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01 February 2006

Anastomosis wrapping with gentamicin-containing collagen sponge in rectal cancer patients following sphincter-preserving total mesorectal excision without defunctioning stoma

Bartłomiej Szynglarewicz, Rafał Matkowski, Józef Forgacz, Marek Pudełko, Zygmunt Grzebieniak

Case Rep Clin Pract Rev 2006; 7:267-271 :: ID: 467991


Background: Since the introduction of total mesorectal excision (TME) better regional control resulting in low recurrence rate and improved survival can be achieved for rectal cancer patients. In spite of the oncological advantages sphincter-preserving TME is related to the risk of anastomotic dehiscence and septic complications increasing postoperative morbidity and mortality.
Case Report: Consecutive ten patients in 33-84 years of age (mean 59.9, median 57.5) with histologically confirmed rectal cancer were studied prospectively. Patients underwent curative R0 anterior resection. Operations were performed strictly according to the TME method. Straight endto-
end anastomoses were constructed with double-stapling technique. Site of the anastomosis ranged 5-8 cm (mean 6.7, median 6.5) from the anal verge. In all cases gentamicin-containing collagen sponge was applied into pelvis cavity at the presacral area and wrapped around the anastomosis. For all patients defunctioning stoma was avoided. There was no postoperative
mortality. Neither clinical symptoms of anastomotic leakage nor any other septic complications in postoperative period were observed. Sponge was well tolerated and no adverse effects were noticed.
Conclusions: Application of gentamicin-containing collagen sponge at the site of the anastomosis after anterior resection with TME may be related with decreased rate of early septic postoperative complications including anastomotic leak despite the lack of defunctioning stoma. Further
controlled randomized studies should be performed to prove its clinical value for routine surgical practice. Cost-effectiveness analyses are also needed.

Keywords: rectal cancer, Anterior resection, total mesorectal excision, anastomotic leakage, collagen sponge, gentamicin

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923