Anastomotic sinus that developed from leakage after a rectal cancer resection: Should we wait for closure of the stoma until the complete resolution of the sinus?

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Abstract

Purpose: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

Original languageEnglish
Pages (from-to)30-35
Number of pages6
JournalAnnals of Coloproctology
Volume35
Issue number1
DOIs
Publication statusPublished - 2019 Feb 1

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Rectal Neoplasms
Ileostomy
Diatrizoate Meglumine
Sigmoidoscopy
Anastomotic Leak
Enema
Dilatation
Pathologic Constriction
Incidence

Keywords

  • Anastomotic leakage
  • Anastomotic sinus
  • Ileostomy repair
  • Low anterior resection
  • Rectal neoplasm

ASJC Scopus subject areas

  • Gastroenterology

Cite this

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title = "Anastomotic sinus that developed from leakage after a rectal cancer resection: Should we wait for closure of the stoma until the complete resolution of the sinus?",
abstract = "Purpose: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results: Of the 876 patients who had undergone a low anterior resection, 14 (1.6{\%}) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.",
keywords = "Anastomotic leakage, Anastomotic sinus, Ileostomy repair, Low anterior resection, Rectal neoplasm",
author = "Chung, {Chris Tae Young} and Se-Jin Baek and Jung-Myun Kwak and Jin Kim and Kim, {Seon Hahn}",
year = "2019",
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T1 - Anastomotic sinus that developed from leakage after a rectal cancer resection

T2 - Should we wait for closure of the stoma until the complete resolution of the sinus?

AU - Chung, Chris Tae Young

AU - Baek, Se-Jin

AU - Kwak, Jung-Myun

AU - Kim, Jin

AU - Kim, Seon Hahn

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Purpose: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

AB - Purpose: The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods: The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results: Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion: Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.

KW - Anastomotic leakage

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KW - Low anterior resection

KW - Rectal neoplasm

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