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  1. Article ; Online: Surgical management of rectal cancer with synchronous treatment of prostate cancer.

    Brière, Raphaëlle / Martin, André-Guy / Letarte, François / Fournier, François Rouleau / Bouchard, Philippe / Drolet, Sébastien

    Langenbeck's archives of surgery

    2024  Volume 409, Issue 1, Page(s) 133

    Abstract: Purpose: To assess the safety and efficacy of synchronous treatments for rectal (RC) and prostate (PC) cancers.: Methods: Single-center retrospective study (2007-2021) of patients treated with neoadjuvant radiotherapy (RT) and total mesorectal ... ...

    Abstract Purpose: To assess the safety and efficacy of synchronous treatments for rectal (RC) and prostate (PC) cancers.
    Methods: Single-center retrospective study (2007-2021) of patients treated with neoadjuvant radiotherapy (RT) and total mesorectal excision (TME) for RC with synchronous PC treatment. The endpoints were 30-day postoperative severe complications, R0 resection rates, 3-year disease-free survival (DFS) and 3-year overall survival (OS).
    Results: Among the 16 patients, 15 (93.7%) received neoadjuvant pelvic RT (40-50.4 Gray) followed by either transperineal high dose rate prostate brachytherapy (62.5%), prostate external RT boost (25.0%), or androgen deprivation therapy (ADT) alone (6.3%). One (6.3%) patient received neoadjuvant rectal brachytherapy and ADT. Pelvic RT was combined with chemotherapy in 87.5% of cases. TME was performed in all patients with low anterior resection (87.5%) or abdominoperineal resection (12.5%), primarily using minimally invasive surgery (87.5%). The R0 resection rate was 93.8%. Six (37.5%) patients experienced 30-day Clavien-Dindo grade IIIb complications, including one (7.1%) anastomotic leak. After a median follow-up of 39.0 months, 63.6% of diverting ileostomies were reversed. Three-year DFS from RC was 71.4% (CI 40.2-88.3) and 3-year OS was 84.4% (CI 95% 50.4-95.9). No PC recurrence or death occurred.
    Conclusions: Synchronous management of RC and PC with pelvic RT followed by curative prostate RT doses and TME showed acceptable morbidity and oncologic results. Prostate brachytherapy, the most commonly used treatment modality, allowed avoidance of prostatectomy and additional external RT to the rectum. PC should not limit the curative intent of RC, as all recurrences were from rectal origin.
    MeSH term(s) Male ; Humans ; Prostatic Neoplasms/radiotherapy ; Prostatic Neoplasms/surgery ; Androgen Antagonists/therapeutic use ; Retrospective Studies ; Follow-Up Studies ; Rectal Neoplasms/surgery ; Rectal Neoplasms/radiotherapy ; Neoadjuvant Therapy ; Treatment Outcome
    Chemical Substances Androgen Antagonists
    Language English
    Publishing date 2024-04-20
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1423681-3
    ISSN 1435-2451 ; 1435-2443
    ISSN (online) 1435-2451
    ISSN 1435-2443
    DOI 10.1007/s00423-024-03327-7
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  2. Article: Treatment of acute otitis media (early childhood).

    LETARTE, F

    Laval medical

    2010  Volume 11, Page(s) 577–580

    Title translation Traitement de l'otite moyenne aiguë (première enfance).
    MeSH term(s) Otitis Media/therapy
    Language French
    Publishing date 2010-08-27
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 411910-1
    ISSN 0023-9046
    ISSN 0023-9046
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  3. Article ; Online: Salvage TME following TEM: a possible indication for TaTME.

    Letarte, F / Raval, M / Karimuddin, A / Phang, P T / Brown, C J

    Techniques in coloproctology

    2018  Volume 22, Issue 5, Page(s) 355–361

    Abstract: Background: Salvage surgery after transanal endoscopic microsurgery (TEM) has shown mixed results. Transanal total mesorectal excision (TaTME) might be advantageous in this population. The aim of this study was to assess the short-term oncologic and ... ...

