Year 2020, Volume 4 , Issue 5, Pages 331 - 333 2020-05-01

Tekrarlayıcı kolorektal anastomoz striktürlerinin tedavisinde yeni bir teknik: Manyetik kompresyon striktüroplasti
A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty

Ali KILIÇ [1] , Abdullah ŞİŞİK [2]


Amaç: Anastomoz kaçakları, anastomozun stapler ile yapılmış olması, anastomoz hattında oluşan iskemi ve radyoterapi uygulamaları kolonik anastomotik darlıkların en önemli sebepleridir. Striktür tedavisinde endoskopik girişimler ilk tercih olmalıdır. Striktür hattının rezeksiyonu ve yeniden anastomoz cerrahi tedavinin temelini oluşturur. Endoskopik yaklaşımlarla karşılaştırıldığında, darlıklara yönelik cerrahi tedavilerin morbidite oranı daha yüksektir. Endoskopik tedavilere izin vermeyen darlık ve çoklu pelvik cerrahi öyküsü olan hastalarda, manyetik kompresyon striküroplastisi (MCS) düşük morbidite için iyi bir seçim olabilir.
Yöntemler: Çalışma popülasyonu kolorektal anastomotik darlığı olan ilave bir rezeksiyon-anastomoz girişiminin yüksek morbiditeye sahip olduğu ve endoskopik tedavilerin başarısız olduğu hastaları içermekteydi. İlk olarak MCS yöntemi kolonoskopik olarak planlandı. İleostomi açıklığından girerek ucunda halka şeklinde bir mıknatıs olan kolonoskop ile mıknatısın kolondaki darlığın proksimaline yerleştirilmesi hedeflendi. Bu endoskopik girişim başarısız oldu. Daha sonra hastalara laparotomi yapıldı. Striktürün proksimal bölgesinden yapılan 1 cm’lik kolotomiden sirküler yapıda 1,5 cm çaplı mıknatıs bağırsağın içine bırakıldı. Anüsten de striktürün distaline başka bir mıknatıs yerleştirildi ve iki mıknatısın, manyetik çekimle striktüre kısmı sıkıştırarak birbirine yapıştığı gözlendi ve ameliyat sonlandırıldı. Hastaların demografik bilgileri, cerrahi geçmişleri, MRG sonuçları, kolonoskopik muayene sonuçları kaydedildi. Hastaların postoperatif takip bilgileri kaydedildi.
Bulgular: İki erkek hastaya MCS uygulandı. Yaş ortalaması 70 (14,14) saptandı. Tüm hastalar daha önce geçirilmiş multipl abdominal cerrahi öyküsüne sahipti. Kolonoskopide, hastalarda tamamen tıkanmış anastomotik darlık gözlendi. Kolonoskopik incelemede anal girimden striktüre olan ortalama mesafe 7±1,41 cm saptandı. Manyetik rezonans görüntülemede ortalama striktür uzunluğu 12±2,82 mm saptandı. Postoperatif takipte kontrol rektosigmoidoskopide mıknatısların rektum lümenine düştüğü ve darlık hattının tamamen açıldığı gözlendi.
Sonuç: MCS, daha önce multipl kolorektal cerrahi geçirmiş olan ve kolorektal anastomoz hattında tam tıkayıcı striktüre sahip hastalarda güvenli ve düşük morbiditeli bir cerrahi teknik olarak tercih edilebilir. 
Aim: Colonic anastomotic strictures are usually caused by staple use, anastomotic leakage, intestinal or suture line ischemia and radiotherapy. Endoscopic treatments should be the first choice. Resection of the stricture line and re-anastomosis form the basis of surgical treatment. Compared to endoscopic approaches, the morbidity rate of surgical treatments for strictures are higher. In patients with stricture and history of multiple pelvic surgeries who don’t allow endoscopic treatments, magnetic compression strictureplasty (MCS) may be a good choice for lower morbidity.
Methods: The study population included patients with colorectal anastomotic stricture who had failed endoscopic treatments and for whom a tertiary resection and anastomosis was also considered as having high morbidity. Firstly, the MCS technique was planned by colonoscopic approach. It was aimed to place the magnet proximal to the stenotic colon with the colonoscope, which has a ring-shaped magnet attached at the tip, through the ileostomy entrance. This endoscopic approach failed. Then, laparotomy was performed. A 1-cm colotomy was performed from the proximal site of the stricture, and the magnet was left inside the intestine. Another magnet was placed distally to stricture from the anus. The two magnets were observed to compress the stricture by magnetic attraction, and the operation was terminated. Patient demographics, surgical history, MRI results, colonoscopic examination results were recorded. The follow-up conditions of the patients were noted.
Results: MCS was performed on two male patients mean aged 70 (14.14) years. All patients had multiple abdominal surgeries in their surgical history. Colonoscopy showed fully obstructing anastomotic stricture in patients. The mean distance from the anal verge to the stricture in colonoscopic examination was 7±1.41 cm. Mean stricture length in MRI was 12±2.82 mm. In follow up, control rectosigmoidoscopies revealed that the magnets had fallen into the rectum lumen and the stricture line was fully patent for all patients.
Conclusion: MCS might be preferred as a safe surgical technique with low morbidity in patients with previous multiple colorectal surgeries and a full obstructive stricture in the colorectal anastomosis line. 
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Primary Language en
Subjects Surgery
Journal Section Research article
Authors

