Compression versus hand-sewn and stapled Anastomosis in colorectal surgery: a systematic review and meta-analysis of randomized controlled trials

Anastomotic leaks are a feared complication of colorectal resections and novel techniques that have the potential to decrease them are still sought. This study aimed to compare the anastomotic leak rates in patients undergoing compression anastomoses versus hand-sewn or stapled anastomoses. Randomized controlled trials (RCTs) comparing outcomes of compression versus conventional (hand-sewn and stapled) colorectal Anastomosis were collected from MEDLINE, Embase and the Cochrane Library. The quality of the RCTs and the potential risk of bias were assessed. Pooled odds ratios (OR) were calculated for categorical outcomes and weighted mean differences for continuous data. Ten RCTs were included, comprising 1969 patients (752 sutured, 225 stapled, and 992 compression anastomoses). Most used the biofragmentable anastomotic ring. There was no significant difference between the two groups in terms of anastomotic leak rates (OR 0.80, 95 % confidence interval (CI) 0.47, 1.37; p  = 0.42), stricture (OR 0.54: 95 % CI 0.18, 1.64; p  = 0.28) or mortality (OR 0.70; 95 % CI 0.39, 1.26; p  = 0.24). Compression Anastomosis was associated with an earlier return of bowel function: 1.02 (95 % CI 1.37, 0.66) days earlier ( p  

meta analysis of observational studies of ileorectal versus ileal pouch anal Anastomosis for familial adenomatous polyposis

Background:

Surgery for familial adenomatous polyposis (FAP) aims to minimize cancer risk while providing good functional outcome. Colectomy with ileorectal Anastomosis and proctocolectomy with ileal pouch–anal Anastomosis both offer this, but there is no clear consensus about which is better.

Methods:

This is a meta-analysis of comparative studies published between 1991 and 2003 reporting early and late postoperative adverse events, functional outcomes and quality of life.

Results:

Twelve studies containing 1002 patients (53·4 per cent ileal pouch, 46·6 per cent ileorectal Anastomosis) were identified. Bowel frequency (weighted mean difference 1·62 (95 per cent confidence interval (c.i.) 1·05 to 2·20)), night defaecation (odds ratio (OR) 6·64 (95 per cent c.i. 2·99 to 14·74)) and use of incontinence pads (OR 2·72 (95 per cent c.i. 1·02 to 7·23)) were significantly less in the ileorectal group, although faecal urgency was reduced with the ileal pouch (odds ratio 0·43 (95 per cent c.i. 0·23 to 0·80)). Reoperation within 30 days was more common after ileal pouch construction (23·4 versus 11·6 per cent; OR 2·11 (95 per cent c.i. 1·21 to 3·70)). There was no significant difference between the techniques in terms of sexual dysfunction, dietary restriction, or postoperative complications. Rectal cancer was a diagnosis only in the ileorectal group (5·5 per cent).

Conclusion:

Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

sequential Anastomosis for lymphatic supermicrosurgery multiple lymphaticovenular anastomoses on 1 venule

BackgroundSupermicrosurgical lymphaticovenular Anastomosis (LVA) is becoming a treatment option for progressive lymphedema. Various types of LVA such as end-to-end, end-to-side, side-to-end, and side-to-side are performed to improve the treatment efficacy.MethodsWe applied sequential Anastomosis for

side to end lymphaticovenular Anastomosis through temporary lymphatic expansion

Objective The number of bypasses is the most important factor in lymphaticovenular Anastomosis (LVA) for lymphedema treatment. Side-to-end (S-E) LVA, which can bypass bidirectional lymph flows via one Anastomosis, is considered to be the most efficient bypass, but creation of lateral window to a small lymphatic vessel is technically demanding. To overcome the difficulty, we introduced S-E Anastomosis through temporary lymphatic expansion (SEATTLE) procedure in S-E LVA. Methods This was a retrospective observational study set in a teaching hospital. Forty eight lower extremity lymphedema (LEL) patients underwent LVA. S-E LVAs were performed with (SEATTLE group) or without (non-SEATTLE group) temporary lymphatic expansion. S-E LVAs were evaluated to compare Anastomosis result in SEATTLE and non-SEATTLE groups. Results S-E LVAs resulted in 44 anastomoses in SEATTLE group (n = 25) and 37 anastomoses in non-SEATTLE group (n = 23). LEL index reduction in SEATTLE group was significantly greater than that in non-SEATTLE group (16.5±14.5 vs. 10.9±11.8, P = 0.041). Success rate of S-E LVA in SEATTLE group was significantly higher than that in non-SEATTLE group (95.5% vs 81.1%, P = 0.040). Thirty seven of 44 (84.1%) lymph vessels in SEATTLE group were successfully dilated by temporary lymphatic expansion maneuver. All of 9 failed S-E LVAs used a lymphatic vessel with diameter of 0.35 mm or smaller. Conclusions The SEATTLE procedure facilitates S-E LVA by a simple and easy maneuver. When the diameter of the lymphatic vessel is 0.35 mm or smaller even after the temporary lymphatic expansion maneuver, S-E LVA is not recommended due to relatively high failure rate.

