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Techniques in Coloproctology
Published in: Techniques in Coloproctology 10/2019

01-10-2019 | Wound Debridement | Original Article

Adipose tissue grafting for management of persistent anastomotic leak after low anterior resection

Authors: W. J. Tan, B. J. Mehrara, J. Garcia-Aguilar, M. R. Weiser, G. M. Nash

Published in: Techniques in Coloproctology | Issue 10/2019

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Abstract

Background

An anastomotic leak is the most dreaded complication after low anterior resection. Adipose tissue grafting may induce healing in a persistent anastomotic defect. The aim of the present study was to report retrospectively reviewed outcomes for a series of patients who were managed with heterotopic grafted adipose tissue to facilitate anastomotic healing.

Methods

Patients with anastomotic leakage after low anterior resection sequentially treated with grafting of adipose tissue were included in the study. All patients had pelvic radiation during treatment and had a diverting ileostomy in situ. The cohort had a persistent defect despite being treated with available modalities such as suture repair, fibrin glue, Endo-Sponge and surgical debridement. The outcomes were reviewed and reported.

Results

There were 11 patients (8 males and 3 females) with a median age of 54 years (range 33–72 years). Five patients experienced complete healing of the anastomotic defect with successful reversal of the diverting ileostomy. The anastomotic defect of one other patient in the series appeared to have healed and hence his diverting ileostomy was reversed. However, he presented with a recurrent leak, which ultimately necessitated an abdominoperineal resection. Another patient had a persistent defect after an attempt at adipose tissue grafting and opted to proceed with a takedown of the anastomosis. In the remaining four patients, the outcome after adipose tissue grafting remains unknown, as two patients succumbed to metastatic disease, one was lost to follow-up and the remaining patient developed a recurrence which required pelvic exenteration. Procedural associated morbidity occurred in one patient who developed fat embolism, which was treated expectantly.

Conclusions

Adipose tissue grafting is safe and feasible, though its effectiveness remains uncertain. It may be useful selectively in the management of persistent anastomotic leak after radiation and low anterior resection.
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Metadata
Title
Adipose tissue grafting for management of persistent anastomotic leak after low anterior resection
Authors
W. J. Tan
B. J. Mehrara
J. Garcia-Aguilar
M. R. Weiser
G. M. Nash
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Techniques in Coloproctology / Issue 10/2019
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-019-02095-7

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