Critical surgical errors by junior fellows and trainees in low rectal cancer surgery: How to overcome?(A cross-sectional study).

AIM

Technical difficulties are usually reported in low rectal cancer (LRC) surgery. Moreover inadvertent surgical errors could happen mostly due to lack of experience of the assisting surgeons. Unfortunately, these errors may end up with raising a permanent stoma. In this study we are reporting seven inadvertent surgical mishaps during surgeries for LRC which resulted in failure of the planned circular end to end anastomosis and how we approached them by different salvage techniques.

PATIENTS AND METHODS

All surgical mistakes were salvaged by two of our senior consultants with intraoperative decision to shift to another approach to attain intestinal continuity. Two patients had direct handswen coloanal anastomosis, three received colon pull through and two with redo stapled circular end to end anastomosis after shifting to the anterior perineal plane. Postoperative assessment of the functional state using wexner score was done for all cases.

RESULTS

All surgical mistakes had been overcomed after shifting to the transanal and/or perineal approach and we were able to regain intestinal continuity in all cases Circumferential and distal margins were free in all specimens. Two patients showed optimal continence with wexner score 3,5 respectively, Two had suboptimal continence Wexner 6,7. Female patient with iatrogenic rectovaginal fistula suffered from poor quality of life and asked for permanent stoma.

CONCLUSION

All trainees and junior fellows in should receive a clearly defined training program and focused education with different staplers; additionally they should work under supervision of the senior consultants who should be sufficiently experienced with different salvage approaches.