- Email: [email protected]
P.12.18 NON SURGICAL MANAGEMENT OF PERFORATION DUE TO COLONOSCOPIC POLYPECTOMY: REPORT OF A CASE
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Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
gas incontinence, soiling of underwear, passive FI, urgency and ineffective squeezing. Incontinence was evaluated by the Wexner Score. All pts underwent to recto-anal manometry with a perfused catheter, which had a balloon attached at the distal end, for the distension of the rectum with increasing volumes from 10 to 100 mL-air. Maximum pressure at rest and during voluntary contraction, threshold of rectal sensitivity, and rectal compliance, were evaluated. Results: Thirty-six patients had idiopathic incontinence, 42 iatrogenic incontinence, and in 17 the FI was associated with constipation. Fifty-three patients reported soiling of underwear, 47 gas incontinence, 42 urgency, 38 ineffective squeezing, 35 passive incontinence, with no difference for gender; 67 pts reported at least 2 symptoms. Wexner score was higher in patients with iatrogenic incontinence than in pts with idiopathic one (12±4 vs 9.1±3.6, p=0.001). Anal pressure during squeezing was higher in pts with FI associated with constipation than the other groups and the difference was statistically significant in comparison with patients with idiopathic FI (120.3±63.5 vs 88.2±47.5 mmHg, p=0.038). The three groups did not differ for the other manometric variables. Considering the clinical presentation, patients reporting passive FI or ineffective squeezing had rectal compliance lower (passive IF 3.2±1.1; inability to retain 3.3±1.6 ml/mmHg) than patients with other symptoms (soiling of underwear 3.9±1.7, urgency 4±1.7, gas incontinence 3.5±1.6, ml/mmHg p<0.05). Conclusions: The results of this study demonstrate that the clinical presentation of the FI is poorly predictive of the pathophysiological mechanism. Voluntary contraction and compliance are the manometric variables that vary in different types of incontinence, and these data suggest that a reduced compliance is associated mainly with the clinical presentation as passive incontinence or ineffective squeezing.
P.12.16 EFFICACY AND SAFETY OF PRUCALOPRIDE IN CHRONIC CONSTIPATION: OUR EXPERIENCE IN A GROUP OF ELDERLY WOMEN
P.12.17 EVALUATION OF THE EFFECT OF HYDROPINIC THERAPY ON GASTROINTESTINAL SYMPTOMS AND THE TIME REQUIRED FOR OROCAECAL TRANSIT IN PATIENTS SUFFERING FROM CHRONIC CONSTIPATION G. Merra, V. Gerardi, M. Candelli, A. Gasbarrini ∗ , G. Gasbarrini Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy Background and aim: Chronic idiopathic constipation is a syndrome marked by a reduced number of weekly defecations accompanied by increased faeces consistency. Prevalence of this pathology in the general population is very high and generally associated with a reduction in intestinal transit time. The high prevalence and discomfort caused in everyday living results in a significant number of pharmaceutical products being prescribed, or in any case taken, to relieve symptoms. Our study aims to evaluate intestinal transit time in patients suffering from chronic constipation after the administration of mineral water-based fluid supplements. Material and methods: 15 patients suffering from chronic constipation and 10 healthy controls were enrolled in the study. Orocaecal transit time was assessed in all subjects enrolled by means of a lactulose breath test. The subjects then began to assume Uliveto water as a supplement (1.5 litres per day for 15 days). Once this period of water supplementation had been completed, a new lactulose breath test was performed. The subjects also completed a questionnaire on intestinal symptoms before and after hydropinic therapy. All values were expressed as mean ± standard deviation. Results: Transit time was found to be generally slower in subjects suffering from constipation than in controls. After hydroponic therapy, we saw an overall reduction in orocaecal transit times in patients and an improvement of symptoms. Conclusions: The hydropinic supplement water per day resulted in improved intestinal transit time in patients suffering from chronic constipation.
