Influence of the type of anatomic resection on anastomotic leak after surgery for colon cancer.

INTRODUCTION: Anastomotic leak (AL) after colon cancer resection is feared by surgeons because of its associated morbidity and mortality. Considerable research has been directed at predictive factors for AL, but not the anatomic type of colonic resection. Anecdotally, certain types of resection are associated with higher leak rates although there remains a paucity of data on this. This study aimed to determine the AL rate for different types of colon cancer resection to inform decisions regarding the choice of operation. METHODOLOGY: Retrospective analysis of Bowel Cancer Outcome Registry (BCOR) for all colonic cancer resections with anastomosis between January 2007 and December 2020. Demographic, patient, tumour and outcome data were analysed. AL rates were compared among the different colonic procedures with both univariate and multivariate analysis. RESULTS: 20 191 patients who underwent resection with anastomosis for cancer were included in this study. Of these 535 (2.6%) suffered ALs. While the univariate analysis found male sex, procedure type, symptomatic cancers, emergency surgery, unsupervised registrars, conversion to open surgery, medical complications and higher TNM staging were associated with AL, multivariate analysis, found only procedure type remained a significant predictor of AL (total colectomy (OR 4.049, P<0.001), subtotal colectomy (OR 2.477, P<0.001) and extended right hemicolectomy (OR 2.171, P < 0.001)). CONCLUSION: AL is more common in extended colonic resections. With growing evidence of similar oncological outcomes between subtotal colectomy and left hemicolectomy for splenic flexure cancers, more limited resections should be considered. The type of colonic resection should be integrated into prediction tools for AL.

Incidence and risk factors for secondary failure after acute obstetric sphincter injury repair - an audit of 239 women.

AIM: The rate of secondary failure after obstetric sphincter injury repair is unknown, with the literature reporting rates ranging from 0.1% to 53%. We aimed to perform an audit to identify the rate and risk factors for failure of sphincter repair in a cohort of postpartum women using endoanal ultrasound (EAUS) and manometry, assessing the risk factors and impact of these events. METHOD: Prospective data were collected within a 2 year period from patients who attended the perineal clinic at Eastern Health. Variables of primary repair and presence of postpartum complications were recorded and subsequently analysed. RESULTS: Of 239 patients with obstetric anal sphincter injury (OASI) included, 100 (41.8%) had EUAS evidence of sphincter defects. Only 20% with secondary repair failure were symptomatic with faecal or flatal incontinence at a mean follow-up of 23.4 months postpartum. Patients with secondary repair failure had lower anal resting (p = 0.006) and maximum squeeze pressures compared with patients with intact repairs (p < 0.001). In terms of variables that were investigated, namely location, operator hierarchy, type of repair and material used, none had a statistically significant correlation with secondary repair failure of OASI. Postpartum complications had an overall incidence of 12.7%, and those with any complication were found to have an increased rate of secondary failure of repair (p = 0.157). CONCLUSION: Using EAUS to confirm secondary failure of repair, incidence was 41.4% in this cohort. There were no identifiable modifiable variables that reduced the risk of secondary failure of repair. Further prospective research with increased sample size and longer follow-up periods is required to assess the validity of the findings.

Sensitivity of pre-operative imaging and radiologist inter-rater reliability in detecting lesions in Crohn's disease.

BACKGROUND: Computed tomography (CT), computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are commonly used pre-operatively in surgical planning in Crohn's Disease (CD). The findings on CT, CTE and MRE may not, however, correlate with operative findings. This study aims to establish the sensitivity of these imaging modalities and analyse radiologist inter-rater reliability by comparing imaging findings of strictures, fistulas and abscesses with intra-operative findings. METHODS: A retrospective review of CD patients who had either CT, CTE and/or MRE imaging and CD related surgical intervention at a public health service from 2010 to 2019 inclusive. The number and locations of strictures, fistulas and abscesses on pre-operative original radiology reports (OR) were recorded. Subsequently, all scans were re-read by two specialist abdominal radiologists and consensus recorded (SR). Lesions recorded from both OR and SR were compared to those found intra-operatively. RESULTS: Eighty-three patients were included. For strictures, sensitivity was 67%, 74% and 79% for OR and 88%, 71% and 87% for SR for CT, CTE and MRE respectively. The frequency of fistulas and abscesses were small hence a conclusion could not be drawn. The level of agreement between radiologists ranged from 44% to 82% for strictures and 64 to 100% for fistulas and abscesses across all three imaging modalities. CONCLUSIONS: CT and MRE have similarly high sensitivities for the identification of strictures pre-operatively when read by specialist radiologists. Inter-rater reliability calculations found similar agreement levels between specialist radiologists and between OR and SR for strictures, fistulas and abscesses across CT, CTE and MRE.

How to do an extended totally extraperitoneal mesh repair for groin hernias.

This study describes the technique for extended view totally extraperitoneal hernia repair.

Anastomotic leaks in stage IV colorectal cancer.

BACKGROUND: The purpose of this study was to determine the anastomotic leak rate for colorectal cancer resections in patients with metastases (compared to those without), and to determine the impact of anastomotic leaks on survival. METHODS: This is a retrospective analysis of all patients who underwent resection and primary anastomosis for colorectal adenocarcinoma at a single institution between January 2002 and December 2014. RESULTS: A total of 843 patients underwent a resection and primary anastomosis for colorectal adenocarcinoma (661 colon and 182 rectal). Of these, 135 (16%) had metastases and 708 (84%) did not. Anastomotic leaks occurred in 17 of 135 (13%) patients with metastases, and in 37 of 798 (5.2%) patients without metastases (P = 0.003). Peri-operative mortality occurred in 13 of 135 (9.6%) patients with metastases, compared with 19 of 708 (2.7%) patients without metastases (P = 0.0003). Anastomotic leak was associated with a reduction in overall survival (median survival 121 months without anastomotic leak versus 66 months in patients who had an anastomotic leak (P = 0.02)). If the patients who died peri-operatively are excluded from this analysis, however, long-term mortality was similar (125 months versus 101 months; P = 0.70). CONCLUSION: Metastatic disease was associated with an increased risk of anastomotic leak and a higher peri-operative mortality rate after colorectal resections for cancer. Patients with anastomotic leaks had a higher peri-operative mortality rate, but long-term survival was unaffected beyond the peri-operative phase.