    Abstract Background: Salvage surgery after transanal endoscopic microsurgery (TEM) has shown mixed results. Transanal total mesorectal excision (TaTME) might be advantageous in this population. The aim of this study was to assess the short-term oncologic and operative outcomes of salvage surgery after TEM, comparing TaTME to conventional salavge TME (sTME).
    Methods: Consecutive patients treated with salvage surgery after TEM were identified. Patients who underwent TaTME were compared to those who had conventional sTME. The primary outcome was the ability to perform an appropriate oncologic procedure defined by a composite outcome (negative distal margins, negative radial margins and complete or near complete mesorectum specimen).
    Results: During the study period, 41 patients had salvage surgery after TEM. Of those, 11 patients had TaTME while 30 patients had sTME. All patients in the TaTME group met the composite outcome of appropriate oncologic procedure compared to 76.7% for the conventional sTME group (p = 0.19). TaTME was associated with significantly higher rates of sphincter preservation (100 vs. 50%, p = 0.01), higher rates of laparoscopic surgery (100 vs. 23.3%, p < 0.001) and lower rates of conversion to open surgery (9.1 vs. 57%, p < 0.001). No difference was found in postoperative morbidity (36.3 vs. 36.7%, p = 0.77).
    Conclusions: The present study demonstrates that for patients requiring salvage surgery after TEM, TaTME is associated with significantly higher rates of sphincter-sparing surgery when compared to conventional transabdominal TME while producing adequate short-term oncologic outcomes. Salvage surgery after TEM might be a clear indication for TaTME rather than conventional surgery.
    MeSH term(s) Aged ; Anal Canal/surgery ; Conversion to Open Surgery/statistics & numerical data ; Female ; Humans ; Laparoscopy/statistics & numerical data ; Male ; Mesocolon/surgery ; Middle Aged ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies ; Salvage Therapy/methods ; Transanal Endoscopic Microsurgery/methods ; Treatment Outcome
    Keywords covid19
    Language English
    Publishing date 2018-05-04
    Publishing country Italy
    Document type Comparative Study ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-018-1784-3
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  4. Article: Recurrence following transanal total mesorectal excision for rectal cancer: a monocentric retrospective series of technically difficult cases.

    Frigault, Jonathan / Morin, Geneviève / Drolet, Sébastien / Bouchard, Philippe / Bouchard, Alexandre / Ngo, Thanh-Quan Philips / Letarte, François

    Annals of coloproctology

    2022  Volume 39, Issue 4, Page(s) 332–341

    Abstract: Purpose: Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate ...

    Abstract Purpose: Transanal total mesorectal excision (TaTME) has been proposed to overcome surgical difficulties encountered during rectal resection, especially for patients having high body mass index or low rectal cancer. The aim of this study was to evaluate oncologic outcomes following TaTME.
    Methods: This retrospective study included all consecutive patients with rectal cancer who had a TaTME from 2013 to 2019. The main outcome was the incidence of locoregional recurrence by the end of the follow-up period.
    Results: Among a total of 81 patients, 96.3% were male, and their mean age was 63±9 years. The mean body mass index was 30.3±5.7 kg/m2, and the median distance from tumor to anal verge was 5.0 cm (interquartile range [IQR], 4.0-6.0 cm). Most patients had a low anterior resection performed (n=80, 98.8%) with a diverting ileostomy (n=64, 79.0%). Distal and circumferential resection margins were positive in 2.5% and 6.2% of patients, respectively. Total mesorectal excision was complete or near complete in 95.1% of patients. A successful resection was achieved in 72 patients (88.9%). After a median follow-up of 27.5 months (IQR, 16.7-48.1 months), 4 patients (4.9%) experienced locoregional recurrence. Anastomotic leaks were observed in 21 patients (25.9%). At the end of the follow-up, 69 patients (85.2%) were stoma-free.
    Conclusion: TaTME was associated with acceptable oncological outcomes, including low locoregional recurrence rates in selected patients with low rectal cancer. Although associated with a high incidence of postoperative morbidities, the use of TaTME enabled a high rate of successful sphincter-saving procedures in selected patients who posed a technical challenge.
    Language English
    Publishing date 2022-11-14
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2711906-3
    ISSN 2287-9722 ; 2287-9714
    ISSN (online) 2287-9722
    ISSN 2287-9714
    DOI 10.3393/ac.2022.00178.0025
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  5. Article ; Online: Prediction model and web-based risk calculator for postoperative ileus after loop ileostomy closure.