P.12.18
S. Signorelli ∗ , S. Greco, A. Indriolo, P. Ravelli
NON SURGICAL MANAGEMENT OF PERFORATION DUE TO COLONOSCOPIC POLYPECTOMY: REPORT OF A CASE
Ospedali Riuniti di Bergamo, Bergamo, Italy
C. Tsagkarousianos ∗ , E. Kapros, A. Papadatou, G. Konidis
Background and aim: Chronic constipation is a common medical disorder which affects patients of all ages, especially in elderly women, and is characterized by difficult, infrequent or incomplete bowel movements. Prucalopride is approved in Italy as a treatment of chronic costipation in women dissatisfied with laxatives. Material and methods: The study evaluated the efficacy and the safety of 1 mg dose of prucalopride given once-daily in elderly women with laxative-refractory chronic constipation. 16 women, whose mean age was 81.6 years, with significant impairments in the quality of life and the use of a variety of laxative agents received prucalopride, a new agent, 5-HT4 receptor agonist, a potent stimulator of gut motility, for a 12-week treatment: in this period the patients did not use any laxatives. The efficacy was evaluated using the Patient Assessment of ConstipationQuality of life (PAC-QOL) questionnaire. Moreover, the patients recorded bowel function in daily diaries. Safety assessments included cardiovascular events, laboratory values and adverse events. Results: 14 (87%) patients completed the study, 2 patients withdrew because of adverse events: haedache the first, nausea and abdominal pain the second. After 12 weeks, improvements in average PAC-QOL satisfaction score with significantly improved bowel function, reducing straining, with decreasing time to first stool were observed. There were no clinically relevant effects on the cardiovascular events (ECG corrected QT interval, ECG arrhythmias), the laboratory parameters and no adverse events at the end of the observation period of 12 weeks. Conclusions: Once-daily prucalopride for 12 weeks is effective and generally well tolerated in elderly women with severe chronic constipation. Gastrointestinal events and headache cause discontinuation of the treatment in the 13% of the patients.
General Hospital of Zakinthos, Zakinthos Island, Greece Background and aim: The aim of this paper is to review our experience of the non surgical management of colonoscopic perforation after polypectomy and to evaluate the indications conservative treatment. Material and methods: A 52 year old man underwent diagnostic colonoscopy. Two polyps were found, one at 10cm which was removed endoscopicaly and the other was found at 30cm and it was a penduculate polyp with mammelonate surface with dimensions 5cm. Two days later the patient was admitted and the polyp was removed using loop diathermy. Was discharged after 6 hours in excellent condition with the proper instructions. The next day, patient was admitted at the ER room reporting left lower quadrant pain. His abdomen was soft with moderate tenderness and focal rebound in the left lower quadrant. Laboratory results included wbc 12870 with 80% segmented neutrophils, and
Image 1
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
Image 2
Image 3
the results from biochemical control was normal. A chest radiograph revealed free air under the diaphragm (Image 1). The CT of the abdomen revealed free air inside the abdominal cavity, thickening of the sigmoid wall, dirtiness of the pericolic fat without existence of gastrographin outside of the sigmoid (Image 2 and 3). Results: Was decided conservative treatment with iv administration of Ampicillin, Gentamycin, Clindamycin, and given nothing per os. After 2 days his symptoms had improved. Laboratory tests showed WBC 7150 with 71 segmented neutrophils. Findings on abdominal x-ray studies was improved. By fourth hospital day the patient was pain free, tolerating a regular diet having a regular bowel movement. He was discharged from the hospital at sixth day with diagnosis of microperforation of the sigmoid colon. Conclusions: Perforation of the colonic wall is the most common serious complication and can lead to peritonitis, shock, sepsis and death. Perforation during diagnostic colonoscopy occurs in less than 1 percent and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal. Management of colonic perforation secondary to colonoscopy remains a controversial issue. Radiology often establishes the diagnosis. Some surgeons recommend surgery for all colonoscopic perforations, however there does appear to be a role for conservative management in carefully selected patients without peritoneal irritation. The treatment however must be individualized according to the patients comorbidities and clinical status.
