ArticleInternational journal of colorectal disease2018
A new direction in anastomotic research: should we redesign the 'angle of sorrow'?
Article in International journal of colorectal disease, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed, 4 citations in OpenAlex.
- Addressing parastomal herniation through biomechanical simulation.Hernia : the journal of hernias and abdominal wall surgery · 2023Article
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1 author at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
introductionDespite advances in oncological outcomes in colo-rectal surgery, rates of anastomotic leak have not improved. The precise mechanisms of anastomotic leak remain poorly understood. Current research has focused on anastomotic reinforcement to tackle anastomotic leak with little success. The 'Angle of Sorrow', the corner of the anastomosis is prone to anastomotic leak, but remains a persistent feature in the gastrointestinal anastomosis. The tendency for stress forces to concentrate in the vulnerable 'Angle of Sorrow' prompts the need for anastomotic design research.
aimThe aim of this study is to explore if redesigning the 'Angle of Sorrow' can reduce the stress forces in the ileocolic anastomosis.
methodsA simulation-based experimental study compared two anastomotic designs: traditional Slit Enterotomy Anastomosis (SEA) vs a novel Radiused Enterotomy Anastomosis (REA). The finite element analysis simulations were performed using FEBIO to measure peak sheer stress in pressurised bowel.
resultsTissue stress was found to concentrate at the 'Angles of Sorrow' in traditional anastomosis design while the REA design distributed sheer stress across the anastomosis. The SEA model had greater peak sheer stress factors than REA for the hand-sewn and stapled 'Barcelona' anastomosis (1.58 (k) vs 0.64 (k), 0.91 (k) vs 0.63 (k)). The REA anastomosis resulted in significantly less peak stress across all anastomotic experiments (p = 0.0047). The mucosa of the SEA model tended to unfavourably evert.
conclusionRedesigning the 'Angle of Sorrow' decreased tissue stress concentration. The direction of future anastomotic research may involve going back to the drawing board, rather than attempting to reinforce a potentially flawed design. Despite advances in colorectal surgery, rates of anastomotic leak have not improved. The 'Angle of Sorrow', the corner of the anastomosis is prone to anastomotic leak, but remains a persistent feature in gastrointestinal anastomosis. The direction of future research may involve going back to redesign this vulnerable area.
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