injury in the urethra, while one patient required blood transfusion.
Conclusion:
Suture reinforcement of the DST anastomosis after ICG assessment can result in safer surgical outcomes by assessing blood flow and anastomotic strength.
Aims:
Suture failure is a serious complication in colorectal cancer surgery, with a reported incidence of 1-30%, increasing as the anastomosis becomes more distal. The cause is associated with various factors, including surgical technique and instruments, and patient factors. Recently, tissue perfusion assessment using indocyanine green (ICG) has improved safety. However, suture failure due to diarrhea in the early postoperative period still arises. In this study, we present a surgical technique preventing suture failure after double stapling technique (DST) anastomosis using horizontal mattress suture reinforcement and LAPRA-TY® Suture Clip at four points on the left and right anterior and posterior walls.
Methods:
From December 2019 to August 2021, 24 patients underwent laparoscopic resection and reconstruction at our institution for primary left-sided colon and rectal cancer stage 1-3 without temporary colostomy placement and DST anastomosis. The following were the patients’ characteristics (median [range]): sex: male 17/female 7; age: 70.5 years [4789]; BMI: 25.2 kg/m2 [18.8-45.7]; ASA: 1/2/3:3/17/4; distance from anal verge: 23 cm [15-40]; tumor size: 40 mm [0-90]; pT1b/2/3/ 4: 4/3/14/3; pN0/N1/N2: 18/4/2; and two combined resection (large reticulum, partial cystectomy) and simultaneous resection cases (right hemicolectomy). Surgical technique: Following DST anastomosis, the reconstructed intestine was clamped, and the leak test was performed using transanal air delivery (50 mL catheter tipped syringe); air leak cases were considered positive. After the test, the positive left and right staple intersections, and the anterior and posterior walls, were sutured and reinforced with horizontal mattress sutures and LAPRA-TY® Suture Clip in the serous muscle layer, respectively, a transanal decompression round tube was placed after.
Results:
Operative time: 215min [123-514], blood loss: 15.5 [0-113], three cases underwent splenic flexure, intraoperative ICG evaluation: 11 cases (46%), DST staple: 60mm in 21 cases/60+45mm in three cases, circular autoanastomosis: 25mm in 20 cases/28mm in four cases, and post anastomosis leak test was positive in two cases, with 3-days postoperative time to resume eating [2-6]. On a postoperative day 2-3, the patients were evaluated for radiological leakage (RL) with rectal fluoroscopy study and CT scan, no RL cases were found. Duration of stay was 7 days [639], Clavien-Dindo 0/2:23/1 with bleeding balloon injury in the urethra, while one patient required blood transfusion.
Conclusion:
Suture reinforcement of the DST anastomosis after ICG assessment can result in safer surgical outcomes by assessing blood flow and anastomotic strength.
Suture failure is a serious complication in colorectal cancer surgery, with a reported incidence of 1-30%, increasing as the anastomosis becomes more distal. The cause is associated with various factors, including surgical technique and instruments, and patient factors. Recently, tissue perfusion assessment using indocyanine green (ICG) has improved safety. However, suture failure due to diarrhea in the early postoperative period still arises. In this study, we present a surgical technique preventing suture failure after double stapling technique (DST) anastomosis using horizontal mattress suture reinforcement and LAPRA-TY® Suture Clip at four points on the left and right anterior and posterior walls.
Methods:
From December 2019 to August 2021, 24 patients underwent laparoscopic resection and reconstruction at our institution for primary left-sided colon and rectal cancer stage 1-3 without temporary colostomy placement and DST anastomosis. The following were the patients’ characteristics (median [range]): sex: male 17/female 7; age: 70.5 years [4789]; BMI: 25.2 kg/m2 [18.8-45.7]; ASA: 1/2/3:3/17/4; distance from anal verge: 23 cm [15-40]; tumor size: 40 mm [0-90]; pT1b/2/3/ 4: 4/3/14/3; pN0/N1/N2: 18/4/2; and two combined resection (large reticulum, partial cystectomy) and simultaneous resection cases (right hemicolectomy). Surgical technique: Following DST anastomosis, the reconstructed intestine was clamped, and the leak test was performed using transanal air delivery (50 mL catheter tipped syringe); air leak cases were considered positive. After the test, the positive left and right staple intersections, and the anterior and posterior walls, were sutured and reinforced with horizontal mattress sutures and LAPRA-TY® Suture Clip in the serous muscle layer, respectively, a transanal decompression round tube was placed after.
Results:
Operative time: 215min [123-514], blood loss: 15.5 [0-113], three cases underwent splenic flexure, intraoperative ICG evaluation: 11 cases (46%), DST staple: 60mm in 21 cases/60+45mm in three cases, circular autoanastomosis: 25mm in 20 cases/28mm in four cases, and post anastomosis leak test was positive in two cases, with 3-days postoperative time to resume eating [2-6]. On a postoperative day 2-3, the patients were evaluated for radiological leakage (RL) with rectal fluoroscopy study and CT scan, no RL cases were found. Duration of stay was 7 days [639], Clavien-Dindo 0/2:23/1 with bleeding balloon injury in the urethra, while one patient required blood transfusion.
Conclusion:
Suture reinforcement of the DST anastomosis after ICG assessment can result in safer surgical outcomes by assessing blood flow and anastomotic strength.
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