lambda shaped Anastomosis with intravascular stenting method for safe and effective lymphaticovenular Anastomosis

Background:Lymphaticovenular Anastomosis has become an increasingly common treatment for lymphedema. Supermicrosurgical techniques are essential for the successful performance of lymphaticovenular Anastomosis. A positive correlation between the number of lymphaticovenular anastomoses performed and t

simulation in coronary artery Anastomosis early in cardiothoracic surgical residency training the boot camp experience

Objective We evaluated focused training in coronary artery Anastomosis with a porcine heart model and portable task station. Methods At “Boot Camp,” 33 first-year cardiothoracic surgical residents participated in 4-hour coronary Anastomosis sessions (6–7 attending surgeons per group of 8–9 residents). At beginning, midpoint, and session end, Anastomosis components were assessed on a 3-point rating scale (1 good, 2 average, 3 below average). Performances were video recorded and reviewed by 3 surgeons in a blinded fashion. Participants completed questionnaires at session end, with follow-up surveys at 6 months. Results Ten to 18 end-to-side anastomoses with porcine model and task station were performed. Initial assessments ranged from 2.11 ± 0.58 (forceps use) to 2.44 ± 0.48 (needle angles). Midpoint scores ranged from 1.76 ± 0.63 (forceps use) to 1.91 ± 0.49 (needle angles). Session end scores ranged from 1.29 ± 0.45 (needle holder use) to 1.58 ± 0.50 (needle transfer and suture management and tension; P 0.5). All respondents agreed that task station and porcine model were good methods of training. At 6 months, respondents noted that the Anastomosis session provided a basis for training; however, only slightly more than half continued to practice outside the operating room. Conclusions Four-hour focused training with porcine model and task station resulted in improved ability to perform anastomoses. Boot Camp may be useful in preparing residents for coronary Anastomosis in the clinical setting, but emphasis on simulation development and deliberate practice is necessary.

improvement in coronary Anastomosis with cardiac surgery simulation

Objective Cardiac surgery trainees might benefit from simulation training in coronary Anastomosis and more advanced procedures. We evaluated distributed practice using a portable task station and experience on a beating-heart model in training coronary Anastomosis. Methods Eight cardiothoracic surgery residents performed 2 end-to-side anastomoses with the task station, followed by 2 end-to-side anastomoses to the left anterior descending artery by using the beating-heart model at 70 beats/min. Residents took home the task station, recording practice times. At 1 week, residents performed 2 anastomoses on the task station and 2 anastomoses on the beating-heart model. Performances of the Anastomosis were timed and reviewed. Results Times to completion for Anastomosis on the task station decreased 20% after 1 week of practice (351 ± 111 to 281 ± 53 seconds, P = .07), with 2 residents showing no improvement. Times to completion for beating-heart Anastomosis decreased 15% at 1 week (426 ± 115 to 362 ± 94 seconds, P = .03), with 2 residents demonstrating no improvement. Home practice time (90–540 minutes) did not correlate with the degree of improvement. Performance rating scores showed an improvement in all components. Eighty-eight percent of residents agreed that the task station is a good method of training, and 100% agreed that the beating-heart model is a good method of training. Conclusions In general, distributed practice with the task station resulted in improvement in the ability to perform an Anastomosis, as assessed by times to completion and performance ratings, not only with the task station but also with the beating-heart model. Not all residents improved, which is consistent with a “ceiling effect” with the simulator and a “plateau effect” with the trainee. Simulation can be useful in preparing residents for coronary Anastomosis and can provide an opportunity to identify the need and methods for remediation.