Orcid: 0000-0002-4948-0055
Author: Ali KILIÇ
Institution: UNIVERSITY OF HEALTH SCIENCES
Country: Turkey


Orcid: 0000-0002-7500-8651
Author: Abdullah ŞİŞİK (Primary Author)
Institution: İSTANBUL ÜMRANİYE HEALTH RESEARCH CENTER
Country: Turkey


Thanks The authors gratefully acknowledge Dr. Sırma Tilev for assistance in the editing of the manuscript.
Dates

Publication Date : May 1, 2020

Bibtex @research article { josam737762, journal = {Journal of Surgery and Medicine}, issn = {}, eissn = {2602-2079}, address = {jsurgmed@gmail.com}, publisher = {Fatih BAŞAK}, year = {2020}, volume = {4}, pages = {331 - 333}, doi = {10.28982/josam.737762}, title = {A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty}, key = {cite}, author = {Kılıç, Ali and Şi̇şi̇k, Abdullah} }
APA Kılıç, A , Şi̇şi̇k, A . (2020). A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty. Journal of Surgery and Medicine , 4 (5) , 331-333 . DOI: 10.28982/josam.737762
MLA Kılıç, A , Şi̇şi̇k, A . "A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty". Journal of Surgery and Medicine 4 (2020 ): 331-333 <http://jsurgmed.com/en/pub/issue/54145/737762>
Chicago Kılıç, A , Şi̇şi̇k, A . "A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty". Journal of Surgery and Medicine 4 (2020 ): 331-333
RIS TY - JOUR T1 - A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty AU - Ali Kılıç , Abdullah Şi̇şi̇k Y1 - 2020 PY - 2020 N1 - doi: 10.28982/josam.737762 DO - 10.28982/josam.737762 T2 - Journal of Surgery and Medicine JF - Journal JO - JOR SP - 331 EP - 333 VL - 4 IS - 5 SN - -2602-2079 M3 - doi: 10.28982/josam.737762 UR - https://doi.org/10.28982/josam.737762 Y2 - 2020 ER -
EndNote %0 Journal of Surgery and Medicine A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty %A Ali Kılıç , Abdullah Şi̇şi̇k %T A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty %D 2020 %J Journal of Surgery and Medicine %P -2602-2079 %V 4 %N 5 %R doi: 10.28982/josam.737762 %U 10.28982/josam.737762
ISNAD Kılıç, Ali , Şi̇şi̇k, Abdullah . "A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty". Journal of Surgery and Medicine 4 / 5 (May 2020): 331-333 . https://doi.org/10.28982/josam.737762
AMA Kılıç A , Şi̇şi̇k A . A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty. J Surg Med. 2020; 4(5): 331-333.
Vancouver Kılıç A , Şi̇şi̇k A . A novel method for treatment of persistent colorectal anastomotic strictures: Magnetic compression strictureplasty. Journal of Surgery and Medicine. 2020; 4(5): 333-331.