PMID- 25546660
OWN - NLM
STAT- MEDLINE
DCOM- 20150708
LR  - 20210109
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 93
IP  - 29
DP  - 2014 Dec
TI  - Use of Valtrac-secured intracolonic bypass in laparoscopic rectal cancer 
      resection.
PG  - e224
LID - 10.1097/MD.0000000000000224 [doi]
LID - e224
AB  - The occurrence of anastomotic leakage (AL) remains a major concern in the early 
      postoperative stage. Because of the relatively high morbidity and mortality of AL 
      in patients with laparoscopic low rectal cancer who receive an anterior 
      resection, a fecal diverting method is usually introduced. The Valtrac-secured 
      intracolonic bypass (VIB) was used in open rectal resection, and played a role of 
      protecting the anastomotic site. This study was designed to assess the efficacy 
      and safety of the VIB in protecting laparoscopic low rectal anastomosis and to 
      compare the efficacy and complications of VIB with those of loop ileostomy (LI). 
      Medical records of the 43 patients with rectal cancer who underwent elective 
      laparoscopic low anterior resection and received VIB procedure or LI between May 
      2011 and May 2013 were retrospectively analyzed, including the patients' 
      demographics, clinical features, and operative data. Twenty-four patients 
      received a VIB and 19 patients a LI procedure. Most of the demographics and 
      clinical features of the groups, including Dukes stages, were similar. However, 
      the median distance of the tumor edge from the anus verge in the VIB group was 
      significantly longer (7.5 cm; inter-quartile range [IQR] 7.0-9.5 cm) than that of 
      the L1 group (6.0 cm; IQR 6.0-7.0 cm). None of the patients developed clinical 
      AL. The comparisons between the LI and the VIB groups were adjusted for the 
      significant differences in the tumor level of the groups. After adjustment, the 
      LI group experienced longer overall postoperative hospital stay (14.0 days, IQR: 
      12.0, 16.0 days; P < 0.001) and incurred higher costs ($6300 (IQR: $5900, $6600)) 
      than the VIB group (7.0 days, $4800; P < 0.05). Stoma-related complications in 
      the ileostomy group included dermatitis (n = 2), stoma bleeding (n = 1), and 
      wound infection after closure (n = 2). No BAR-related complications occurred. The 
      mean time to Valtrac ring loosening was 14.1 +/- 3.2 days. The VIB procedure, as a 
      good partner with the laparoscopic rectal cancer resection, appears to be a safe 
      and effective, but time-limited, diverting technique to protect an elective low 
      colorectal anastomosis.
FAU - Ye, Feng
AU  - Ye F
AD  - From the Department of Colorectal Surgery (FY, DC, DW, JL); and Department of 
      General Surgery, the First Affiliated Hospital, Zhejiang University, No. 79, 
      Qinchun Road, Hangzhou, China (SZ).
FAU - Chen, Dong
AU  - Chen D
FAU - Wang, Danyang
AU  - Wang D
FAU - Lin, Jianjiang
AU  - Lin J
FAU - Zheng, Shusen
AU  - Zheng S
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - *Absorbable Implants
MH  - Aged
MH  - Anastomosis, Surgical/*instrumentation
MH  - Anastomotic Leak/prevention & control
MH  - Female
MH  - Hospital Costs
MH  - Humans
MH  - Ileostomy
MH  - *Laparoscopy
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Rectal Neoplasms/economics/*surgery
MH  - Retrospective Studies
PMC - PMC4602602
COIS- The authors have no funding or conflicts of interest to disclose.
EDAT- 2014/12/30 06:00
MHDA- 2015/07/15 06:00
PMCR- 2014/12/02
CRDT- 2014/12/30 06:00
PHST- 2014/12/30 06:00 [entrez]
PHST- 2014/12/30 06:00 [pubmed]
PHST- 2015/07/15 06:00 [medline]
PHST- 2014/12/02 00:00 [pmc-release]
AID - 00005792-201412040-00004 [pii]
AID - 10.1097/MD.0000000000000224 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2014 Dec;93(29):e224. doi: 10.1097/MD.0000000000000224.