The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
J P Arnaud - One of the best experts on this subject based on the ideXlab platform.
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intracorporeal Colorectal Anastomosis following laparoscopic left colon resection
Surgical Endoscopy and Other Interventional Techniques, 1997Co-Authors: Roberto Bergamaschi, J P ArnaudAbstract:Background: The aim of this study was to assess the impact of an intracorporeal double-stapled Colorectal Anastomosis upon the outcome of laparoscopic left colon resection.
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intracorporeal Colorectal Anastomosis following laparoscopic left colon resection
Surgical Endoscopy and Other Interventional Techniques, 1997Co-Authors: Roberto Bergamaschi, J P ArnaudAbstract:Background: The aim of this study was to assess the impact of an intracorporeal double-stapled Colorectal Anastomosis upon the outcome of laparoscopic left colon resection. Methods: Fifty-four selected patients underwent elective laparoscopic left colon resection for benign disease. Once resection was completed, a 33-mm suprapubic port allowed insertion of the anvil of a circular stapler into the colon, which was closed by a handsewn purse-string suture using the T-needle technique. The circular stapler was passed transanally to perform a double-stapled Anastomosis. Specimens were delivered in a plastic bag via the suprapubic port. Results: There were no deaths. Minor intraoperative and postoperative complications occurred in 3.7% and 9.2% of the patients, respectively. Median operating time was 125 min (range 80–210 min). Complete proximal and distal doughnuts were obtained in all patients and anastomoses were all methylene blue tight. Median hospital stay was 4 (range 3–7) days. Conclusions: Fashioning double-stapled Colorectal anastomoses intracorporeally is feasable and safe.
Noriyuki Inaki - One of the best experts on this subject based on the ideXlab platform.
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laparoscopic intracorporal Colorectal sutured Anastomosis using the radius surgical system in a phantom model
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: J Torres R Bermudez, G Buess, Makoto Waseda, I A Gacek, F Becerra C Garcia, G A Manukyan, Noriyuki InakiAbstract:Background The Radius Surgical System (RSS) is a manipulator with additional degrees of freedom to enhance the dexterity of laparoscopic suturing. Our aim was to determine the feasibility and potentially added value of laparoscopic intracorporal sutured Colorectal Anastomosis (RSS) compared with suturing with conventional laparoscopic instruments (CLI).
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laparoscopic intracorporal Colorectal sutured Anastomosis using the radius surgical system in a phantom model
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: J Torres R Bermudez, G Buess, Makoto Waseda, I A Gacek, F Becerra C Garcia, G A Manukyan, Noriyuki InakiAbstract:The Radius Surgical System (RSS) is a manipulator with additional degrees of freedom to enhance the dexterity of laparoscopic suturing. Our aim was to determine the feasibility and potentially added value of laparoscopic intracorporal sutured Colorectal Anastomosis (RSS) compared with suturing with conventional laparoscopic instruments (CLI). A total of 72 Colorectal anastomoses and 30 single sutures using RSS and CLI were performed in the study. The experiment was divided as follows: One surgeon performed 40 Colorectal anastomoses using RSS to assess the learning curve and the feasibility of the technique; The same surgeon performed 10 additional Colorectal anastomoses with CLI which were then compared to the last 10 cases of the 40 anastomoses with RSS; Fifteen single sutures in the horizontal plane with RSS and 15 with CLI between two segments of colon were performed to compare the traction force to disrupt the suture; Twelve anastomoses were performed by the other three participants to evaluate ergonomy. Three leakages (7.5%) were found in the 40 anastomoses with RSS but none after the eighth case. There was no stenosis. The mean time for the anastomoses once the learning curve was achieved was 32.7 min. After 21 anastomoses with RSS there was no improvement in the operating time. The quality of the suture was superior with RSS, with a larger Anastomosis diameter, higher bursting pressure, and fewer suturing failures being found. The RSS suture withstood a higher traction force. The participants showed more discomfort suturing with CLI. This study demonstrated the feasibility of laparoscopic Colorectal Anastomosis using RSS. Anastomosis with RSS was shown to be safer. The three participants evaluating ergonomy reflected less discomfort in hand/wrist using RSS. Others ergonomic problems were comparable to CLI.
Rolland Parc - One of the best experts on this subject based on the ideXlab platform.
