RESUMEN
INTRODUCTION: Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge® therapy. METHODS: In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed. RESULTS: Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7-29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were 8933 (95% CI 7268-10,707) per patient. CONCLUSION: Vacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.
Asunto(s)
Fuga Anastomótica/cirugía , Colon/cirugía , Terapia de Presión Negativa para Heridas/métodos , Neoplasias del Recto/cirugía , Recto/cirugía , Técnicas de Sutura , Adulto , Anciano , Anastomosis Quirúrgica/efectos adversos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Estudios Prospectivos , Calidad de Vida , Radioterapia Adyuvante , Neoplasias del Recto/radioterapiaRESUMEN
An 11-year-old Arabian mare had sudden signs of colic 10 days post partum. Rectal examination revealed a large mass in the abdomen. The mare was successfully operated on for a granulosa cell tumour of 31.5 kg. The large abdominal wound healed by primary intention.
Asunto(s)
Cólico/veterinaria , Tumor de Células de la Granulosa/veterinaria , Enfermedades de los Caballos/etiología , Neoplasias Ováricas/veterinaria , Animales , Cólico/diagnóstico , Cólico/etiología , Femenino , Tumor de Células de la Granulosa/complicaciones , Tumor de Células de la Granulosa/cirugía , Enfermedades de los Caballos/diagnóstico , Caballos , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/patología , Cuidados Posoperatorios , Periodo Posparto , Cuidados PreoperatoriosRESUMEN
Wound healing is discussed in the introduction. Subsequently in a review of the suture materials used in large animal laparotomies is presented. In the discussion examples are given of the suture materials that are used at the Department of General and Large Animal Surgery.