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Video

Session: Ongoing Videos

VM24 - Optimal Strategies to Minimize the Risk of Anastomotic Leakage: Prerequisites for Safe Anastomosis

ONGOING VIDEOS
Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • HYE-JIN KIM

    Associated professor
    Kyungpook National University Chilgok Hospital
    Daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • GC

    Gyu-Seog Choi, n/a

    professor
    Kyungpook National University Chilgok Hospital
    daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Seungho Song

    Assistant professor
    Kyungpook National University Chilgok Hospital
    Daegu, Taegu-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • MJ

    Min Hye Jeong, n/a

    Fellow
    Kyungpook National University Chilgok Hospital
    daegu, Taegu-jikhalsi, Republic of Korea

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
HYE-JIN KIM: This individual has no financial relationships with ineligible companies.
Gyu-Seog Choi, n/a: This individual has no financial relationships with ineligible companies.
Seungho Song: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: The anastomotic leak (AL) rate has remained largely unchanged over time, consistently reported at 7 to 10%, regardless of the use of a stoma. Despite advancements, AL continues to be a major concern in colorectal surgery, posing significant risks to patient outcomes. AL is influenced by numerous risk factors, both systemic and technical, but addressing modifiable technical factors can provide an opportunity to improve outcomes. The purpose of this study is to demonstrate specific surgical techniques designed to minimize modifiable risk factors, thereby strengthening anastomotic integrity and potentially reducing the incidence of AL.

Methods/Interventions: Firstly, to confirm blood perfusion in the proximal colon at our institution, 7.5 mg of ICG was injected, allowing visualization of the proximal colon within one minute of injection. The transection line became clearly visible, and we proceeded to cut along this line, and place the anvil. Secondly, the double-stapled anastomosis (DSA) has a weak point at the staple-crossing line, commonly referred to as a 'dog ear.' To address this, we converted the DSA to a single-stapled anastomosis (SSA). However, in some cases of very low rectal cancer, this approach can be challenging. As an additional effort to strengthen the anastomosis, reinforcement sutures are used. We adopted running full-layer stitches using barbed suture. This procedure is more convenient, especially with the robotic approach. In some very low-lying double-stapled anastomoses, we placed the stitches transanally. Lastly, comprehensive surveillance is crucial to detect leaks early, before patients experience severe symptoms. To effectively monitor peritoneal fluid, we perform extraperitoneal drain insertion, by passing the drain through the extraperitoneal space, using a laparoscopic instrument from the trocar incision.

Results/Outcomes: By adopting these techniques, we have strengthen the anastomosis without complications.

Conclusion/Discussion: While these techniques for modifying risk factors and enhancing anastomotic integrity are feasible, further studies are necessary to confirm their efficacy in reducing the risk of AL.