Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-07-17

AUTHORS

Christelle Blot, Charles Sabbagh, Lionel Rebibo, Franck Brazier, Cyril Chivot, Mathurin Fumery, Jean-Marc Regimbeau

ABSTRACT

IntroductionAnastomotic leakage (AL) is a major complication of colorectal surgery. The leakage is classified as grade B when the patient’s clinical condition requires an active therapeutic intervention but does not require further surgery. The management of grade B AL commonly includes administration of antibiotics and/or the placement of a pelvic drainage performed under radiological guidance or transanal drain. The objective of this study was to evaluate the feasibility and the efficacy of endoscopic transanastomotic drainage using double-pigtail stents (DPSs) in the management of grade B AL in colorectal surgery.Patients and methodsBetween September 2011 and December 2014, 650 patients underwent a colorectal procedure in our university hospital; 8.7 % presented with AL, including 42.8 % with grade B. Fourteen patients required endoscopic management and constituted the study population. The study’s primary objective was to assess the feasibility and efficacy of DPS placement for the treatment of grade B AL after colorectal surgery. The secondary endpoints were the requirement for radiological drainage, the DPS placement failure rate, the rate of stoma closure and, lastly, feasibility of chemotherapy (if indicated).ResultsDPS placement was feasible in 92.8 % of the 14 patients (n = 13). The overall success rate for endoscopic management was 78.5 % (n = 11). The median length of hospitalization after DPS placement was 5 days (3–17). The average duration of drainage through a DPS was 62 days (28–181). Five patients (35.7 %) also underwent drainage with radiological guidance. Of the 10 patients with stoma, closure occurred in 80 %. All patients that required adjuvant chemotherapy were able to receive it.ConclusionThe treatment of AL requires multidisciplinary collaboration to save the anastomosis. DPS placement under endoscopic control is associated with AL healing, good clinical tolerance and the ability to undergo chemotherapy and is an alternative to repeat laparotomy when radiological drainage is unfeasible or inefficient. More... »

PAGES

1869-1875

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-015-4404-6

DOI

http://dx.doi.org/10.1007/s00464-015-4404-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1034217276

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/26183957


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70 conditions
71 control
72 days
73 double-pigtail stent
74 drain
75 drainage
76 duration
77 efficacy
78 endoscopic control
79 endoscopic management
80 endoscopic transanastomotic drainage
81 endpoints
82 failure rate
83 feasibility
84 feasibility of chemotherapy
85 feasibility study
86 further surgery
87 good clinical tolerance
88 grade B
89 grade B AL
90 grade B colorectal leakage
91 grade B. Fourteen patients
92 guidance
93 healing
94 hospital
95 hospitalization
96 intervention
97 laparotomy
98 leakage
99 length
100 major complications
101 management
102 median length
103 multidisciplinary collaboration
104 objective
105 overall success rate
106 patient's clinical condition
107 patients
108 pelvic drainage
109 pilot feasibility study
110 placement
111 placement failure rate
112 population
113 primary objective
114 procedure
115 radiological drainage
116 radiological guidance
117 rate
118 requirements
119 stents
120 stoma closure
121 stomata
122 study
123 study population
124 study's primary objective
125 success rate
126 surgery
127 therapeutic intervention
128 tolerance
129 transanal drain
130 transanastomotic double-pigtail stents
131 transanastomotic drainage
132 treatment
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