    Garfinkle, R / Filion, K B / Bhatnagar, S / Sigler, G / Banks, A / Letarte, F / Liberman, S / Brown, C J / Boutros, M

    The British journal of surgery

    2019  Volume 106, Issue 12, Page(s) 1676–1684

    Abstract: Background: Postoperative ileus (POI) is a significant complication after loop ileostomy closure given both its frequency and impact on the patient. The purpose of this study was to develop and externally validate a prediction model for POI after loop ... ...

    Abstract Background: Postoperative ileus (POI) is a significant complication after loop ileostomy closure given both its frequency and impact on the patient. The purpose of this study was to develop and externally validate a prediction model for POI after loop ileostomy closure.
    Methods: The model was developed and validated according to the TRIPOD checklist for prediction model development and validation. The development cohort included consecutive patients who underwent loop ileostomy closure in two teaching hospitals in Montreal, Canada. Candidate variables considered for inclusion in the model were chosen a priori based on subject knowledge. The final prediction model, which modelled the 30-day cumulative incidence of POI using logistic regression, was selected using the highest area under the receiver operating characteristic curve (AUC) criterion. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. The model was then validated externally in an independent cohort of similar patients from the University of British Columbia.
    Results: The development cohort included 531 patients, in whom the incidence of POI was 16·8 per cent. The final model included five variables: age, ASA fitness grade, underlying pathology/treatment, interval between ileostomy creation and closure, and duration of surgery for ileostomy closure (AUC 0·68, 95 per cent c.i. 0·61 to 0·74). The model demonstrated good calibration (P = 0·142). The validation cohort consisted of 216 patients, and the incidence of POI was 15·7 per cent. On external validation, the model maintained good discrimination (AUC 0·72, 0·63 to 0·81) and calibration (P = 0·538).
    Conclusion: A prediction model was developed for POI after loop ileostomy closure and included five variables. The model maintained good performance on external validation.
    MeSH term(s) Aged ; Clinical Decision-Making ; Female ; Humans ; Ileostomy/adverse effects ; Ileus/etiology ; Male ; Middle Aged ; Models, Statistical ; Postoperative Complications ; Probability ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity
    Language English
    Publishing date 2019-07-17
    Publishing country England
    Document type Journal Article ; Validation Study
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11235
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  6. Article ; Online: Loop Ileostomy Closure as a 23-Hour Stay Procedure With Preoperative Efferent Limb Enteral Stimulation: A Randomized Controlled Trial.

    Charbonneau, Janyssa / Morin, Geneviève / Paré, Xavier G / Frigault, Jonathan / Drolet, Sébastien / Bouchard, Alexandre / Rouleau-Fournier, François / Bouchard, Philippe / Thibault, Claude / Letarte, François

    Diseases of the colon and rectum

    2023  Volume 67, Issue 3, Page(s) 466–475

    Abstract: Background: Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with a low complication rate, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates ... ...

