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  1. Article ; Online: Isoleucyl-tRNA synthetase levels modulate the penetrance of a homoplasmic m.4277T>C mitochondrial tRNA(Ile) mutation causing hypertrophic cardiomyopathy.

    Perli, Elena / Giordano, Carla / Tuppen, Helen A L / Montopoli, Monica / Montanari, Arianna / Orlandi, Maurizia / Pisano, Annalinda / Catanzaro, Daniela / Caparrotta, Laura / Musumeci, Beatrice / Autore, Camillo / Morea, Veronica / Di Micco, Patrizio / Campese, Antonio F / Leopizzi, Martina / Gallo, Pietro / Francisci, Silvia / Frontali, Laura / Taylor, Robert W /
    d'Amati, Giulia

    Human molecular genetics

    2011  Volume 21, Issue 1, Page(s) 85–100

    Abstract: ... with hypertrophic cardiomyopathy harboring a homoplasmic m.4277T>C mutation in the mt-tRNA(Ile) (MTTI) gene. Skeletal muscle showed ... cybrids, harboring a previously described homoplasmic m.4300A>G MTTI mutation. The pathogenic role ... of the m.4277T>C mutation may be ascribed to misfolding of the mt-tRNA molecule, as demonstrated ...

    Abstract The genetic and epigenetic factors underlying the variable penetrance of homoplasmic mitochondrial DNA mutations are poorly understood. We investigated a 16-year-old patient with hypertrophic cardiomyopathy harboring a homoplasmic m.4277T>C mutation in the mt-tRNA(Ile) (MTTI) gene. Skeletal muscle showed multiple respiratory chain enzyme abnormalities and a decreased steady-state level of the mutated mt-tRNA(Ile). Transmitochondrial cybrids grown on galactose medium demonstrated a functional effect of this mutation on cell viability, confirming pathogenicity. These findings were reproduced in transmitochondrial cybrids, harboring a previously described homoplasmic m.4300A>G MTTI mutation. The pathogenic role of the m.4277T>C mutation may be ascribed to misfolding of the mt-tRNA molecule, as demonstrated by the altered electrophoretic migration of the mutated mt-tRNA. Indeed, structure and sequence analyses suggest that thymidine at position 4277 of mt-tRNA(Ile) is involved in a conserved tertiary interaction with thymidine at position 4306. Interestingly, the mutation showed variable penetrance within family members, with skeletal muscle from the patient's clinically unaffected mother demonstrating normal muscle respiratory chain activities and steady-state levels of mt-tRNA(Ile), while homoplasmic for the m.4277T>C mutation. Analysis of mitochondrial isoleucyl-tRNA synthetase revealed significantly higher expression levels in skeletal muscle and fibroblasts of the unaffected mother when compared with the proband, while the transient over-expression of the IARS2 gene in patient transmitochondrial cybrids improved cell viability. This is the first observation that constitutively high levels of aminoacyl-tRNA synthetases (aaRSs) in human tissues prevent the phenotypic expression of a homoplasmic mt-tRNA point mutation. These findings extend previous observations on aaRSs therapeutic effects in yeast and human.
    MeSH term(s) Adolescent ; Base Sequence ; Cardiomyopathy, Hypertrophic/enzymology ; Cardiomyopathy, Hypertrophic/genetics ; DNA, Mitochondrial/genetics ; DNA, Mitochondrial/metabolism ; Humans ; Isoleucine-tRNA Ligase/genetics ; Isoleucine-tRNA Ligase/metabolism ; Male ; Mitochondria/genetics ; Mitochondria/metabolism ; Molecular Sequence Data ; Penetrance ; Point Mutation ; RNA, Transfer, Ile/genetics ; RNA, Transfer, Ile/metabolism
    Chemical Substances DNA, Mitochondrial ; RNA, Transfer, Ile ; Isoleucine-tRNA Ligase (EC 6.1.1.5)
    Language English
    Publishing date 2011-09-26
    Publishing country England
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1108742-0
    ISSN 1460-2083 ; 0964-6906
    ISSN (online) 1460-2083
    ISSN 0964-6906
    DOI 10.1093/hmg/ddr440
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: What is the best surgical option after failure of graciloplasty in patients with recurrent rectovaginal fistula? A study of 19 consecutive patients.

    Muller, O / Labiad, C / Frontali, A / Giacca, M / Monsinjon, M / Panis, Y

    Techniques in coloproctology

    2022  Volume 27, Issue 6, Page(s) 453–458

    Abstract: Background: Management of recurrent rectovaginal fistula (rRVF) remains challenging despite the good results of graciloplasty reported in the literature. However, little is known about how to avoid a permanent stoma if graciloplasty fails. The aim of ... ...

