Abstract
The practice of surgery requires the surgeon to have a broad skill as well as the ability to constantly learn and adapt to increasingly complex procedures. Every operative case represents an opportunity to be challenged technically. Whether it is a hostile reoperative abdomen or a stapler misfire on a low rectal cancer, there will be situations in the operating room that are low frequency but high acuity that require a breadth and depth of skills and decision-making. In this chapter, we review these technical challenges that occur infrequently and offer an approach that has proven successful in our experience.
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References
Neutzling CB, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2012;2:CD003144.
Lustosa SA, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2001;(3):CD003144.
Ballantyne GH. Intestinal suturing. Review of the experimental foundations for traditional doctrines. Dis Colon Rectum. 1983;26(12):836–43. Review. PubMed PMID: 6357675.
Burch JM, et al. Single-layer continuous versus two-layer interrupted intestinal anastomosis: a prospective randomized trial. Ann Surg. 2000;231(6):832–7.
Sarin S, Lightwood RG. Continuous single-layer gastrointestinal anastomosis: a prospective audit. Br J Surg. 1989;76(5):493–5.
Law WL, et al. Single-layer continuous colon and rectal anastomosis using monofilament absorbable suture (Maxon): study of 500 cases. Dis Colon Rectum. 1999;42(6):736–40.
Hastings JC, et al. Effect of suture materials on healing wounds of the stomach and colon. Surg Gynecol Obstet. 1975;140(5):701–7.
Trimpi HD, et al. Advances in intestinal anastomosis: experimental study and an analysis of 984 patients. Dis Colon Rectum. 1977;20(2):107–17.
Munday C, McGinn FP. A comparison of polyglycolic acid and catgut sutures in rat colonic anastomoses. Br J Surg. 1976;63(11):870–2.
Lord MG, Broughton AC, Williams HT. A morphologic study on the effect of suturing the submucosa of the large intestine. Surg Gynecol Obstet. 1978;146(2):211–6.
Koruda MJ, Rolandelli RH. Experimental studies on the healing of colonic anastomoses. J Surg Res. 1990;48(5):504–15.
Didolkar MS, et al. A prospective randomized study of sutured versus stapled bowel anastomoses in patients with cancer. Cancer. 1986;57(3):456–60.
Kracht M, et al. Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn? A prospective, multicenter, randomized trial. Int J Colorectal Dis. 1993;8(1):29–33.
Choy PY, et al. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011;9, CD004320.
Suturing or stapling in gastrointestinal surgery: a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg. 1991;78(3):337–41.
Docherty JG, et al. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg. 1995;221(2):176–84.
Simillis C, et al. A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum. 2007;50(10):1674–87.
Resegotti A, et al. Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum. 2005;48(3):464–8.
Yamamoto T, et al. Stapled functional end-to-end anastomosis versus sutured end-to-end anastomosis after ileocolonic resection in Crohn disease. Scand J Gastroenterol. 1999;34(7):708–13.
Balik E, et al. Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series. Clinics (Sao Paulo). 2011;66(11):1935–41.
Leung TT, et al. Comparison of stapled versus handsewn loop ileostomy closure: a meta-analysis. J Gastrointest Surg. 2008;12(5):939–44.
Ritchey ML, Lally KP, Ostericher R. Comparison of different techniques of stapled bowel anastomoses in a canine model. Arch Surg. 1993;128(12):1365–7.
Zilling T, Walther BS. Are intersecting staple lines a hazard in intestinal anastomosis? Dis Colon Rectum. 1992;35(9):892–6.
Goto T, et al. Evaluation of the mechanical strength and patency of functional end-to-end anastomoses. Surg Endosc. 2007;21(9):1508–11.
Munoz-Juarez M, et al. Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum. 2001;44(1):20–5.
Chung RS. Blood flow in colonic anastomoses. Effect of stapling and suturing. Ann Surg. 1987;206(3):335–9.
Nakayama S, et al. The importance of precompression time for secure stapling with a linear stapler. Surg Endosc. 2011;25(7):2382–6.