    Abstract Background: Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with a low complication rate, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery.
    Objectives: This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway.
    Design: Randomized controlled trial.
    Settings: Two high-volume colorectal surgery centers.
    Patients: Healthy adults undergoing elective ileostomy closure from July 2019 to January 2022.
    Intervention: All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure, including daily irrigation of efferent limb with a nutritional formula for 7 days before surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24).
    Main outcome measures: Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, and postoperative morbidity and mortality.
    Results: A total of 47 patients were ultimately randomly allocated. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 vs 2 days, p = 0.02) and similar rates of readmission (4% vs 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0% vs 4%, p = 0.49), postoperative morbidity (21% vs 22%, p = 1.00), and mortality (none in both arms).
    Limitations: Due to coronavirus disease 2019, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power.
    Conclusion: Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through the stoma's efferent limb, although specific randomized controlled trials are needed to confirm this association. See Video Abstract .
    Cierre de ileostoma en asa como procedimiento ambulatorio de horas con estmulo preoperatorio enteral eferente estudio aleatorio controlado: ANTECEDENTES:El cierre de la ileostomía en asa es un procedimiento común en la cirugía colorrectal. A menudo vista como una operación simple asociada con bajas tasas de complicaciones, aún conduce a largas hospitalizaciones. La reducción de las complicaciones postoperatorias y las tasas de íleo podría conducir a una estadía hospitalaria más corta o incluso a una cirugía ambulatoria.OBJETIVOS:El presente estudio pretende evaluar la seguridad y la viabilidad del cierre de ileostomía realizadas en un entorno de hospitalización de 23 horas utilizando una vía de recuperación mejorada y estandarizada.DISEÑO:Estudio aleatorio controladoAJUSTES:Dos centros de cirugía colorrectal de gran volúmenPACIENTES:Adultos sanos sometidos a cierre electivo de ileostomía, desde Julio de 2019 hasta Enero de 2022.INTERVENCIÓN:Todos los pacientes fueron inscritos en una vía de recuperación mejorada y estandarizada específica para el cierre de la ileostomía, incluyendo la irrigación diaria de la extremidad eferente del intestino asociada a una fórmula nutricional durante 7 días previos a la cirugía. Los pacientes fueron asignados aleatoriamente en hospitalización convencional (n = 23) o a una estadía de 23 horas (n = 24).PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la duración total de la estadía hospitalaria y los resultados secundarios fueron las tasas de reingreso a los 30 días, el íleo postoperatorio, las infecciones de la herida quirúrgica, la morbilidad y mortalidad postoperatorias.RESULTADOS:Finalmente fueron randomizados un total de 47 pacientes. Aquellos que se encontraban en el grupo de hospitalización de 23 horas tuvieron una estadía media más corta (1 día versus 2 días, p = 0,02) y tasas similares de reingreso (4% vs 13%, p = 0,35), de íleo postoperatorio (ninguno en ambos brazos), de infección del sitio quirúrgico (0 vs 4%, p = 0,49), de morbilidad postoperatoria (21% vs 22%, p > 0,99) y de mortalidad (ninguna en ambos brazos).LIMITACIONES:Debido a la pandemia SARS CoV-2, el acceso a las camas quirúrgicas fue muy limitado, lo que llevó a un cambio hacia la cirugía ambulatoria para el cierre de ileostomías. El estudio finalizó anticipadamente, lo que afectó su poder estadístico.CONCLUSIÓN:Los cierres de ileostomía en asa como procedimientos de estadía de 23 horas son factibles y seguros. La tasa de íleo podría reducirse mediante la estimulación intestinal preoperatoria a través de la rama eferente del estoma asociada a fórmulas nutricionales, por lo que se necesitan estudios randomizados específicos para confirmar esta asociación. (Traducción-Dr. Xavier Delgadillo ).
    MeSH term(s) Adult ; Humans ; Digestive System Surgical Procedures ; Hospitalization ; Ileostomy ; Ileus/epidemiology ; Ileus/prevention & control ; Postoperative Complications/epidemiology ; Retrospective Studies ; Surgical Wound Infection
    Language English
    Publishing date 2023-11-16
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Video-Audio Media
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000003111
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  7. Article ; Online: Transanal endoscopic microsurgery for rectal villous tumours: Can we rely solely on preoperative biopsies and the surgeon’s experience?

    Letarte, François / Drolet, Sébastien / Laliberté, Anne-Sophie / Bouchard, Philippe / Bouchard, Alexandre

    Canadian journal of surgery. Journal canadien de chirurgie

    2019  Volume 62, Issue 6, Page(s) 454–459

    Abstract: Background: Transanal endoscopic microsurgery has become the standard of treatment for rectal villous adenomas. However, the role of preoperative imaging for these lesions is not clear. The aim of this study was to compare the value of preoperative ... ...