    Abstract Background: Management of recurrent rectovaginal fistula (rRVF) remains challenging despite the good results of graciloplasty reported in the literature. However, little is known about how to avoid a permanent stoma if graciloplasty fails. The aim of our study was to report the management of rRVF after failure of graciloplasty.
    Methods: A retrospective study was performed on consecutive patients with rRVF after failure of graciloplasty treated at our institution in January 2005-December 2021.
    Results: There were 19 patients, with a median age at graciloplasty of 39 years (range 25-64 years). Etiologies of RVF were Crohn's disease (CD) (n = 10), postoperative (n = 5), post-obstetrical (n = 3), and unknown (n = 1). After failure of graciloplasty, 45 new procedures were performed, all of them with a covering stoma: trans-anal repairs (n = 31), delayed colo-anal anastomosis (DCAA) (n = 4), biological mesh interposition (n = 3), second graciloplasty (n = 3), stoma only (n = 2) and redo ileal pouch-anal anastomosis (IPAA) (n = 2). One patient was not re-operated on and instead treated medically for CD. After a mean follow-up of 63 ± 49 months, success (i.e., absence of stoma or RVF) was obtained in 11 patients (58%): 4/4 DCAA (100%), 5/31 after local repair (16%), 1 after stoma creation alone (50%) and 1 after redo IPAA (50%). Second graciloplasty and biologic mesh interposition all failed. All 8 patients with failed intervention had CD.
    Conclusions: In cases of rRVF after failed graciloplasty, reoperation is possible, although the chance of success is relatively low. The best results were obtained with DCAA. CD is a predictor of poor outcome.
    MeSH term(s) Female ; Humans ; Adult ; Middle Aged ; Rectovaginal Fistula/etiology ; Rectovaginal Fistula/surgery ; Retrospective Studies ; Treatment Outcome ; Crohn Disease/complications ; Crohn Disease/surgery ; Proctocolectomy, Restorative/adverse effects ; Postoperative Complications/etiology
    Language English
    Publishing date 2022-12-27
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02742-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease.

    Guyard, C / de Ponthaud, C / Frontali, A / Monsinjon, M / Giacca, M / Panis, Y

    Techniques in coloproctology

    2022  Volume 26, Issue 6, Page(s) 443–451

    Abstract: Background: The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC).: ... ...

    Abstract Background: The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC).
    Methods: Four hundred and ten patients who underwent laparoscopic ICR for CD: 153 patients (CRP group) between June 2016 and June 2020 at our department, had a CRP-driven monitoring discharge on postoperative day (POD) 3 and were discharged on POD 4 if CRP < 100 mg/L. These patients were matched (according to age, sex, body mass index, type of CD (and stoma or not) to 257 patients who underwent laparoscopic ICR for CD between January 2009 and May 2016, without CRP monitoring (Control group). For SC, 79 patients with CRP monitoring were matched with 88 control patients. Primary outcome was overall length of hospital stay (LHS). Secondary outcomes were discharge on POD 4 for SC and POD 4 and POD 6 for ICR, 3-month postoperative overall morbidity and severe morbidity rates, surgical site infection, readmission rates, and CRP level in cases of morbidity at 3 months.
    Results: For ICR without stoma, mean LHS was significantly shorter in the CRP group than in the control group (6.9 ± 2 days vs 8.3 ± 6 days, p = 0.017). Discharge occurred on POD 6 (or before) in 73% of the patients (CRP group) vs 60% (Control group) (p = 0.027). For ICR with stoma, LHS was 8 days for both groups (p = 0.612). For SC, LHS was significantly shorter in the CRP group than in the control group (5.5 ± 3 days vs 7.1 ± 4 days; p = 0.002). Discharge occurred on POD 4 in 62% (CRP group) vs 30% (Control) (p = 0.003). Postoperative 3-month overall and severe morbidity, and rehospitalization rates were similar between groups.
    Conclusions: CRP-driven monitoring discharge strategy after laparoscopic ICR for CD is associated with a significant reduction of LHS, without increasing morbidity, reoperation or rehospitalisation rates.
    MeSH term(s) C-Reactive Protein/analysis ; Cecum/surgery ; Crohn Disease/surgery ; Humans ; Laparoscopy/adverse effects ; Length of Stay ; Postoperative Complications/etiology ; Postoperative Complications/surgery
    Chemical Substances C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2022-03-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02590-4
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Episodic Ataxias: Faux or Real?

