Download to read offline
More Related Content
Similar to resection and anastmosis of intestne lare small
resection and anastmosis of intestne lare small
- 1. Reinforcement of Intestinalanastomosis in Elective surgery with or without tissue adhesive glue (Glubran 2) By: Steven NABIL FOUAD WASEF Title
- 2.
- 3. Prof. Salah EldeenAbd ELRAZIK Prof.ass. Mohamed Kalaf Alah Kamel Dr. Mohhamed AbdElaziz Abdelzahhher Lecturer of General Surgery Faculty of Medicine - Minia University Supervisors Professor of General Surgery Faculty of Medicine - Minia University Professor assis of Surgery Faculty of Medicine - Minia University
- 4. Welcome Prof. Amr Yaheimohamed Professor of General Surgery Faculty of Medicine – Assuit university Prof. AbdelFattah S. AboZeid Professor of General Surgery Faculty of Medicine - Minia University
- 5.
- 6.
- 7. Each year, millionsof gastrointestinal (GIT) anastomoses are created worldwide. Anastomotic leakage (AL) after the creation of a GIT anastomosis remains an important complication in GIT surgery. Despite years of research, the incidence of AL remains high, especially after esophageal and colorectal anastomosis .Anastomotic leakage is known to have a multifactorial etiology, mostly based on ischemia of the bowel endings and/or technical failure,,, with use of glue decrease rate of leakage and complication.
- 8. Aim Of TheWork
- 9. To compare betweenintestinal resection reanastmosis with use of tissue glue (Glubran 2) or without as regard complication as intestinal leakage , operative time ,and hospital stay. Aim Of The Work
- 10.
- 11. Our study wasconducted on 40 patients with colorectal malignancy undergoing laparoscopic cholecysteresection anastmosis from may 2023 to june 2024. The current study was conducted , in General Surgery Department, Minia University Hospital, Minia, Egypt. Study Design
- 12. Inclusion criteria Agebetween 15 and 80 years. Patients who are diagnosed with colorectal malignancy. .
- 13. • Age >80 or <15 years • liver Diseases (e.g. cirrhosis) • Irresectable mass. • Intestinal malignancy with distant metastasis • Patients who are unfit for surgery Exclusion criteria
- 14. • Complete detailedhistory taking : Personal history ,allergy or blood transfusion and history of chemo or radiotherapy. • Colonic preparation. • Abdominal examinations (to detect any mass, organomegally, signs of cirrhosis, or ascites) • Laboratory investigation: a) Complete blood picture: WBCs, RBCs, Platelets count. b) Liver function tests: Albumin, c) Coagulation profile: concentration (PC) and INR. d) Tumor marker :CEA , CA19-9 Preoperative assessment
- 15. • Radiological evaluation: abdominal ultrasound. CT abdomen with contrast. • Colonoscopy and biopsy. • chest ct • brain ct
- 16.
- 17. Anesthesia and position **General anaesthesiawit endotracheal intubation • ** patients in a supine position, with arms spread laterally
- 18.
- 19. Removal of spicemen(descending colon mass)
- 20. Colonic anastomosis (Transevrsecolon & sigmoid)
- 21. Applicator of (Glubran 2) & Tissue glue ( Glubran 2)
- 22. Draw the Glubran2 out of its vial
- 23. Addition of gluein spraying manner
- 25.