    Abstract Background: Transanal endoscopic microsurgery has become the standard of treatment for rectal villous adenomas. However, the role of preoperative imaging for these lesions is not clear. The aim of this study was to compare the value of preoperative imaging and surgeon clinical staging in the preoperative evaluation of patients with rectal villous adenomas having transanal endoscopic microsurgery resection.
    Methods: We conducted a single-centre comparative retrospective cohort study of patients who underwent transanal endoscopic microsurgery surgery for rectal villous adenomas from 2011 to 2013. The intervention was preoperative imaging versus surgeon clinical staging. The primary outcome was the accuracy of clinical staging by preoperative imaging and surgeon clinical staging according to the histopathologic staging.
    Results: A total of 146 patients underwent transanal endoscopic microsurgery surgery for rectal villous adenomas. One hundred and twelve (76.7%) of those patients had no preoperative imaging while 34 patients (23.3%) had either endorectal ultrasound (22 patients) or magnetic resonance imaging (12 patients). Surgeon staging was accurate in 89.3% of cases whereas staging by endorectal ultrasound was accurate in 40.9% cases and magnetic resonance imaging was accurate in 0% of cases. In the imaging group, inaccurate staging would have led to unnecessary radical surgery in 44.0% of patients.
    Conclusion: This study was subject to selection bias because of its retrospective nature and the limited number of patients with imaging. Patients with rectal villous tumours without invasive carcinoma on biopsies and without malignant characteristics on appearance in the judgment of an experienced colorectal surgeon might not benefit from preoperative imaging before undergoing transanal endoscopic microsurgery procedures.
    MeSH term(s) Adenoma, Villous/diagnostic imaging ; Adenoma, Villous/pathology ; Adenoma, Villous/surgery ; Biopsy ; Clinical Competence ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasm Staging ; Predictive Value of Tests ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Retrospective Studies ; Transanal Endoscopic Microsurgery ; Ultrasonography
    Language English
    Publishing date 2019-09-10
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 410651-9
    ISSN 1488-2310 ; 0008-428X
    ISSN (online) 1488-2310
    ISSN 0008-428X
    DOI 10.1503/cjs.012416
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  8. Article: McKittrick-Wheelock Syndrome Presenting with Acute Kidney Injury and Metabolic Alkalosis: Case Report and Narrative Review.

    Caron, Mireille / Dubrûle, Charles-Etienne / Letarte, François / Lemelin, Valéry / Lafleur, Alexandre

    Case reports in gastrointestinal medicine

    2019  Volume 2019, Page(s) 3104187

    Abstract: A rare combination of severe volume depletion and electrolyte imbalance caused by a rectal villous adenoma is often referred to as the McKittrick-Wheelock syndrome. Patients usually seek medical care because of chronic hypersecretory diarrhea and display ...

    Abstract A rare combination of severe volume depletion and electrolyte imbalance caused by a rectal villous adenoma is often referred to as the McKittrick-Wheelock syndrome. Patients usually seek medical care because of chronic hypersecretory diarrhea and display renal failure, metabolic acidosis, hyponatremia, and hypokalemia. We report the case of a 68-year-old woman who presented with this condition but showed unusual features such as severe hypokalemia and metabolic alkalosis, without diarrhea. She subsequently underwent transanal endoscopic microsurgery (TEMS), an innovative procedure in the management of large rectal adenomas. We also provide a narrative review of the literature on this rare entity.
    Language English
    Publishing date 2019-01-31
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2627636-7
    ISSN 2090-6536 ; 2090-6528
    ISSN (online) 2090-6536
    ISSN 2090-6528
    DOI 10.1155/2019/3104187
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  9. Article ; Online: Assessing the safety and outcomes of repeat transanal endoscopic microsurgery.

    Ramkumar, Jonathan / Letarte, Francois / Karimuddin, Ahmer A / Phang, P Terry / Raval, Manoj J / Brown, Carl J

    Surgical endoscopy

    2019  Volume 33, Issue 6, Page(s) 1976–1980

    Abstract: Background: Transanal endoscopic microsurgery (TEM) is the treatment of choice for benign rectal tumors and select early rectal cancers. This surgical approach has become ubiquitous and surgeons are seeing recurrent lesions after TEM resection. This ... ...

