Complications and Management

The rate of complications following LAR has been reported as high as 41% (5). Most of these are common to most major abdominal procedures and would include atelectasis, urinary tract infection, wound infection, and deep venous thrombosis. Significant complications specific to LAR include anastomotic leakage, anastomotic stricture, and imperfections of continence or bowel habit. Leakage from the anastomosis after LAR

VI vi

Distal end of resected bowel

Circularstapler

Rectal cuff

Fig. 1. Use of a circular stapler to create an anastomosis. (A) Resection of bowel containing a low lying tumor. (B) Positioning of the device in the rectal remnant and apposition of the bowel. (C) Completed anastomosis by a stapler that places a double or triple row of staples circumferentially, and then cuts out the center tissue.

Rectal remnant

Rectal cuff

Low anterior anastomosis

Fig. 1. Use of a circular stapler to create an anastomosis. (A) Resection of bowel containing a low lying tumor. (B) Positioning of the device in the rectal remnant and apposition of the bowel. (C) Completed anastomosis by a stapler that places a double or triple row of staples circumferentially, and then cuts out the center tissue.

is more common than from other colonic anastomoses because of the deep pelvic dissection and the inherent technical difficulty of the anastomosis. Rates of leakage have traditionally been reported in the range of 10% (6), though more recently rates less than 3% are seen (7). Many factors have been implicated in increased leakage rates. Chief among them being anemia, diabetes, local atherosclerotic disease, and prior pelvic irradiation. Anastomotic leakage leads to pelvic abscess and possibly sepsis, and requires drainage (in either an opened or closed CT-guided fashion) and usually temporary proximal diversion with either a colostomy or ileostomy. Anastomotic stricture may be the result of an anastomotic leak or may occur de novo with fibrosis at the anastomotic site. It is a late complication and can usually be managed with dilatation. It may require a local procedure or, less commonly, reresection. Imperfections of continence and irregularities of bowel habit are not uncommon and are generally related to loss of the fecal reservoir with rectal resection. The majority of these problems resolve within six mo without intervention.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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