    Giunti, Paola / Mantuano, Elide / Frontali, Marina

    International journal of molecular sciences

    2020  Volume 21, Issue 18

    Abstract: The term Episodic Ataxias (EA) was originally used for a few autosomal dominant diseases, characterized by attacks of cerebellar dysfunction of variable duration and frequency, often accompanied by other ictal and interictal signs. The original group ... ...

    Abstract The term Episodic Ataxias (EA) was originally used for a few autosomal dominant diseases, characterized by attacks of cerebellar dysfunction of variable duration and frequency, often accompanied by other ictal and interictal signs. The original group subsequently grew to include other very rare EAs, frequently reported in single families, for some of which no responsible gene was found. The clinical spectrum of these diseases has been enormously amplified over time. In addition, episodes of ataxia have been described as phenotypic variants in the context of several different disorders. The whole group is somewhat confused, since a strong evidence linking the mutation to a given phenotype has not always been established. In this review we will collect and examine all instances of ataxia episodes reported so far, emphasizing those for which the pathophysiology and the clinical spectrum is best defined.
    MeSH term(s) Ataxia/genetics ; Ataxia/metabolism ; Ataxia/physiopathology ; Calcium Channels/genetics ; Cerebellar Ataxia/genetics ; Excitatory Amino Acid Transporter 1/genetics ; Humans ; Ion Channels/genetics ; Ion Channels/metabolism ; Kv1.1 Potassium Channel/genetics ; Kv1.1 Potassium Channel/metabolism ; NAV1.2 Voltage-Gated Sodium Channel/genetics
    Chemical Substances Calcium Channels ; Excitatory Amino Acid Transporter 1 ; Ion Channels ; NAV1.2 Voltage-Gated Sodium Channel ; Kv1.1 Potassium Channel (147173-20-4)
    Language English
    Publishing date 2020-09-05
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms21186472
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Rectovaginal fistula: Risk factors for failure after graciloplasty-A bicentric retrospective European study of 61 patients.

    Frontali, Alice / Rottoli, Matteo / Chierici, Andrea / Poggioli, Gilberto / Panis, Yves

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 8, Page(s) 2113–2118

    Abstract: Aim: Graciloplasty (GP) is indicated in the case of recurrent rectovaginal fistula (RVF) after failure of previous local treatments. The aim of this study was to assess risk factors for GP failure performed for RVF.: Methods: This is a retrospective ... ...

    Abstract Aim: Graciloplasty (GP) is indicated in the case of recurrent rectovaginal fistula (RVF) after failure of previous local treatments. The aim of this study was to assess risk factors for GP failure performed for RVF.
    Methods: This is a retrospective study based on a prospective database on GP, coming from two expert centres.
    Results: Sixty-one patients undergoing a first GP for RVF (n = 51) or ileal-vaginal fistula after ileal pouch anal anastomosis (n = 10), with a mean age of 42 years (range 24-72), were analysed. After a mean follow-up of 56 ± 48 months (range 1-183), failure of GP (considered as persistent stoma and/or clinical RVF) was noted in 24/61 patients (39%). The failure rate was 43% (13/30) in the case of Crohn's disease, 38% (3/8) in the case of ileal-vaginal fistula after ileal pouch anal anastomosis for ulcerative colitis, 30% (3/10) in the case of obstetrical RVF, 33% (1/3) in the case of post radiotherapy RVF and 40% (4/10) for other causes (not significant). Two risk factors for failure of GP were found on univariate analysis: (1) absence of postoperative antibiotic prophylaxis-only 3/24 (13%) patients with failure of GP received postoperative antibiotic prophylaxis versus 18/37 (49%) patients with success of GP (P = 0.0053); (2) postoperative perineal infection-11/23 (48%) with failure of GP developed postoperative perineal infection versus only 4/37 (10%) patients with success of GP (P = 0.0021).
    Conclusions: Failure of GP for RVF is observed in approximately 40% of the patients whatever the aetiology of the fistula. A reduced failure rate was associated with systematic postoperative antibiotic prophylaxis.
    MeSH term(s) Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Proctocolectomy, Restorative ; Rectovaginal Fistula/etiology ; Rectovaginal Fistula/surgery ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult
    Language English
    Publishing date 2021-04-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15673
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Patients' perception of using telehealth for consultation: insights after pandemic and development of an online calculator platform to predict acceptance of remote consultation: the TELEMED international study.

    Sánchez-Guillén, Luis / Lillo-García, Cristina / Barber, Xavier / González-Mora, César / Álvarez-Gallego, Mario / Ioannidis, Argyrios / Clermonts, Stefan / Frontali, Alice / Saldaña, Roberto / Mayol, Julio / Pellino, Gianluca

    Updates in surgery

    2024  

    Abstract: The COVID-19 pandemic has led to a change in healthcare models. The aim of this study was to evaluate patient acceptance of telehealth as an alternative to physical consultations, and to identify factors predicting higher satisfaction. This was an ... ...