    Abstract Background: Transanal endoscopic microsurgery (TEM) is the treatment of choice for benign rectal tumors and select early rectal cancers. This surgical approach has become ubiquitous and surgeons are seeing recurrent lesions after TEM resection. This study aims to outline the safety and outcomes of repeat TEM when compared to primary TEM procedures.
    Methods: At St. Paul's Hospital, demographic, surgical, pathologic, and follow-up data for patients treated by TEM are maintained in a prospectively populated database. Two groups were established for comparison: patients undergoing first TEM procedure (TEM-P) and patients undergoing repeat TEM procedure (TEM-R).
    Results: Between 2007 and 2017, 669 patients had their first TEM procedure. Over this time frame, 57 of these patients required repeat TEM procedures, including 15 of these patients treated by 3 or more TEMs. Indications for repeat TEM included recurrence (78%), positive margins (15%), and metachronous lesions (7%). There were no differences between the groups in patient age, gender, or tumor histology. Compared to TEM-P, TEM-R had shorter operative times (38 vs. 52 min, p < 0.001), more distal lesions (5 vs. 7 cm, p < 0.004), and smaller lesions (3 vs. 4 cm, p < 0.0003). The TEM-R group had similar length of hospital stay (0.45 vs. 0.56 days, p = 0.65), rates of clear margins on pathology (81% vs. 88%, p = 0.09), and 30-day readmission rates (7% vs. 4%, p = 0.27) when compared to TEM-P group. TEM-R was more likely to be managed without suturing the surgical defect (72% vs. 32%, p < 0.0001). Repeat TEM was associated with similar post-operative complications as primary TEM graded on the Clavien-Dindo classification scale (Grade 1: 5% vs. 5%, Grade 2: 5% vs. 4%, Grade 3: 5% vs. 1%, p = 0.53). No 30-day mortality occurred in either group.
    Conclusions: The St. Paul's Hospital TEM experience suggests repeat TEM is a safe and feasible procedure with similar outcomes as patients undergoing first TEM.
    MeSH term(s) Aged ; Feasibility Studies ; Female ; Humans ; Male ; Postoperative Complications/etiology ; Precancerous Conditions/surgery ; Rectal Neoplasms/surgery ; Safety Management ; Transanal Endoscopic Microsurgery/methods ; Treatment Outcome
    Language English
    Publishing date 2019-02-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-018-6501-9
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    ab Jg. 2022: Lesesaal (EG)

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  10. Article: Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study of anastomotic complications.

    Frigault, Jonathan / Avoine, Samuel / Drolet, Sébastien / Letarte, François / Bouchard, Alexandre / Gagné, Jean-Pierre / Thibault, Claude / Grégoire, Roger C / Bouthillette, Naomee Jutras / Gosselin, Maude / Bouchard, Philippe

    Annals of coloproctology

    2022  Volume 39, Issue 2, Page(s) 147–155

    Abstract: Purpose: Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on ... ...

    Abstract Purpose: Laparoscopic right hemicolectomy (LRH) can be performed with an intracorporeal anastomosis (IA) or extracorporeal anastomosis (EA). It is not clear which technique is best. This study evaluated the impact of each anastomosis technique on perioperative safety and postoperative evolution.
    Methods: We performed a retrospective study at a tertiary colorectal surgery center. All patients who had an elective LRH from 2015 to 2019 were analyzed according to the anastomosis technique used.
    Results: In total, 285 patients were included in the study. IA was performed in 64 patients (22.5%). Mean operative time was longer in the patients with IA (IA, 160±31 minutes vs. EA, 138±42 minutes; P<0.001). No differences were observed in intraoperative complications, time to first bowel movement, length of stay, reoperation, or rehospitalization. Time to first flatus was longer in the patients with IA (P=0.049). At 30 days after surgery, there were no differences in the frequency of anastomotic leak (IA, 0% vs. EA, 2.3%; P=0.59), bleeding (IA, 3.1% vs. EA, 2.7%; P>0.99), or intraabdominal abscess (IA, 0% vs. EA, 0.5%; P>0.99). During follow-up, we noted more incisional hernias in patients with EA (IA, 1.6% vs. EA, 11.3%; P=0.01) and a trend toward more hernia in patients with EA in multivariate analysis (hazard ratio, 7.13; P=0.06). Anastomosis technique had no influence on recurrence.
    Conclusion: For LRH, both IA and EA are safe, with a low incidence of complications when performed by experienced surgeons. IA may be associated with a lower incidence of incisional hernia.
    Language English
    Publishing date 2022-03-29
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2711906-3
    ISSN 2287-9722 ; 2287-9714
    ISSN (online) 2287-9722
    ISSN 2287-9714
    DOI 10.3393/ac.2021.00983.0140
    Database MEDical Literature Analysis and Retrieval System OnLINE

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