Modified delayed coloanal anastomosis following TME for mid and low rectal cancer: 19 consecutive patients from a single center.

Surgery and management of rectal cancer have made significant progress in recent decades. However, there is still no coloanal anastomosis technique that offers a good compromise between functionality and low morbidity. The aim of this study is to evaluate the safety and efficiency of the modified delayed coloanal anastomosis (mDCA). In this retrospective study, we analyzed the morbi-mortality as well as functional outcomes of 19 patients treated with mDCA, out of 73 colorectal cancer patients treated at our institution from September 2021 to June 2023. The inclusion criteria were cancer of the mid and low rectum (tumor less than 10 cm from the anal verge). Morbidity represented by complications of Clavien-Dindo grade III or higher was estimated at 5.2%. Only one patient experienced an asymptomatic anastomotic leak (AL) grade A. Ischemia of the colonic stump occurred in one patient, taken back to the OR on the 5th postoperative day. No stump retraction was noted. Anastomotic stenosis appeared in one patient (5.2%) during the 90-day postoperative period, and was treated by instrumental dilation. Perioperative mortality was nil. The mean St Marks incontinence score at 90 days was 13.2 points. At the 3-month follow-up, 15 patients (78.9%) had major low anterior resection syndrome (LARS), three (15.7%) had minor LARS, and one patient (5.2%) had no LARS. None of the patients had a diversion loop ileostomy. The mDCA, by decreasing the rate of AL, without the need for diversion ileostomy, might be an interesting alternative to the conventional immediate coloanal anastomosis (ICA), for restoring the GI tract after proctectomy for cancer.

Scarless two-stage delayed coloanal anastomosis: a technique description

Introduction: In current clinical practice, immediate coloanal anastomosis (ICA) remains the standard technique for restoring the gastrointestinal tract following coloproctectomy for low rectal cancer. This anastomosis still requires a temporary diverting stoma to decrease the postoperative morbidity, which remains significantly high. As an alternative, some authors have proposed a two-stage delayed coloanal anastomosis (TS-DCA). This article reports on the surgical technique of TS-DCA. Methods: The case described is of a 53-year-old woman, without any particular history, in whom colonoscopy motivated by rectal bleeding revealed an adenocarcinoma of the low rectum. Magnetic resonance imaging showed a tumor ~ 1 cm above the puborectalis muscle, graded cT3N +. The extension workup was negative. Seven weeks after chemoradiotherapy, a coloproctectomy with total mesorectal excision (TME) was performed. A TS-DCA was chosen to restore the digestive tract. Conclusion: Two-stage delayed coloanal anastomosis is a safe and effective alternative for restoring the digestive tract after proctectomy for low rectal cancer. Recent data seem to show a clear advantage of this technique in terms of morbidity. (AU)

A case of Right Hepatic Artery anterior to the common hepatic duct: A not so rare variation.

INTRODUCTION AND IMPORTANCE: The hepatic arteries may be subject to anatomical variations that can cause operating difficulties with a risk of iatrogenic vascular injuries. A perfect knowledge of anatomy is an essential prerequisite for both surgeons and interventional radiologists. CASE PRESENTATION: During a duodenopancreatectomy for a pancreatic head tumor in a 46-year-old man, we observed an anatomical variation regarding the course of the right hepatic artery (RHA). Indeed, RHA arose from the proper hepatic artery (PHA) at the left edge of the hepatoduodenal ligament and instead of crossing the common hepatic duct (CHD) posteriorly which is the usual course, it passed overhead before ascending and finishing its course in the liver hilum. CLINICAL DISCUSSION: Anatomical variations of the hepatic arteries can be explained by the partial or complete persistence of the fetal model. Variations in the RHA may concern its number, origin or route. A prebiliary course of the RHA has been described with a prevalence ranging from 15 to 25% depending on series. The high sensitivity of Multidetector Computed Tomographic Angiography (MCTA) allows performing a complete vascular mapping, which remains essential before any Hepato-Pancreato-Biliary (HPB) surgery. CONCLUSION: This case confirms once again the frequency of anatomical variations of the hepatic arteries, and underlines the value of CT Angiography to detect them in order to best plan any HPB surgery, where RHA remains an essential anatomical landmark that all surgeons must keep in mind in order to avoid any unfortunate incidents.