P.12.19 PREOPERATIVE ENDOSCOPIC TATTOOING AND IMPROVED LYMPH NODE RETRIEVAL IN COLORECTAL CANCER: A CASE-CONTROL STUDY V.G. Matarese ∗ , M. Zuolo, M. Portinari, S. Targa, L. Trevisani, R. Gafà, G. Lanza, C. Feo Nuovo Ospedale S.Anna, Cona-Ferrara, Italy Background and aim: Many factors may affect the total number of lymph nodes examined in surgical specimens including surgical technique and methodology of nodes evaluation. Lymph node retrieval has recently been shown to be facilitated in colorectal cancer specimens with preoperative
S179
endoscopic tattooing, as the nodes may be more easily identified. The aim of study was to confirm such evidence in an Italian tertiary care center. Material and methods: All patients undergoing an elective colonic or rectal resection for possible cancer between January 2009-December 2011 at the Department of Surgery of the S. Anna Hospital in Ferrara (Italy) were included and divided into two groups: 107 patients in whom India ink tattooing was performed at preoperative colonoscopy (tattooed group) and 143 in whom it was not (control group). The primary outcome measures were: total number of lymph nodes harvested per specimen, number of adequate lymphadenectomies (≥12 nodes) performed. All factors known to influence lymph node retrieval from colorectal specimen were specifically evaluated. Rectal cancers were analyzed together and separately from colonic cancers. Results: Tattooed patients with colonic cancer were slightly younger than controls (69.5±11.6 years vs 72.9±9.6 years, p=0.02). Tumor size for colonic cancer was less in the tattooed group compared to controls (4.6±2.4 cm vs 5.4±2.8 cm, p=0.03). Besides that, the study groups were comparable regarding age, gender, BMI, tumor location and size, TNM staging, DNA microsatellite instability–high status and preoperative chemoradiation therapy. No difference could be detected neither in the median number of lymph nodes retrieved 16.0 (4–46) vs 17.0 (3–60), p=NS) nor in the number of adequate lymphadenectomies (78% vs 83%, p=NS) between the tattooed and control groups. There was no difference in the number of both lymph nodes harvested and adequate lymphadenectomies among high-volume and low-volume surgeons. Pathologists dedicated to gastrointestinal diseases showed a higher number of lymph nodes retrieved as well as adequate lymphadenectomies in in both study groups compared to non-dedicated pathologists. Conclusions: This study does not confirm that preoperative ink tattooing improves the lymph nodes yield from colorectal cancer specimen. Further studies are therefore needed to determine if colonscopic tattooing can refine staging. The pathologist is confirmed as a fundamental element.
P.12.20 ENDOSPONGE FOR ENDOSCOPIC MANAGEMENT OF ANASTOMOTIC LEAKAGE AFTER COLORECTAL SURGERY: RESULTS FROM A SINGLE CENTRE EXPERIENCE A. Repici ∗ , N. Pagano, E.C. Ferrara, C. Ciscato, G. Strangio, E. Vitetta, G. Rando, U. Elmore, U. Fumagalli, R. Rosati, A. Spinelli, S. Bona, M. Montorsi, A. Malesci Istituto Clinico Humanitas, Rozzano - Milano, Italy Background and aim: Endo-sponge treatment represents a novel approach to manage patients with anastomotic dehiscence following colorectal surgery. Limited data are available to predict success rate and complication. Material and methods: Between September 2008 and October 2012, patients suffering from anastomotic leakage after surgery were managed with endo-sponge placement. 18 pts underwent anterior rectal resection, all but one for rectal adenocarcinoma and one for rectal endometriotic nodule; 3 pts underwent left hemicolectomy, for diverticulosis in one case and for left-sided adenocarcinoma in the other 2 cases; one patient underwent proctocolectomy for ulcerative colitis. After surgery, when anastomotic leakage was suspected, a CT scan was performed. The endo-sponge is an open-pored polyurethane sponge which is installed transanally after examination and rinsing of the abscess cavity using a small-calibre gastroscope. Afterwards, the sponge is connected to a low vacuum suction bottle, creating a constant negative pressure. Primary outcome parameters were closure of the cavity and the ability to close the ileostomy. Results: In total 22 patients [M:F = 17:5 – mean age 67 years (range 37–89 y)] were included. Mean time of endo-sponge treatment was 4.3 weeks (range: 1–32 weeks). There were 3 major complications: one case of ureteric fistula, one of ileal fistula and one of pararectal abscess. In 18 (82%) patients, the anastomotic leakage healed successfully. Three patients showed no response (14%) and one patient was improved for partial but not complete leakage healing at the time of data collection. The lack of success was associated with to complexity of the leakages, which comprised either more than 270 degrees of the circumference or consisted of two distant fistulas. Formation of granulation tissue and final healing were unaffected by concomitant radio or chemotherapy. Mean follow-up was 9 months. Three patients died during