Morita K, et al. Effects of the time interval between clamping and linear stapling for resection of porcine small intestine. Surg Endosc. 2008;22(3):750–6.
Saklani A, et al. Internal herniation following laparoscopic left hemicolectomy: an underreported event. J Laparoendosc Adv Surg Tech A. 2012;22(5):496–500.
Cabot JC, et al. Long-term consequences of not closing the mesenteric defect after laparoscopic right colectomy. Dis Colon Rectum. 2010;53(3):289–92.
Causey MW, Oguntoye M, Steele SR. Incidence of complications following colectomy with mesenteric closure versus no mesenteric closure: does it really matter? J Surg Res. 2011;171(2):571–5.
Marderstein E, Trunzo J, Stulberg J, Champagne B, Reynolds H, Delaney CP. Analysis of stapler misfire during colorectal surgical procedures using a National Event Report Database. 2007. Available from: http://www.casesurgery.com/research/Abstract08WEB.pdf.
Pandya S, et al. Laparoscopic colectomy: indications for conversion to laparotomy. Arch Surg. 1999;134(5):471–5.
Kirat HT, et al. Influence of stapler size used at ileal pouch-anal anastomosis on anastomotic leak, stricture, long-term functional outcomes, and quality of life. Am J Surg. 2010;200(1):68–72.
Polese L, et al. Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Colorectal Dis. 2012;14(3):e124–8.
Kyzer S, Gordon PH. Experience with the use of the circular stapler in rectal surgery. Dis Colon Rectum. 1992;35(7):696–706.
Detry RJ, et al. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team. Surgery. 1995;117(2):140–5.
Moore JW, Chapuis PH, Bokey EL. Morbidity and mortality after single- and double-stapled colorectal anastomoses in patients with carcinoma of the rectum. Aust N Z J Surg. 1996;66(12):820–3.
Yamamoto H, et al. Feasibility of end-to-anterior wall anastomosis in conversion of the double-stapling technique during laparoscopically assisted surgery. Surg Endosc. 2010;24(9):2178–81.
Nakada I, et al. Abdominal stapled side-to-end anastomosis (Baker type) in low and high anterior resection: experiences and results in 69 consecutive patients at a regional general hospital in Japan. Colorectal Dis. 2004;6(3):165–70.
Levine RA, Kadro O. When staplers misfire: endoscopic rescue of low pelvic anastomoses. Tech Coloproctol. 2010;14(4):349–51.
Beard JD, et al. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg. 1990;77(10):1095–7.
Yalin R, et al. Importance of testing stapled rectal anastomoses with air. Eur J Surg. 1993;159(1):49–51.
Ricciardi R, et al. Anastomotic leak testing after colorectal resection: what are the data? Arch Surg. 2009;144(5):407–11; discussion 411–2.
Schmidt O, Merkel S, Hohenberger W. Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol. 2003;29(3):239–43.
Offodile 2nd AC, et al. High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg. 2010;210(3):331–5.
Brennan DJ, et al. Routine mobilization of the splenic flexure is not necessary during anterior resection for rectal cancer. Dis Colon Rectum. 2007;50(3):302–7; discussion 307.
Park JS, et al. Laparoscopic versus open resection without splenic flexure mobilization for the treatment of rectum and sigmoid cancer: a study from a single institution that selectively used splenic flexure mobilization. Surg Laparosc Endosc Percutan Tech. 2009;19(1):62–8.
Chand M, Miskovic D, Parvaiz AC. Is splenic flexure mobilization necessary in laparoscopic anterior resection? Dis Colon Rectum. 2012;55(11):1195–7.
Marsden MR, et al. The selective use of splenic flexure mobilization is safe in both laparoscopic and open anterior resections. Colorectal Dis. 2012;14(10):1255–61.
Masoomi H, et al. Predictive factors of splenic injury in colorectal surgery: data from the Nationwide Inpatient Sample, 2006–2008. Arch Surg. 2012;147(4):324–9.
