ABSTRACT

INTRODUCTION:

We aimed to determine the effect of anastomosis technique and primary diagnosis in relapse and stenosis development in the anastomosis line in patients who were applied colonoscopy process, colon operation.

METHODS:

In July 2011-2013, in the General Surgery Endoscopy Unit of Konya Tranining and Research Hospital, the colonoscopy findings of the colon operated patients who were applied lower gastrointestinal system endoscopy (GIS) and records of the processes were retrospectively examined. Failure to pass the endoscope from the anastomosis line was defined as stenosis. The determination of malignity as a result of the biopsy taken from the anastomosis line was defined as relapse. We tried to determine the factors which affect the relapse and stenosis development in the anastomosis line.

RESULTS:

The age average of 76 patients who were taken to our study was 59.6±13.5, 45 (59%) male, 31 (41%) female. 74 of them (97%) received colon operation due to malign reasons, and 2 of them (3%) due to benign reasons. Average follow-up period was 22 (1-124) months. 42 of the anastomoses (55%) were applied colo colostomy and 28 of them (67%) were applied with stapler while 34 of them (45%) were applied ileocolostomy and 10 of them (29%) were applied with stapler. Anastomosis stenosis was detected in 12 patients (16%). Among the 12 (16%) patients who developed anastomosis stenosis, 4 of them (5%) had ileocolostomy, and 8 of them (10%) had colo colostomy. Circular stapler was used in anastomosis in 9 of them while anastomosis was made manually in 3 of them. While stenosis was detected in 4 (11%) of the 34 patients (45%) who were applied ileo colostomy and stenosis was detected 8 (%19) of the 42 patients who were applied colo colostomy. While anastomosis application with stapler (p=0.04) and anastomosis level in the rectum (p<0.004) was found effective in the development of anastomosis stenosis, anastomosis application in colo colostomy or ileocolostomy did not have any effects (p>0.05). Relapse cancer was determined in 10 (13%) patients from whom biopsy was taken as suspicious lesion was observed in the anastomosis line. While the anastomosis level in the rectum was effective in the relapse cancer in the anastomosis location (p<0.002), anastomosis application with stapler did not have any effects (p>0.05).

DISCUSSION AND CONCLUSION:

Anastomosis level in the rectum is effective in the development of relapse cancer in the anastomosis line. Anastomosis stenosis is higher in those applied with stapler than those applied manually. Ileocolic or colo colic anastomosis does not have any effect on the anastomosis stenosis.