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Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer

Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were ident...

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Main Authors: Ramage, Lisa, Mclean, Paul, Simillis, Constantinos, Qiu, Shengyang, Kontovounisios, Christos, Tan, Emile, Tekkis, Paris
Format: Online Article Text
Language:English
Published: Springer Milan 2018
Subjects:
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866271/
https://www.ncbi.nlm.nih.gov/pubmed/29313248
http://dx.doi.org/10.1007/s13304-017-0507-z
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author Ramage, Lisa
Mclean, Paul
Simillis, Constantinos
Qiu, Shengyang
Kontovounisios, Christos
Tan, Emile
Tekkis, Paris
author_facet Ramage, Lisa
Mclean, Paul
Simillis, Constantinos
Qiu, Shengyang
Kontovounisios, Christos
Tan, Emile
Tekkis, Paris
author_sort Ramage, Lisa
collection PubMed
description Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were identified from a single-surgeon series. Included participants underwent anorectal physiology testing of anal sphincter function, in addition to completion of several questionnaires: Wexner Incontinence Score (WIS); Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ); Low Anterior Resection Syndrome (LARS) Score; SF36. Non-parametric data compared using the Mann–Whitney U test. 20 participants were included; 11 stapled and 9 handsewn. Mean follow-up was 2.95 ± 1.97 years. The mean LARS score was 21.9 ± 1.97 years in the stapled group versus 29.4 ± 9.57 in the handsewn group (p = 0.133). The Wexner incontinence score was significantly higher in the handsewn group (p = 0.0076), with a mean score of 4.6 ± 3.69 versus 10.9 ± 4.76. The incontinence domain of the BBUSQ was also significantly worse in patients with a handsewn anastomosis (p = 0.001). With the exception of general health (p = 0.035) and social functioning (p = 0.035), which were worse in the handsewn groups, the other six domains of the SF-36 showed no statistical difference between groups. Anorectal physiology scores were not significantly different. Handsewn CAA anastomosis is known to be safe and oncologically feasible. Patient selection should be vigorous, with preoperative counseling regarding the likelihood of incontinence to manage patients’ expectations and promote comparable quality of life in the long-term.
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spelling pubmed-58662712018-03-27 Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer Ramage, Lisa Mclean, Paul Simillis, Constantinos Qiu, Shengyang Kontovounisios, Christos Tan, Emile Tekkis, Paris Updates Surg Original Article Adequate oncological outcomes have been demonstrated with rectal resection and handsewn coloanal anastomosis (CAA) in tumours in close proximity to the internal anal sphincter. Our aim was to assess functional differences between handsewn CAA and ultralow stapled anastomosis. Participants were identified from a single-surgeon series. Included participants underwent anorectal physiology testing of anal sphincter function, in addition to completion of several questionnaires: Wexner Incontinence Score (WIS); Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ); Low Anterior Resection Syndrome (LARS) Score; SF36. Non-parametric data compared using the Mann–Whitney U test. 20 participants were included; 11 stapled and 9 handsewn. Mean follow-up was 2.95 ± 1.97 years. The mean LARS score was 21.9 ± 1.97 years in the stapled group versus 29.4 ± 9.57 in the handsewn group (p = 0.133). The Wexner incontinence score was significantly higher in the handsewn group (p = 0.0076), with a mean score of 4.6 ± 3.69 versus 10.9 ± 4.76. The incontinence domain of the BBUSQ was also significantly worse in patients with a handsewn anastomosis (p = 0.001). With the exception of general health (p = 0.035) and social functioning (p = 0.035), which were worse in the handsewn groups, the other six domains of the SF-36 showed no statistical difference between groups. Anorectal physiology scores were not significantly different. Handsewn CAA anastomosis is known to be safe and oncologically feasible. Patient selection should be vigorous, with preoperative counseling regarding the likelihood of incontinence to manage patients’ expectations and promote comparable quality of life in the long-term. Springer Milan 2018-01-08 2018 /pmc/articles/PMC5866271/ /pubmed/29313248 http://dx.doi.org/10.1007/s13304-017-0507-z Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Ramage, Lisa
Mclean, Paul
Simillis, Constantinos
Qiu, Shengyang
Kontovounisios, Christos
Tan, Emile
Tekkis, Paris
Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title_full Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title_fullStr Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title_full_unstemmed Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title_short Functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
title_sort functional outcomes with handsewn versus stapled anastomoses in the treatment of ultralow rectal cancer
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866271/
https://www.ncbi.nlm.nih.gov/pubmed/29313248
http://dx.doi.org/10.1007/s13304-017-0507-z
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