Kim HJ, Kim CH, Lim SW, Huh JW, Kim YJ, Kim HR. An extended medial to lateral approach to mobilize the splenic flexure during laparoscopic low anterior resection. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012. Epub 2012/10/16. doi: 10.1111/codi.12056. PubMed PMID: 23061515.
Kanemitsu Y, et al. Survival benefit of high ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery. Br J Surg. 2006;93(5):609–15.
Chin CC, et al. The oncologic benefit of high ligation of the inferior mesenteric artery in the surgical treatment of rectal or sigmoid colon cancer. Int J Colorectal Dis. 2008;23(8):783–8.
Titu LV, Tweedle E, Rooney PS. High tie of the inferior mesenteric artery in curative surgery for left colonic and rectal cancers: a systematic review. Dig Surg. 2008;25(2):148–57.
Rutegard M, et al. High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage. Br J Surg. 2012;99(1):127–32.
Karanjia ND, et al. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994;81(8):1224–6.
Lange MM, et al. Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum. 2008;51(7):1139–45.
Buunen M, et al. Level of arterial ligation in total mesorectal excision (TME): an anatomical study. Int J Colorectal Dis. 2009;24(11):1317–20.
Kim J, Choi DJ, Kim SH. Laparoscopic rectal resection without splenic flexure mobilization: a prospective study assessing anastomotic safety. Hepatogastroenterology. 2009;56(94–95):1354–8.
Hall NR, et al. High tie of the inferior mesenteric artery in distal colorectal resections–a safe vascular procedure. Int J Colorectal Dis. 1995;10(1):29–32.
Nelsen TS, Anders CJ. Dynamic aspects of small intestinal rupture with special consideration of anastomotic strength. Arch Surg. 1966;93(2):309–14.
Shikata J, Shida T. Effects of tension on local blood flow in experimental intestinal anastomoses. J Surg Res. 1986;40(2):105–11.
Howes EL, Sooy JW, Samuel HC. The healing of wounds as determined by their tensile strength. JAMA. 1929;92(1):42–5.
Deloyers L. Suspension of the right colon permits without exception preservation of the anal sphincter after extensive colectomy of the transverse and left colon (including rectum). Technic -indications- immediate and late results. Lyon Chir. 1964;60:404–13.
Manceau G, et al. Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes. Dis Colon Rectum. 2012;55(3):363–8.
Material Safety Data Sheet: FREDâ„¢ Anti-Fog Solution. North Haven, C.U.S.S. Material Safety Data Sheet: FREDâ„¢ Anti-Fog Solution. North Haven: United States Surgical. 2004. Available from: http://www.autosuture.com/imageServer.aspx?contentID=6591&contenttype=application/pdf.
DHELP. Visualization challenges and solutions in laparoscopic surgery 2010. Available from: http://www.newwavesurgical.com/sites/default/files/imce-uploads/value_analysis_final_9.7.2012.pdf.
Ott DE, et al. Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study. JSLS. 1998;2(4):321–9.
Binnebosel M, et al. Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models. Langenbecks Arch Surg. 2011;396(1):133–7.
Wu MP, et al. Complications and recommended practices for electrosurgery in laparoscopy. Am J Surg. 2000;179(1):67–73.
Tucker RD. Laparoscopic electrosurgical injuries: survey results and their implications. Surg Laparosc Endosc. 1995;5(4):311–7.
Chino A, et al. A comparison of depth of tissue injury caused by different modes of electrosurgical current in a pig colon model. Gastrointest Endosc. 2004;59(3):374–9.
Joniau SG, et al. Complications and functional results of surgery for locally advanced prostate cancer. Adv Urol. 2012;2012:706309.
Yildirim M, et al. Rectal injury during radical prostatectomy. Ulus Travma Acil Cerrahi Derg. 2012;18(3):250–4.
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The hostile abdomen (Video by Amir Bastawrous, MD) (MOV 52032 kb)
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Davis, B., Rafferty, J.F. (2014). Technical Aspects. In: Steele, S.R., Maykel, J.A., Champagne, B.J., Orangio, G.R. (eds) Complexities in Colorectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9022-7_33
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DOI: https://doi.org/10.1007/978-1-4614-9022-7_33
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