    Abstract The COVID-19 pandemic has led to a change in healthcare models. The aim of this study was to evaluate patient acceptance of telehealth as an alternative to physical consultations, and to identify factors predicting higher satisfaction. This was an observational, cross-sectional, multi-center, international study. All consecutive patients for whom telehealth was used in consultations between April and July 2020 were considered for inclusion. The validated Telehealth Usability Questionnaire (TUQ) was used as a model to measure patient acceptance. Overall, 747 patients were observed, of whom 721 agreed to participate (96·5%). The TUQ showed that 86·9% of patients agreed that telehealth was useful; 85·2% supported the interface quality and 81·4% endorsed the interaction quality. Patients aged > 60 y were less likely to agree with the use of telehealth (p < 0·05). A web-based prediction tool was generated to calculate global satisfaction and to identify patients more likely to feel comfortable with telehealth. Telehealth is feasible and allows consultations that are satisfactory for patients. Technological advancements could ease safe implementation of telehealth into everyday practice. Adequate patient selection can be useful to ensure that the ideal strategy is used for each individual during and after the pandemic.
    Language English
    Publishing date 2024-04-15
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2572692-4
    ISSN 2038-3312 ; 2038-131X
    ISSN (online) 2038-3312
    ISSN 2038-131X
    DOI 10.1007/s13304-024-01780-z
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Laparoscopic appendectomy for a large appendiceal mucinous neoplasm - A video vignette.

    Bonomi, Alessandro M / Colombo, Francesco / Frontali, Alice / Ferrario, Luca / Danelli, Piergiorgio

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 5, Page(s) 1293

    MeSH term(s) Adenocarcinoma, Mucinous/surgery ; Appendectomy ; Appendiceal Neoplasms/surgery ; Humans ; Laparoscopy
    Language English
    Publishing date 2021-03-24
    Publishing country England
    Document type Letter ; Video-Audio Media
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15612
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Monitoring of C-reactive protein decreases length of stay after laparoscopic total mesorectal excision for cancer: a prospective case-matched study in 236 patients.

    Cazelles, Antoine / Giacca, Massimo / Monsinjon, Marie / Hain, Elisabeth / Frontali, Alice / Panis, Yves

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2021  Volume 23, Issue 5, Page(s) 1158–1166

    Abstract: Aim: The aim of this study was to evaluate a discharge strategy driven by monitoring of C-reactive protein (CRP) in a homogeneous group of patients undergoing laparoscopic total mesorectal excision with sphincter-saving surgery for rectal cancer (TME).!# ...

    Abstract Aim: The aim of this study was to evaluate a discharge strategy driven by monitoring of C-reactive protein (CRP) in a homogeneous group of patients undergoing laparoscopic total mesorectal excision with sphincter-saving surgery for rectal cancer (TME).
    Method: One hundred and thirteen patients who underwent a TME had CRP monitoring on postoperative day (POD) 5. Patients were discharged on POD 6 if the CRP level was ≤100 mg/L. Patients were matched (according to age, gender, body mass index, neoadjuvant pelvic irradiation and type of anastomosis) to 123 control patients who underwent the same operation with the same postoperative care but without CRP monitoring.
    Results: Postoperative 3-month overall [CRP group 62/113 (55%) vs controls 73/123 (59%); p = 0.487] and severe (i.e. Clavien-Dindo grade 3 and above) [CRP group 17/113 (15%) vs controls 19/123 (15%); p = 0.931] morbidity rates were similar between groups. Mean length of hospital stay (LHS) was significantly shorter in the CRP group (CRP group 9.7 ± 14 days vs controls 11.6 ± 7 days; p < 0.001). Discharge occurred on POD 6 in 55/113 (49%) patients from the CRP group vs 7/123 (6%) from the control group (p < 0.001). The rehospitalization rate [CRP group 19/113 (17%) vs controls 13/123 (11%); p = 0.177] was similar between groups. The CRP level on POD 5 had a diagnostic property to assess an anastomotic leakage with an area under the curve of 0.81.
    Conclusion: In patients who underwent TME, a discharge strategy based on CRP monitoring significantly decreased LHS without increasing morbidity, mortality or rehospitalization rates.
    MeSH term(s) Anastomotic Leak/etiology ; C-Reactive Protein/analysis ; Humans ; Laparoscopy ; Length of Stay ; Rectal Neoplasms/surgery ; Treatment Outcome
    Chemical Substances C-Reactive Protein (9007-41-4)
    Language English
    Publishing date 2021-02-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.15573
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Systematic C-reactive protein monitoring reduces hospital stay after laparoscopic ileal pouch-anal anastomosis. A comparative study of 158 consecutive patients with ulcerative colitis.

    de Ponthaud, Charles / Guyard, Clémence / Blondeau, Marc / Giacca, Massimo / Monsinjon, Marie / Frontali, Alice / Panis, Yves

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  

    Abstract: Aim: C-reactive protein (CRP) is a common biomarker of inflammation which has largely been used to predict the risk of postoperative septic complications after colorectal surgery. However, no data exist concerning its potential benefit after ileal pouch- ...