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influence of a defunctioning stoma on leakage rates after low Colorectal Anastomosis and colonic j pouch anal Anastomosis
British Journal of Surgery, 1998Co-Authors: Nidal Dehni, Rodolfo Daniel Schlegel, Marguerite Guiguet, Emmanuel Tiret, C Cunningham, Rolland ParcAbstract:Background Anal sphincter function is increasingly preserved following rectal excision for cancer and provides a better quality of life for patients than does a permanent colostomy. However, anastomotic complications may cause considerable morbidity and mortality. This retrospective study examined the incidence of anastomotic complications following two forms of reconstruction after resection for mid-rectal cancer: colonic pouch–anal Anastomosis (CPAA) and low Colorectal Anastomosis (LCRA). Methods Some 258 consecutive patients with mid-rectal cancers between 6 and 11 cm from the anal verge underwent proctectomy with mesorectal excision and either CPAA or LCRA. The incidence of clinical and radiological leaks was determined in these patients who were considered in three groups: LCRA (defunctioning stoma), LCRA (no defunctioning stoma) and CPAA (all defunctioned). Results In the LCRA group without a defunctioning stoma, a clinical leak occurred in 17·0 per cent, compared with two of 30 in the LCRA group with a defunctioning stoma. In the CPAA group a clinical leak occurred in 4·9 per cent of patients, which was not significantly different from the rate in those with a defunctioned LCRA. Patients with a non-defunctioned LCRA were more likely to suffer a clinical anastomotic leak (P=0·01), peritonitis (P=0·001) and require unscheduled reoperation (P=0·006) than those with a defunctioned LCRA and/or CPAA. Conclusion The use of a protective defunctioning stoma is advocated in conjunction with LCRAs. © 1998 British Journal of Surgery Society Ltd
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long term functional outcome after low anterior resection comparison of low Colorectal Anastomosis and colonic j pouch anal Anastomosis
Diseases of The Colon & Rectum, 1998Co-Authors: Nidal Dehni, Rodolfo Daniel Schlegel, Marguerite Guiguet, Emmanuel Tiret, C Cunningham, Jean Dominique Singland, Rolland ParcAbstract:OBJECTIVE: The purpose of this study was to compare long-term functional results of two methods of reconstruction after anterior rectal resection for cancer: low Colorectal Anastomosis and colonic J-pouch-anal Anastomosis. SUMMARY BACKGROUND DATA: After anterior resection for mid or low rectal cancer, the decision to perform low Colorectal or coloanal Anastomosis is made intraoperatively, depending on the distance of the tumor from the anal verge. Functional results of these operations are considered to be similar one to two years after surgery. No study to date has compared long-term functional results after rectal excision followed by either low Colorectal Anastomosis or colonic J-pouch-anal Anastomosis. METHODS: From 1987 to 1992, 173 patients underwent anterior resection for cancer located between 2 to 12 cm from the anal verge. All patients alive without recurrence were contacted by telephone interview for assessment of functional results. There were 47 patients with colonic J-pouch-anal Anastomosis and 34 patients with low Colorectal Anastomosis. Minimum follow-up was three years for all patients (mean, 5 years). RESULTS: The two groups were well matched for gender, age, histologic stage, and use of adjuvant therapies. Patients with colonic J-pouch-anal Anastomosis displayed significantly better function in terms of frequency of defecation (1.57±1vs. 2.79±1;P=0.001) and presence of irregular transit or stool “clustering” (30vs. 71 percent;P=0.003). Patients who underwent colonic J-pouch-anal Anastomosis were significantly less likely to require constipating agents (4vs. 21 percent;P=0.03) or need to follow a estricted diet (14vs. 41 percent;P=0.01). Results concerning the need to defecate again within one hour and disruption of social or professional life as a consequence of surgery showed a tendency in favor of colonic J-pouch-anal Anastomosis. CONCLUSION: Colonic J-pouch-anal Anastomosis offers superior long-term function compared with low Colorectal Anastomosis after radical treatment of rectal cancer. Preservation of a short rectal segment followed by a straight Colorectal Anastomosis does not offer any clinical advantage over colonic J-pouch-anal Anastomosis.
Abe Fingerhut - One of the best experts on this subject based on the ideXlab platform.
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Colorectal Anastomosis after laparoscopic extended left colectomy techniques and outcome
Colorectal Disease, 2020Co-Authors: Yichang Chen, Abe Fingerhut, M Y Shen, H C Chen, S J Chang, Y Y Tsai, H M Wang, William Tzu Liang ChenAbstract:AIM After extended left colectomy, traditional Colorectal Anastomosis is often not feasible because of insufficient length of the remaining colon to perform a tension-free Anastomosis. Total colectomy with ileorectal Anastomosis could be an alternative but this can lead to unsatisfactory quality of life. Trans-mesenteric Colorectal Anastomosis or inverted right colonic transposition (the so-called Deloyers procedure) are two possible solutions for creating a tension-free Colorectal Anastomosis after extended left colectomy. Few studies have reported their results of these two techniques and mostly via laparotomy. The aim of this study was to describe the trans-mesenteric Colorectal Anastomosis and the inverted right colonic transposition procedure via a laparoscopic approach and report the outcome in a series of 13 consecutive patients. METHOD This was retrospective chart review of laparoscopic Colorectal surgery with trans-mesenteric Colorectal Anastomosis or the inverted right colonic transposition procedure from January 2015 up to 2019. An accompanying video demonstrates these two techniques. RESULTS Thirteen consecutive patients underwent either a laparoscopic trans-mesenteric Colorectal Anastomosis (n = 9) or an inverted right colonic transposition procedure (n = 4). One patient had intra-operative presacral bleeding that was stopped successfully without conversion. Two patients had a postoperative intra-abdominal abscess, but no anastomotic complications were recorded. The median number of bowel movements per day after 6 months was 2 (range 2-5). CONCLUSIONS Trans-mesenteric Colorectal Anastomosis or the inverted right colonic transposition procedure is feasible laparoscopically. The now well-established classical advantages of the laparoscopic approach are associated with good functional outcome after these procedures.
