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Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis

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Abstract

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.

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Acknowledgements

Grant Support: the work was support by the grants NV16-31806A (Czech Health Research Council) and DZRVO MO1012.

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Authors and Affiliations

  1. Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic

    J. Kalvach, O. Ryska, J. Martinek, T. Hucl, J. Pazin, J. Hadac, O. Foltan, H. Kristianova, J. Ptacnik, J. Juhasova & S. Juhas

  2. Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic

    J. Kalvach, J. Pazin, J. Hadac & M. Ryska

  3. Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, UK

    O. Ryska

  4. Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

    J. Martinek & T. Hucl

  5. 1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic

    O. Foltan, H. Kristianova & J. Ptacnik

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  1. J. Kalvach
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  2. O. Ryska
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Correspondence to J. Kalvach.

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Disclosures

Drs. Kalvach Jaroslav, Ryska Ondřej, Martínek Jan, Hucl Tomáš, Pažin Jan, Hadač Jan, Foltán Ondřej, Kristiánová Hana, Ptáčník Jan, Juhásová Jana Ryska Miroslav, Juhás Štefan have no conflicts of interest or financial ties to disclose.

Ethical statement

All experiments were carried out according to the guidelines for the care and use of experimental animals and approved by the Resort Professional Commission of the Czech Academy of Science for Approval of Projects of Experiments on Animals (Approved Protocol No. 28/2015, 18/2017, 42/2018).

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Kalvach, J., Ryska, O., Martinek, J. et al. Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis. Surg Endosc 36, 4050–4056 (2022). https://doi.org/10.1007/s00464-021-08726-1

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