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
gas incontinence, soiling of underwear, passive FI, urgency and ineffective squeezing. Incontinence was evaluated by the Wexner Score. All pts underwent to recto-anal manometry with a perfused catheter, which had a balloon attached at the distal end, for the distension of the rectum with increasing volumes from 10 to 100 mL-air. Maximum pressure at rest and during voluntary contraction, threshold of rectal sensitivity, and rectal compliance, were evaluated. Results: Thirty-six patients had idiopathic incontinence, 42 iatrogenic incontinence, and in 17 the FI was associated with constipation. Fifty-three patients reported soiling of underwear, 47 gas incontinence, 42 urgency, 38 ineffective squeezing, 35 passive incontinence, with no difference for gender; 67 pts reported at least 2 symptoms. Wexner score was higher in patients with iatrogenic incontinence than in pts with idiopathic one (12±4 vs 9.1±3.6, p=0.001). Anal pressure during squeezing was higher in pts with FI associated with constipation than the other groups and the difference was statistically significant in comparison with patients with idiopathic FI (120.3±63.5 vs 88.2±47.5 mmHg, p=0.038). The three groups did not differ for the other manometric variables. Considering the clinical presentation, patients reporting passive FI or ineffective squeezing had rectal compliance lower (passive IF 3.2±1.1; inability to retain 3.3±1.6 ml/mmHg) than patients with other symptoms (soiling of underwear 3.9±1.7, urgency 4±1.7, gas incontinence 3.5±1.6, ml/mmHg p<0.05). Conclusions: The results of this study demonstrate that the clinical presentation of the FI is poorly predictive of the pathophysiological mechanism. Voluntary contraction and compliance are the manometric variables that vary in different types of incontinence, and these data suggest that a reduced compliance is associated mainly with the clinical presentation as passive incontinence or ineffective squeezing.
P.12.16 EFFICACY AND SAFETY OF PRUCALOPRIDE IN CHRONIC CONSTIPATION: OUR EXPERIENCE IN A GROUP OF ELDERLY WOMEN
P.12.17 EVALUATION OF THE EFFECT OF HYDROPINIC THERAPY ON GASTROINTESTINAL SYMPTOMS AND THE TIME REQUIRED FOR OROCAECAL TRANSIT IN PATIENTS SUFFERING FROM CHRONIC CONSTIPATION G. Merra, V. Gerardi, M. Candelli, A. Gasbarrini ∗ , G. Gasbarrini Policlinico “Agostino Gemelli”, Università Cattolica del Sacro Cuore, Roma, Italy Background and aim: Chronic idiopathic constipation is a syndrome marked by a reduced number of weekly defecations accompanied by increased faeces consistency. Prevalence of this pathology in the general population is very high and generally associated with a reduction in intestinal transit time. The high prevalence and discomfort caused in everyday living results in a significant number of pharmaceutical products being prescribed, or in any case taken, to relieve symptoms. Our study aims to evaluate intestinal transit time in patients suffering from chronic constipation after the administration of mineral water-based fluid supplements. Material and methods: 15 patients suffering from chronic constipation and 10 healthy controls were enrolled in the study. Orocaecal transit time was assessed in all subjects enrolled by means of a lactulose breath test. The subjects then began to assume Uliveto water as a supplement (1.5 litres per day for 15 days). Once this period of water supplementation had been completed, a new lactulose breath test was performed. The subjects also completed a questionnaire on intestinal symptoms before and after hydropinic therapy. All values were expressed as mean ± standard deviation. Results: Transit time was found to be generally slower in subjects suffering from constipation than in controls. After hydroponic therapy, we saw an overall reduction in orocaecal transit times in patients and an improvement of symptoms. Conclusions: The hydropinic supplement water per day resulted in improved intestinal transit time in patients suffering from chronic constipation.