    Abstract Aim: C-reactive protein (CRP) is a common biomarker of inflammation which has largely been used to predict the risk of postoperative septic complications after colorectal surgery. However, no data exist concerning its potential benefit after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The aim of this study was to evaluate a CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC.
    Methods: Since 2012, 158 patients undergoing a laparoscopic IPAA for UC have been included: 66 patients (CRP group) operated since 2016 had a CRP-driven monitoring discharge on postoperative day 5 (POD 5) and were discharged on POD 6 if CRP < 100 mg/L; these patients were matched (according to age, gender, body mass index, IPAA in two or three steps) to 92 patients operated between 2012 and 2016 without any CRP monitoring (control group).
    Results: Median length of hospital stay was shorter in the CRP than the control group (7 vs. 9 days; P < 0.001) and discharge on POD 6 occurred more frequently in the CRP group (47% vs. 7%, P < 0.001). No difference was observed between the two groups concerning overall morbidity (P = 0.980), surgical site infection (P = 0.554), Clavien-Dindo ≥ IIIa morbidity (P = 0.523), unplanned rehospitalization (P = 0.734) and 30-day reoperation (P = 0.240).
    Conclusion: CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC is associated with a significant reduction in length of hospital stay, without increasing morbidity, reoperation or rehospitalization rates.
    Language English
    Publishing date 2022-07-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16246
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Delayed pull-through coloanal anastomosis without temporary stoma: an alternative to the standard manual side-to-end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer.

    Melka, Dan / Leiritz, Elsa / Labiad, Camélia / Blondeau, Marc / Frontali, Alice / Giacca, Massimo / Monsinjon, Marie / Panis, Yves

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  Volume 24, Issue 5, Page(s) 587–593

    Abstract: Aim: After total mesorectal excision (TME) for low rectal cancer, current guideline recommendations for sphincter-saving surgery are to perform a side-to-end manual coloanal anastomosis (CAA) (or with J-pouch) with a temporary stoma. Our study aimed to ... ...

    Abstract Aim: After total mesorectal excision (TME) for low rectal cancer, current guideline recommendations for sphincter-saving surgery are to perform a side-to-end manual coloanal anastomosis (CAA) (or with J-pouch) with a temporary stoma. Our study aimed to evaluate if delayed pull-through coloanal anastomosis (DCAA) without a temporary stoma could represent a safe alternative in low rectal cancer.
    Method: From 2003 to 2020, 223 consecutive patients with low rectal cancer undergoing TME were compared: CAA and diverting stoma (n = 190) versus DCAA without stoma (n = 33).
    Results: Overall 3-month and severe (Dindo ≥ IIIb) morbidity rates were similar in CAA versus DCAA groups: 34% (65/190) vs. 36% (12/33) and 2.6% (5/190) vs. 3% (1/33), respectively. In the DCAA group, only one patient (3%) underwent reoperation (Hartmann's procedure) at day 3 due to colon necrosis. The anastomotic leakage rate (both clinical and radiological) was significantly higher after CAA than DCAA: 28% (53/190) vs. 3% (1/33; p = 0.00138). Failure of the procedure (with return to stoma) was observed in 8% (15/190) vs. 6% (2/33) of patients after CAA and DCAA respectively (not significant).
    Conclusion: Our comparative study suggested that in patients with low rectal cancer, DCAA without a temporary stoma could represent an interesting alternative to the actual recommended CAA with a temporary ileostomy. DCAA could offer two major advantages over CAA: a significantly lower rate of anastomotic leakage and absence of a temporary stoma and its potential complications (rehospitalization, dehydration, wound hernia after stoma closure).
    MeSH term(s) Anal Canal/surgery ; Anastomosis, Surgical/methods ; Anastomotic Leak/etiology ; Anastomotic Leak/surgery ; Colon/surgery ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Rectal Neoplasms/complications ; Rectal Neoplasms/surgery ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2022-02-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16069
    Database MEDical Literature Analysis and Retrieval System OnLINE

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