Background

Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair.

Methods

A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day.

Results

Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14).

Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110–300) mmHg in TAMIS and 200 (100–300) mmHg in ENDO group (p = 0.644).

Conclusion

In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.

中文翻译：

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经肛门修复裂开低位直肠吻合术两种新技术的随机实验研究

背景

低位前直肠切除术后吻合口漏是一种可怕的并发症。早期诊断、脓毒症的及时处理以及吻合口缺损的闭合可能会增加吻合口抢救的机会。在这项随机实验研究中，我们评估了两种不同的经肛门吻合修复方法。

方法

在 42 只雄性猪中创建吻合口漏模型。腹腔镜下低位前切除术使用圆形吻合器进行吻合，其中一半的吻合钉被移除。两天后，动物被随机分为 TAMIS（经肛门微创手术）修复、内窥镜缝合 (ENDO) 或不进行治疗的对照组 (CONTROL)。在术后第 9 天处死动物后，评估腹内感染 (IAI) 迹象、宏观吻合口愈合和爆裂试验以评估闭合质量。

结果

关闭所有 28 只动物在技术上都是可行的。在内窥镜闭合后四天和五天，由于进行性败血症，两只动物不得不被安乐死。在 TAMIS 和 ENDO 组中分别有 10/14 和 11/14 只动物观察到没有可见缺陷的愈合吻合，而在 CONTROL 组中为 2/14 ( p  < 0.05)。 与 CONTROL (12/14) 相比，TAMIS (4/14；p  = 0.006) 和 ENDO (5/14；p = 0.018) 的总体 IAI 率显着降低。

爆破试验证实愈合吻合口密封闭合，TAMIS 组的中位失效压力为 190 (110-300) mmHg，ENDO 组为 200 (100-300) mmHg ( p  = 0.644)。

结论

在这项随机实验研究中，我们发现这两种评估技术在裂开性结直肠吻合术的早期修复中均有效，愈合率高。