P.12.18
S. Signorelli ∗ , S. Greco, A. Indriolo, P. Ravelli
NON SURGICAL MANAGEMENT OF PERFORATION DUE TO COLONOSCOPIC POLYPECTOMY: REPORT OF A CASE
Ospedali Riuniti di Bergamo, Bergamo, Italy
C. Tsagkarousianos ∗ , E. Kapros, A. Papadatou, G. Konidis
Background and aim: Chronic constipation is a common medical disorder which affects patients of all ages, especially in elderly women, and is characterized by difficult, infrequent or incomplete bowel movements. Prucalopride is approved in Italy as a treatment of chronic costipation in women dissatisfied with laxatives. Material and methods: The study evaluated the efficacy and the safety of 1 mg dose of prucalopride given once-daily in elderly women with laxative-refractory chronic constipation. 16 women, whose mean age was 81.6 years, with significant impairments in the quality of life and the use of a variety of laxative agents received prucalopride, a new agent, 5-HT4 receptor agonist, a potent stimulator of gut motility, for a 12-week treatment: in this period the patients did not use any laxatives. The efficacy was evaluated using the Patient Assessment of ConstipationQuality of life (PAC-QOL) questionnaire. Moreover, the patients recorded bowel function in daily diaries. Safety assessments included cardiovascular events, laboratory values and adverse events. Results: 14 (87%) patients completed the study, 2 patients withdrew because of adverse events: haedache the first, nausea and abdominal pain the second. After 12 weeks, improvements in average PAC-QOL satisfaction score with significantly improved bowel function, reducing straining, with decreasing time to first stool were observed. There were no clinically relevant effects on the cardiovascular events (ECG corrected QT interval, ECG arrhythmias), the laboratory parameters and no adverse events at the end of the observation period of 12 weeks. Conclusions: Once-daily prucalopride for 12 weeks is effective and generally well tolerated in elderly women with severe chronic constipation. Gastrointestinal events and headache cause discontinuation of the treatment in the 13% of the patients.
General Hospital of Zakinthos, Zakinthos Island, Greece Background and aim: The aim of this paper is to review our experience of the non surgical management of colonoscopic perforation after polypectomy and to evaluate the indications conservative treatment. Material and methods: A 52 year old man underwent diagnostic colonoscopy. Two polyps were found, one at 10cm which was removed endoscopicaly and the other was found at 30cm and it was a penduculate polyp with mammelonate surface with dimensions 5cm. Two days later the patient was admitted and the polyp was removed using loop diathermy. Was discharged after 6 hours in excellent condition with the proper instructions. The next day, patient was admitted at the ER room reporting left lower quadrant pain. His abdomen was soft with moderate tenderness and focal rebound in the left lower quadrant. Laboratory results included wbc 12870 with 80% segmented neutrophils, and
Image 1
Abstracts of the 19th National Congress of Digestive Diseases / Digestive and Liver Disease 45S (2013) S55–S218
Image 2
Image 3
the results from biochemical control was normal. A chest radiograph revealed free air under the diaphragm (Image 1). The CT of the abdomen revealed free air inside the abdominal cavity, thickening of the sigmoid wall, dirtiness of the pericolic fat without existence of gastrographin outside of the sigmoid (Image 2 and 3). Results: Was decided conservative treatment with iv administration of Ampicillin, Gentamycin, Clindamycin, and given nothing per os. After 2 days his symptoms had improved. Laboratory tests showed WBC 7150 with 71 segmented neutrophils. Findings on abdominal x-ray studies was improved. By fourth hospital day the patient was pain free, tolerating a regular diet having a regular bowel movement. He was discharged from the hospital at sixth day with diagnosis of microperforation of the sigmoid colon. Conclusions: Perforation of the colonic wall is the most common serious complication and can lead to peritonitis, shock, sepsis and death. Perforation during diagnostic colonoscopy occurs in less than 1 percent and may be seen in up to 3 percent of patients undergoing therapeutic procedures such as polyp removal. Management of colonic perforation secondary to colonoscopy remains a controversial issue. Radiology often establishes the diagnosis. Some surgeons recommend surgery for all colonoscopic perforations, however there does appear to be a role for conservative management in carefully selected patients without peritoneal irritation. The treatment however must be individualized according to the patients comorbidities and clinical status.
