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International Journal of Colorectal Disease

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Open Access 01-10-2013 | Original Article

Thirty-seven patients treated with the C-seal: protection of stapled colorectal anastomoses with a biodegradable sheath

Authors: Annelien N. Morks, Klaas Havenga, Henk O. ten Cate Hoedemaker, Jeroen W. A. Leijtens, Rutger J. Ploeg, For the C-seal Study Group

Published in: International Journal of Colorectal Disease | Issue 10/2013

Abstract

Purpose

The present study was performed to get a better insight in the incidence of anastomotic leakage leading to reintervention when using the C-seal: a biodegradable sheath that protects the stapled colorectal anastomosis from leakage.

Methods

The C-seal is a thin walled tube-like sheath that forms a protective sheath within the bowel lumen. Thirty-seven patients undergoing surgery with creation of a stapled colorectal anastomosis with C-seal were analyzed. Follow-up was completed until 3 months after surgery.

Results

One patient (3 %) developed anastomotic leakage leading to reintervention. None of the 37 anastomoses was dismantled. One patient was diagnosed with a rectovaginal fistula. In three patients (8 %), a perianastomotic abscess spontaneously drained.

Conclusion

The incidence of anastomotic leakage leading to reintervention when using the C-seal (3 %) is lower than expected based on the literature (11 %). We have currently set-up a multicenter randomized trial to confirm the efficiency of the C-seal (www.csealtrial.nl).

Matthiessen P, Hallbook O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6(6):462–469PubMedCrossRef

Bertelsen CA, Andreasen AH, Jorgensen T et al (2010) Danish colorectal cancer group. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 12(1):37–43PubMedCrossRef

Paun BC, Cassie S, MacLean AR et al (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251(5):807–818PubMedCrossRef

Peeters KC, Tollenaar RA, Marijnen CA et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(2):211–216PubMedCrossRef

Wouters MW, van Leersum NJ, Snijders HS, et al (2012) Uitkomst van zorg registratie, transparantie en kwaliteit. Jaarrapportage Dutch Surgical Colorectal Audit 2011. Utrecht, Dutch Surgical Colorectal Audit

Matthiessen P, Hallbook O, Rutegard J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214PubMedCrossRef

Ravo B, Ger R (1985) Temporary colostomy—an outmoded procedure? A report on the intracolonic bypass. Dis Colon Rectum 28(12):904–907PubMedCrossRef

Ravo B, Ger R (1984) A preliminary report on the intracolonic bypass as an alternative to a temporary colostomy. Surg Gynecol Obstet 159(6):541–545PubMed

Bakx R, Busch OR, Bemelman WA et al (2004) Morbidity of temporary loop ileostomies. Dig Surg 21(4):277–281PubMedCrossRef

10.

Bailey CM, Wheeler JM, Birks M et al (2003) The incidence and causes of permanent stoma after anterior resection. Colorectal Dis 5(4):331–334PubMedCrossRef

11.

Lindgren R, Hallbook O, Rutegard J et al (2011) What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54(1):41–47PubMedCrossRef

12.

Kolkert JL, Havenga K, ten Cate Hoedemaker HO et al (2011) Protection of stapled colorectal anastomoses with a biodegradable device: the C-seal feasibility study. Am J Surg 201(6):754–758PubMedCrossRef

13.

Morks AN, Havenga K, ten Cate Hoedemaker HO et al (2011) C-seal for prevention of anastomotic leakage following colorectal anastomosis. Ned Tijdschr Geneeskd 155:A2812PubMed

14.

Morks AN, Havenga K, Ten Cate Hoedemaker HO, et al (2010) The C-seal: a biofragmentable drain protecting the stapled colorectal anastomosis from leakage. J.Vis.Exp. Nov 4;(45). pii: 2223. doi(45):10.3791/2223

15.

Buchs NC, Gervaz P, Secic M et al (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270PubMedCrossRef

16.

Khan AA, Wheeler JM, Cunningham C et al (2008) The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 10(6):587–592PubMedCrossRef

17.

Damrauer SM, Bordeianou L, Berger D (2009) Contained anastomotic leaks after colorectal surgery: are we too slow to act? Arch Surg 144(4):333–338, discussion 338PubMedCrossRef

18.

Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the international study group of rectal cancer. Surgery 147(3):339–351PubMedCrossRef

19.

Eckmann C, Kujath P, Schiedeck TH et al (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19(2):128–133PubMedCrossRef

20.

Akyol AM, McGregor JR, Galloway DJ et al (1992) Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity. Int J Colorectal Dis 7(3):141–143PubMedCrossRef

Title: Thirty-seven patients treated with the C-seal: protection of stapled colorectal anastomoses with a biodegradable sheath
Authors: Annelien N. Morks
Klaas Havenga
Henk O. ten Cate Hoedemaker
Jeroen W. A. Leijtens
Rutger J. Ploeg
For the C-seal Study Group
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 10/2013
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-013-1724-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thirty-seven patients treated with the C-seal: protection of stapled colorectal anastomoses with a biodegradable sheath

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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