- 26. Demographic data Group AGroup B P value N=20 N=20 Age Range Mean ± SD (43-78) 61.8±10 (38-70) 60.6±10 0.70 Sex Male Female 12(60%) 8(40%) 7(35%) 13(65%) 0.11 Chronic illness No DM HTN Both 6(30%) 6(30%) 4(20%) 4(20%) 4(20%) 8(40%) 4(20%) 4(20%) 0.87
- 27. Preoperative data Group AGroup B P value N=20 N=20 CT abdomen low-density masses and LN Fat stranding 12(60%) 8(40%) 14(70%) 6(30%) 0.507 Colonoscopy Exophytic mass Sessile mass Circumferential mass 8(40%) 7(35%) 5(25%) 7(35%) 6(30%) 7(35%) 0.78 Biopsy Adenocarcinoma Signet ring cell Medullary 12(60%) 6(30%) 2(10%) 14(70%) 6(30%) 0(0%) 0.56
- 28. Operative data Group AGroup B P value N=20 N=20 Site colorectal cancer ceacum Asecending colon Transverse colon Descending colon Sigmoid 4(20%) 6(30%) 6(30%) 2(10%) 2(10%) 6(30%) 6(30%) 4(20%) 2(10%) 2(10%) 0.938 Total operative time (min) Range Mean ± SD (180-280) 204±28 (200-250) 214±25 0.24 Total blood loss Median IQR 250 (200-387.5) 275 (125-400) 0.967
- 29. Postoperative data Group AGroup B P value N=20 N=20 ICU admission after operation No Yes 17(85%) 3(15%) 15(75%) 5(25%) 0.42 Need for Post. Operative Blood Transfusion No Yes 6(30%) 14(70%) 10(50%) 10(50%) 0.197 Hospital stay Median IQR 10 (7-14) 7 (4-12) 0.05*
- 30. Postoperative complications Group AGroup B P value N=20 N=20 Leakage No Yes 17(85%) 3(15%) 19(95%) 1(5%) 0.29 DVT No Yes 19(95%) 1(5%) 20(100%) 0(0%) 0.99 Chest infection No Yes 18(85%) 2(10%) 19(95%) 1(5%) 0.54
- 31. leakage data betweenstudied groups Group A Group B N=3 N=1 Time of diagnosis Mean ±SD Range 3±1 2-4 6±0 6-6 Method of diagnosis Fever Tachypnea Tachycardia 2(66.7%) 1(33.3%) 2(66.7%) 1(100%) 1(100%) 1(100%) Drain Low output <200 cc enteric High output >500 cc enetric 2(66.7%) 1(33.3%) 1(100%) 0(0%) wound Clean Eenetric discharge 2(66.7%) 1(33.3%) 1(100%) 0(0%) Hospital stay Mean ±SD Range 17.6±2.1 14-20 12±0 12-12
- 32. Quality Of surgicalspecimen Group A Group B P value N=20 N=20 Histopathology Adenocarcinoma Signet ring cell Medullary 12(60%) 6(30%) 2(10%) 14(70%) 6(30%) 0(0%) 0.56 Resection margins Free Infiltrated 18(90%) 2(10%) 19(95%) 1(5%) 0.54 Total number of LN removed Mean ±SD Range 15±3.5 12-22 16.2±3.1 12-20 0.25 Lymph Nodes Status -ve +ve 17(85%) 3(15%) 19(95%) 1(5%) 0.29 Number of positive LN Mean ±SD Range 5±1 4-6 6±0 6-6 0.35
- 33.
- 34. Conclusion Regarding to ourresults we concluded that there was difference in group A than group B as regard leakage After resection anastmosis but there is no statistically significant difference between the studied groups. However , there was no statistically significant difference between the studied groups regarding ICU admission after op , Hb , Albumin posr operative, Post. Operative Bl. Transfusion operation , Hospital stay , DVT , Quality surgical spicmen (Histopathology , Resection margins and Lymph Nodes Status) Further studies with larger scales are needed for confirming our results.
- 35.
Editor's Notes
- #1 Reinforcement of Intestinal anastomosis with tissue glue (Glubran 2) after elective colorectal sugrery
- #3 Firstly I would like to thank Allah for guiding me and giving me power to complete this work . I would like to express my appreciation to Prof. Salahh Eldeen AbdELrazik , my professor of general and laparoscopic surgery , for his kind supervision and great efforts during all steps of this work . My thanks to Prof. mohhamed kh. kamel, professor of General and laparoscopic surgery, for his kind supervision, Encouragement and constructive advice throughout the work. I am grateful to Dr. Mohhhameed Abdelaziz, lecturer in general surgery department , for devoting much of his time to guide me & for his sincere effort and support throughout every stage of this work, his comments and guidance had been of great value.
- #4 Many thanks to Prof. Amr yahie mohamed Professor of general surgery, for honoring us with his attendance and for sharing his knowledge and experience with us thanks to Prof. AbdelFattah S. AboZeid my professor of general and laparoscopic surgery and the head of laparscopic unit for your special attendance Also, I would like to thank Prof Dr. Amr Hamdy the Head of the Department ,all my professors and colleagues at General surgery department for their support. Their comments have been very helpful.
- #5 At the end, special thanks to my family, my parents, and my FRIENDS for their emotional support throughout my work. I gratefully thank my mother and father for their great help and support.
- #7 Each year, millions of gastrointestinal (GIT) anastomoses are created worldwide. Anastomotic leakage (AL) after the creation of a GIT anastomosis remains an important complication in GIT surgery. Despite years of research, the incidence of AL remains high, especially after esophageal and colorectal anastomosis .Anastomotic leakage is known to have a multifactorial etiology, mostly based on ischemia of the bowel endings and/or technical failure,,, with use of glue decrease rate of leakage and complication. The aim is to reduce thhe rate of intestinal leakage after elective colorectal malignant surgery.