P.12.19 PREOPERATIVE ENDOSCOPIC TATTOOING AND IMPROVED LYMPH NODE RETRIEVAL IN COLORECTAL CANCER: A CASE-CONTROL STUDY V.G. Matarese ∗ , M. Zuolo, M. Portinari, S. Targa, L. Trevisani, R. Gafà, G. Lanza, C. Feo Nuovo Ospedale S.Anna, Cona-Ferrara, Italy Background and aim: Many factors may affect the total number of lymph nodes examined in surgical specimens including surgical technique and methodology of nodes evaluation. Lymph node retrieval has recently been shown to be facilitated in colorectal cancer specimens with preoperative
S179
endoscopic tattooing, as the nodes may be more easily identified. The aim of study was to confirm such evidence in an Italian tertiary care center. Material and methods: All patients undergoing an elective colonic or rectal resection for possible cancer between January 2009-December 2011 at the Department of Surgery of the S. Anna Hospital in Ferrara (Italy) were included and divided into two groups: 107 patients in whom India ink tattooing was performed at preoperative colonoscopy (tattooed group) and 143 in whom it was not (control group). The primary outcome measures were: total number of lymph nodes harvested per specimen, number of adequate lymphadenectomies (≥12 nodes) performed. All factors known to influence lymph node retrieval from colorectal specimen were specifically evaluated. Rectal cancers were analyzed together and separately from colonic cancers. Results: Tattooed patients with colonic cancer were slightly younger than controls (69.5±11.6 years vs 72.9±9.6 years, p=0.02). Tumor size for colonic cancer was less in the tattooed group compared to controls (4.6±2.4 cm vs 5.4±2.8 cm, p=0.03). Besides that, the study groups were comparable regarding age, gender, BMI, tumor location and size, TNM staging, DNA microsatellite instability–high status and preoperative chemoradiation therapy. No difference could be detected neither in the median number of lymph nodes retrieved 16.0 (4–46) vs 17.0 (3–60), p=NS) nor in the number of adequate lymphadenectomies (78% vs 83%, p=NS) between the tattooed and control groups. There was no difference in the number of both lymph nodes harvested and adequate lymphadenectomies among high-volume and low-volume surgeons. Pathologists dedicated to gastrointestinal diseases showed a higher number of lymph nodes retrieved as well as adequate lymphadenectomies in in both study groups compared to non-dedicated pathologists. Conclusions: This study does not confirm that preoperative ink tattooing improves the lymph nodes yield from colorectal cancer specimen. Further studies are therefore needed to determine if colonscopic tattooing can refine staging. The pathologist is confirmed as a fundamental element.
P.12.20 ENDOSPONGE FOR ENDOSCOPIC MANAGEMENT OF ANASTOMOTIC LEAKAGE AFTER COLORECTAL SURGERY: RESULTS FROM A SINGLE CENTRE EXPERIENCE A. Repici ∗ , N. Pagano, E.C. Ferrara, C. Ciscato, G. Strangio, E. Vitetta, G. Rando, U. Elmore, U. Fumagalli, R. Rosati, A. Spinelli, S. Bona, M. Montorsi, A. Malesci Istituto Clinico Humanitas, Rozzano - Milano, Italy Background and aim: Endo-sponge treatment represents a novel approach to manage patients with anastomotic dehiscence following colorectal surgery. Limited data are available to predict success rate and complication. Material and methods: Between September 2008 and October 2012, patients suffering from anastomotic leakage after surgery were managed with endo-sponge placement. 18 pts underwent anterior rectal resection, all but one for rectal adenocarcinoma and one for rectal endometriotic nodule; 3 pts underwent left hemicolectomy, for diverticulosis in one case and for left-sided adenocarcinoma in the other 2 cases; one patient underwent proctocolectomy for ulcerative colitis. After surgery, when anastomotic leakage was suspected, a CT scan was performed. The endo-sponge is an open-pored polyurethane sponge which is installed transanally after examination and rinsing of the abscess cavity using a small-calibre gastroscope. Afterwards, the sponge is connected to a low vacuum suction bottle, creating a constant negative pressure. Primary outcome parameters were closure of the cavity and the ability to close the ileostomy. Results: In total 22 patients [M:F = 17:5 – mean age 67 years (range 37–89 y)] were included. Mean time of endo-sponge treatment was 4.3 weeks (range: 1–32 weeks). There were 3 major complications: one case of ureteric fistula, one of ileal fistula and one of pararectal abscess. In 18 (82%) patients, the anastomotic leakage healed successfully. Three patients showed no response (14%) and one patient was improved for partial but not complete leakage healing at the time of data collection. The lack of success was associated with to complexity of the leakages, which comprised either more than 270 degrees of the circumference or consisted of two distant fistulas. Formation of granulation tissue and final healing were unaffected by concomitant radio or chemotherapy. Mean follow-up was 9 months. Three patients died during