Document Detail


Regenerated oxidized cellulose reinforcement of low rectal anastomosis: do we still need diversion?
MedLine Citation:
PMID:  20485002     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The leak rate after low anterior resection is in the region of 10% to 15%. The highest risks of anastomotic leak are in anastomoses less than 5 cm from the anal verge. We evaluated the outcome of oxidized regenerated cellulose reinforcement of low rectal anastomosis.
METHODS: The study group consisted of 108 patients with rectal cancer. Patients with low rectal cancer had low anterior resection with stapled straight low colorectal or coloanal anastomosis without proximal diversion. They were prospectively randomized to either oxidized regenerated cellulose reinforcement or no reinforcement. Data collected included age, sex, hemoglobin percentage, albumin level, histopathologic type of the tumor, anastomotic leak, and stricture.
RESULTS: The mean age of patients was 56 years, and sex was matched in both groups. Clinical leak occurred in 6 of 38 cases (15.7%) in the group that did not undergo reinforcement versus 2 of 33 (6.1%) in the oxidized regenerated cellulose reinforcement group (P < .01). In the case of a leak, diversion was needed in 3 of 6 patients in the group that did not undergo reinforcement vs no patients in the oxidized regenerated cellulose reinforcement group (P = .05). Generalized peritonitis occurred in 3 patients in the group that did not undergo reinforcement versus no patients in the oxidized regenerated cellulose reinforcement group (P < .01). Length of stay was 4.8 days in the oxidized regenerated cellulose reinforcement group versus 5.9 days in the group that did not undergo reinforcement (P = .047), with no mortalities in either group.
CONCLUSION: Oxidized regenerated cellulose reinforcement of low rectal anastomosis significantly decreases the risk of postoperative leak in low rectal anastomosis and may reduce the requirement for proximal diversion. Potential benefits include avoidance of a stoma, lower morbidity, shorter hospital stay, and a lower cost of care.
Authors:
Khaled M Madbouly; Ahmed Hussein; Waleed Omar; Mohamed Farid
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Retracted Publication    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  53     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-20     Completed Date:  2010-06-10     Revised Date:  2011-05-23    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889-95     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Alexandria, Alexandria, Egypt. khaled.madbouly@alexmed.edu.eg
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anastomosis, Surgical / methods*
Cellulose, Oxidized / therapeutic use*
Chi-Square Distribution
Female
Hemostatics / therapeutic use*
Humans
Logistic Models
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Peritonitis / epidemiology
Postoperative Complications / epidemiology,  surgery*
Prospective Studies
Rectal Neoplasms / pathology,  surgery*
Statistics, Nonparametric
Surgical Stapling
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hemostatics; 9032-53-5/Cellulose, Oxidized
Comments/Corrections
Comment In:
Dis Colon Rectum. 2010 Jun;53(6):859-60   [PMID:  20484997 ]
Retraction In:
Madbouly K, Hussein A, Omar W, Farid M. Dis Colon Rectum. 2011 May;54(5):656   [PMID:  21471772 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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