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Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection

The occurrence of anastomotic leakage (AL) remains a major concern in the early postoperative stage. Because of the relatively high morbidity and mortality of AL in patients with laparoscopic low rectal cancer who receive an anterior resection, a fecal diverting method is usually introduced. The Val...

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Autores principales: Ye, Feng, Chen, Dong, Wang, Danyang, Lin, Jianjiang, Zheng, Shusen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602602/
https://www.ncbi.nlm.nih.gov/pubmed/25546660
http://dx.doi.org/10.1097/MD.0000000000000224
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author Ye, Feng
Chen, Dong
Wang, Danyang
Lin, Jianjiang
Zheng, Shusen
author_facet Ye, Feng
Chen, Dong
Wang, Danyang
Lin, Jianjiang
Zheng, Shusen
author_sort Ye, Feng
collection PubMed
description The occurrence of anastomotic leakage (AL) remains a major concern in the early postoperative stage. Because of the relatively high morbidity and mortality of AL in patients with laparoscopic low rectal cancer who receive an anterior resection, a fecal diverting method is usually introduced. The Valtrac™-secured intracolonic bypass (VIB) was used in open rectal resection, and played a role of protecting the anastomotic site. This study was designed to assess the efficacy and safety of the VIB in protecting laparoscopic low rectal anastomosis and to compare the efficacy and complications of VIB with those of loop ileostomy (LI). Medical records of the 43 patients with rectal cancer who underwent elective laparoscopic low anterior resection and received VIB procedure or LI between May 2011 and May 2013 were retrospectively analyzed, including the patients’ demographics, clinical features, and operative data. Twenty-four patients received a VIB and 19 patients a LI procedure. Most of the demographics and clinical features of the groups, including Dukes stages, were similar. However, the median distance of the tumor edge from the anus verge in the VIB group was significantly longer (7.5 cm; inter-quartile range [IQR] 7.0–9.5 cm) than that of the L1 group (6.0 cm; IQR 6.0–7.0 cm). None of the patients developed clinical AL. The comparisons between the LI and the VIB groups were adjusted for the significant differences in the tumor level of the groups. After adjustment, the LI group experienced longer overall postoperative hospital stay (14.0 days, IQR: 12.0, 16.0 days; P < 0.001) and incurred higher costs ($6300 (IQR: $5900, $6600)) than the VIB group (7.0 days, $4800; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (n = 2), stoma bleeding (n = 1), and wound infection after closure (n = 2). No BAR-related complications occurred. The mean time to Valtrac™ ring loosening was 14.1 ± 3.2 days. The VIB procedure, as a good partner with the laparoscopic rectal cancer resection, appears to be a safe and effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis.
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spelling pubmed-46026022015-10-27 Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection Ye, Feng Chen, Dong Wang, Danyang Lin, Jianjiang Zheng, Shusen Medicine (Baltimore) 7100 The occurrence of anastomotic leakage (AL) remains a major concern in the early postoperative stage. Because of the relatively high morbidity and mortality of AL in patients with laparoscopic low rectal cancer who receive an anterior resection, a fecal diverting method is usually introduced. The Valtrac™-secured intracolonic bypass (VIB) was used in open rectal resection, and played a role of protecting the anastomotic site. This study was designed to assess the efficacy and safety of the VIB in protecting laparoscopic low rectal anastomosis and to compare the efficacy and complications of VIB with those of loop ileostomy (LI). Medical records of the 43 patients with rectal cancer who underwent elective laparoscopic low anterior resection and received VIB procedure or LI between May 2011 and May 2013 were retrospectively analyzed, including the patients’ demographics, clinical features, and operative data. Twenty-four patients received a VIB and 19 patients a LI procedure. Most of the demographics and clinical features of the groups, including Dukes stages, were similar. However, the median distance of the tumor edge from the anus verge in the VIB group was significantly longer (7.5 cm; inter-quartile range [IQR] 7.0–9.5 cm) than that of the L1 group (6.0 cm; IQR 6.0–7.0 cm). None of the patients developed clinical AL. The comparisons between the LI and the VIB groups were adjusted for the significant differences in the tumor level of the groups. After adjustment, the LI group experienced longer overall postoperative hospital stay (14.0 days, IQR: 12.0, 16.0 days; P < 0.001) and incurred higher costs ($6300 (IQR: $5900, $6600)) than the VIB group (7.0 days, $4800; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (n = 2), stoma bleeding (n = 1), and wound infection after closure (n = 2). No BAR-related complications occurred. The mean time to Valtrac™ ring loosening was 14.1 ± 3.2 days. The VIB procedure, as a good partner with the laparoscopic rectal cancer resection, appears to be a safe and effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis. Wolters Kluwer Health 2014-12-02 /pmc/articles/PMC4602602/ /pubmed/25546660 http://dx.doi.org/10.1097/MD.0000000000000224 Text en Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 7100
Ye, Feng
Chen, Dong
Wang, Danyang
Lin, Jianjiang
Zheng, Shusen
Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title_full Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title_fullStr Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title_full_unstemmed Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title_short Use of Valtrac™-Secured Intracolonic Bypass in Laparoscopic Rectal Cancer Resection
title_sort use of valtrac™-secured intracolonic bypass in laparoscopic rectal cancer resection
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602602/
https://www.ncbi.nlm.nih.gov/pubmed/25546660
http://dx.doi.org/10.1097/MD.0000000000000224
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