Transanal Intubation for Preventing Colorectal Anastomotic Failure.

IF 1.6 Q4 ONCOLOGY International Journal of Surgical Oncology Pub Date : 2024-08-10 eCollection Date: 2024-01-01 DOI:10.1155/2024/5562420
Mykola Gordiichuk
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Abstract

Introduction: Failure of low colorectal anastomosis remains challenging in surgical oncology, necessitating the exploration of new methods and improvements in existing preventive measures.

Materials and methods: This prospective study was conducted in two stages: intraluminal pressure in the colon was monitored in 32 patients by manometry and sonography over a 5-day postoperative period; 213 patients who underwent anterior resection of the rectum were analyzed, of whom 126 and 87 underwent diverting stoma (DS) and transanal intubation (TAI), respectively.

Results: The effectiveness of the recommended technique for applying and removing transanal intubation (TAI) to prevent pneumo hydro strike (≥15 kPa) on the anastomosis line was analyzed in 87 patients and compared with imposed DS. TAI showed better borderline statistical significance (p = 0.051). The incidence of repeat surgery for anastomotic failure (AL) was seven (5.55%) and four (4.59%) in the DS and TAI groups, respectively. The distance of the anastomosis from the dentate line <60 mm was associated with a higher risk of AL occurrence (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.007-1.017; p < 0.001; area under the curve (AUC) = 0.82). DS is recommended for men, as the risk of AL is significantly lower among women (OR, 0.41; 95% CI, 0.16-1.04; p = 0.062; AUC, 0.61; 95% CI, 0.54-0.67).

Conclusions: Although TAI is advantageous over DS for preventing AL, surgeons select the method for the preventive approach based on the preoperative and intraoperative results.

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经肛门插管预防大肠吻合失败
导言:低位结肠直肠吻合术失败仍然是肿瘤外科面临的挑战,因此有必要探索新的方法并改进现有的预防措施:这项前瞻性研究分两个阶段进行:在术后 5 天内通过测压计和超声波检查对 32 名患者的结肠腔内压力进行监测;对 213 名接受直肠前切除术的患者进行分析,其中 126 人和 87 人分别接受了分流造口(DS)和经肛插管(TAI)术:结果:分析了 87 例患者采用经肛门插管(TAI)和经肛门插管(DS)的效果,并将两者进行了比较。TAI显示出更好的边缘统计学意义(P = 0.051)。DS 组和 TAI 组因吻合失败(AL)而再次手术的发生率分别为 7 例(5.55%)和 4 例(4.59%)。吻合口与齿状线的距离 p < 0.001;曲线下面积 (AUC) = 0.82)。建议男性接受 DS,因为女性的 AL 风险明显较低(OR,0.41;95% CI,0.16-1.04;p = 0.062;AUC,0.61;95% CI,0.54-0.67):尽管TAI在预防AL方面比DS更有优势,但外科医生会根据术前和术中结果选择预防方法。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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