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anastomotic leakage after elective right versus left colectomy for cancer prevalence and independent risk factors
Journal of The American College of Surgeons, 2007Co-Authors: Nicolas Veyrie, Abe Fingerhut, Jeanmarie Hay, Toufik Ata, Fabrice Muscari, Annececile Couchard, Simon Msika, Chadli DziriAbstract:Background Anastomotic leakage in Colorectal surgery remains a major challenge because of its early and late consequences. Study Design To determine whether prevalence and risk factors for anastomotic leakage (AL) differed between right and left elective colectomy for cancer, we conducted univariate and multivariate analyses and compared 33 variables (15 preoperative, 18 intraoperative) culled prospectively for 520 right and 1,230 left colectomies, followed by immediate Anastomosis in 1,750 adult patients with or without AL. Results The overall AL rate was 4% (71 of 1,750) and was significantly lower (p Independent risk factors for AL were preoperative in right colectomy: loss of weight (> 10%), odds ratio (OR)=5.62, with 95% CI 1.06 to 29.8; and intraoperative in left colectomy: palliative resection (OR=2.12; 95% CI 1.06 to 4.23), "poor" colonic cleanliness (OR=2.4; 95% CI 1.34 to 4.28), proximal Colorectal Anastomosis (OR=1.34; 95% CI 1 to 1.8), and distal Colorectal Anastomosis (OR=3.91; 95% CI 1.64 to 9.81). Conclusions In right colectomy for cancer, preoperative nutritive support leading to regain of lost weight could reduce postoperative morbidity. Concerning left colectomy, if colonic cleanliness is poor, intraoperative colonic lavage should be done. When poor colonic cleanliness is associated with palliative resection and low distal rectal Anastomosis, a protective stoma should be considered.
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supraperitoneal Colorectal Anastomosis hand sewn versus circular staples a controlled clinical trial
Surgery, 1995Co-Authors: Abe Fingerhut, Jeanmarie Hay, Andre Elhadad, F Lacaine, Yves FlamantAbstract:Background Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. Methods. One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8±12.1years) were randomized to undergo hand-sewn (n=74) or circular stapled (n=85) supraperitoneal Colorectal Anastomosis after left colectomy. Results. Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n=10) and hemorrhage (n=5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p Conclusions. According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal Colorectal Anastomosis.
Roberto Bergamaschi - One of the best experts on this subject based on the ideXlab platform.
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intracorporeal Colorectal Anastomosis following laparoscopic left colon resection
Surgical Endoscopy and Other Interventional Techniques, 1997Co-Authors: Roberto Bergamaschi, J P ArnaudAbstract:Background: The aim of this study was to assess the impact of an intracorporeal double-stapled Colorectal Anastomosis upon the outcome of laparoscopic left colon resection.
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intracorporeal Colorectal Anastomosis following laparoscopic left colon resection
Surgical Endoscopy and Other Interventional Techniques, 1997Co-Authors: Roberto Bergamaschi, J P ArnaudAbstract:Background: The aim of this study was to assess the impact of an intracorporeal double-stapled Colorectal Anastomosis upon the outcome of laparoscopic left colon resection. Methods: Fifty-four selected patients underwent elective laparoscopic left colon resection for benign disease. Once resection was completed, a 33-mm suprapubic port allowed insertion of the anvil of a circular stapler into the colon, which was closed by a handsewn purse-string suture using the T-needle technique. The circular stapler was passed transanally to perform a double-stapled Anastomosis. Specimens were delivered in a plastic bag via the suprapubic port. Results: There were no deaths. Minor intraoperative and postoperative complications occurred in 3.7% and 9.2% of the patients, respectively. Median operating time was 125 min (range 80–210 min). Complete proximal and distal doughnuts were obtained in all patients and anastomoses were all methylene blue tight. Median hospital stay was 4 (range 3–7) days. Conclusions: Fashioning double-stapled Colorectal anastomoses intracorporeally is feasable and safe.