Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients.

OBJECTIVE: To report postoperative morbidity after low anterior resection (LAR) and coloanal anastomosis (CAA) for rectal cancer and identify possible risk factors of complications. BACKGROUND: Coloanal anastomosis after total mesorectal excision (TME) is associated with significant morbidity. Precise data on the specific morbidity and the risk factors are lacking. METHODS: We analyzed retrospectively 483 consecutive LARs with TME and CAA carried out in a single center between 1996 and 2005. All complications occurring up to 3 months after LAR and up to 3 months after closure of the diverting stoma were graded according to the Dindo classification. RESULTS: Of 483 patients, 164 (33.9%) suffered at least 1 complication, leading to death in 2 (0.4%) patients. Grade III/IV complications occurred in 69 of 483 (14.2%) patients. Thirty-four (7.0%) patients developed leakage of the CAA and 3 patients had leakage of the small bowel anastomosis after stoma closure. Ileostomy closure was carried out after a mean of 88.7 days (36-630) after LAR. The stoma was not closed in 4 of 456 (0.6%) patients. In multivariate analysis, male sex (P = 0.0216) and postoperative transfusion (P = 0.0025) were associated with complications. Medical complications were furthermore associated with previous thrombembolic events (P = 0.0012) and associated surgery at the time of LAR (P = 0.0010). Circumferential tumor localization was predictive of surgical complications (P = 0.0015). The only factor associated with a risk of leakage was transfusion (P = 0.0216). CONCLUSIONS: In this series morbidity occurred in 34% and dehiscence of the CAA in 7.0%. Transfusion requirement was an independent risk factor for postoperative complications and anastomotic leakage.

[Aerobilia: a rare consequence of anaerobic acute cholecystitis: a case report]. / L'aérobilie: une conséquence rare de la cholécystite aiguë à germes anaérobies.

Acute acalculous cholecystitis is rare in non critically ill or postoperative patients. We report a case of acute acalculous cholecystitis with secondary bile infection with Clostridium perfringens. Ultrasound and tomodensitometry revealed diffuse aerobilia. The germ in this case report is atypical and contrasts with the very discrete clinical findings. Aerobilia, secondary to the development of bacteria in the biliary tract falsely suggested a bilio-digestive fistula. Treatment included a simple cholecystectomy associated with 7 days of antibiotherapy.

Feasibility of laparoscopic restorative proctocolectomy without diverting stoma.

AIM: Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy. METHOD: Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database. RESULTS: Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma. CONCLUSION: Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.

Functional results after the Orr-Loygue transabdominal rectopexy for complete rectal prolapse.

PURPOSE: The aim of this study was to assess functional results after Orr-Loygue transabdominal rectopexy for complete rectal prolapse. METHODS: Thirty-one consecutive patients operated on for complete rectal prolapse between 1995 and 1998 were evaluated preoperatively and postoperatively with regard to anal incontinence, constipation, evacuation difficulties, and overall satisfaction with a standardized questionnaire. Anal continence assessment was based on a clinical scoring system. RESULTS: After a mean follow-up of 28 +/- 13 (range, 12-57) months, no prolapse recurred. Preoperative and postoperative rates of incontinence were 81 percent (25/31) and 55 percent (17/31), respectively (P < 0.03). Continence improved in 24 (96 percent) of the 25 patients who were incontinent before surgery. The mean incontinence score decreased from 11.7 +/- 7.8 preoperatively to 3.2 +/- 4.2 postoperatively (P < 0.001). The self-reported constipation rate was 61 percent (19/31) before surgery and 71 percent (22/31) after surgery (P = nonsignificant). Constipation appeared or worsened in 16 patients (52 percent), whereas it disappeared or improved in 8 (26 percent; P = nonsignificant). Evacuation difficulties increased significantly after surgery from 23 percent (7/31) to 61 percent (19/31; P < 0.003). Ninety-seven percent of patients reported good or very good satisfaction. CONCLUSIONS: Transabdominal Orr-Loygue rectopexy resulted in improved continence and a high satisfaction level. Despite a significant postoperative increase in evacuation difficulties, only a 10 percent (nonsignificant) increase in the self-reported constipation rate was observed.