- #17 As for Anesthesia : General anaesthesia with endotracheal intubation and hepatotoxic drugs are avoided . A muscle relaxant was also administered antibiotic prophylaxis in form of 2gm of 3rd generation cephalosporin were given during induction of anesthesia,. As for Position & Draping: The patients lied in a supine position, with arms spread apart or the right arm tucked alongside the patient for better access to the anaesthesiologist. Draping & sterlization is done to the abdomen up to the level of the nipples and mid thigh.
- #18 ** After midline abdominal incision, Peritoneal cavity is explored including liver for metastasis , omentum and malignant asacites . ** Dissection & kocerization and vascular ligation.
- #19 After dissection and removal of spicemen anastmosis done.
- #20 This anastmosis between tr.colon and sigmoid using vicryl 2\0
- #21 This is the set of applicator of glubran
- #23 Addition of glue in spraying manner After resection anastmosis between tr.colon sigmoid.
- #24 **Addition of glue in spraying manner after Rt hemicolectomy. **There is adhesive layer formed after spraying.
- #26 The demographic and clinical characteristics of the two groups show remarkable similarities.as mean age of group A was 61.8±10 years compared to 60.6±10 years, While Group A has a higher proportion of males (60%) compared to Group B, which has more females, this difference in sex distribution is not statistically significant (p=0.11). The prevalence of chronic illnesses, including diabetes mellitus and hypertension, is comparable between the groups (p=0.877). Although. There is no statistically significant differences in any of the examined variables.
- #27 **The CT abdomen findings reveal no statistically significant differences between the two groups across various parameters, including low-density masses, lymph nodes and fat stranding. **Colonoscopy findings and histopathological analysis reveal some differences between the two groups, although most do not reach statistical significance.
- #28 The analysis of the surgical aspects reveals similarities between the two groups. The distribution of colorectal cancer sites is comparable between the groups, with no statistically significant difference . In terms of total operative time, Group B experienced a slightly longer mean duration at 214±25 minutes compared to Group A's 204±28 minutes. However, this difference of 10 minutes is not statistically significant ,while Group B had a higher median total blood loss at 275 ml compared to Group A's 250 ml, this difference also fails to reach statistical significance .
- #29 The postoperative outcomes reveal some variations between the two groups Group B had a higher rate of ICU admissions (5 cases with percentage of 25%) compared to 3 cases in group A with percentage of 15%, but this difference is not statistically significant. While more patients in Group A required postoperative blood transfusions (70% vs 50% in Group B), this difference also fails to reach statistical significance. While Group A had a notably longer median hospital stay of 10 days compared to 7 days for Group B, and this difference shows statistical significance.
- #30 The postoperative complications reveal that the most striking difference is in the incidence of leakage, (15% vs 5% in group B, (p=0.29), however this difference is non-statistically significant, Other complications such as deep vein thrombosis,and chest infection showed no statistically significant differences between the groups.
- #31 Regarding the incidence of leakage between studied groups, the result was statistically significant as 3 cases in group A compared to only 1 case in group B had leakage. For time of diagnosis and method of diagnosis, it was found that, mean time of diagnosis in group A was 3 days ranged from 2 to 4 days with fever positive in 2 cases, tachycardia positive in 2 cases and tachypnea was positive in only 1 case, for the case that had leakage in group B, the diagnosis was done after 6 days with positive fever, tachycardia and tachypnea. Regarding drains, 2 cases in group A had low output less than 200 cc enteric and the remaining 1 case had high output in drain more than 500 cc enteric, on other hand, the only 1 case who had leakage in group B, had low output in drain less than 200 cc enteric discharge.
- #32 The distribution of cancer types varies between the groups, but this difference is not statistically significant . Regarding resection margins, Group B showed a very slight higher percentage of free margins at 95% compared to 90% in Group A. and also this small difference is not significan. Similarly, the mean numbers of LN removed in group A was 15 and three cases showed positive LN with mean number of positive LN was 5 compared to 16.2 LNs removed in group B with only 1 case who had 6 positive LN and this slight difference wasn’t statistically significant (p value >0.05).
- #34 **Regarding to our results we concluded that there was difference in group A than group B as regard leakage After resection anastmosis but there is no statistically significant difference between the studied groups. **However , there was no statistically significant difference between the studied groups regarding ICU admission after op , Hb , Albumin posr operative, Post. Operative Bl. Transfusion operation , Hospital stay , DVT , Pulmonary embolism , Chest infection and Wound infection. There was no statistically significant difference between the studied groups regarding Quality surgical spicemen (Histopathology , Resection margins and Lymph Nodes Status) Further studies with larger scales are needed for confirming our results.