title: Complications are increased with the need for an abdominal-assisted Kraske procedure.
abstract: The Kraske procedure offers a sphincter-saving alternative for surgical correction of rectal disease. This study was performed to investigate the complication rate with the traditional (transsacral) Kraske procedure versus an abdominal-assisted Kraske approach (laparoscopic or open). We conducted a retrospective review of all patients undergoing the Kraske procedure at Harper University Hospital over a 10-year period. A total of 54 patients were identified. Indications for surgery included rectal carcinoma (43), large villous adenomas (6), and other (5). Average post-operative follow-up was 40 +/- 25 months (mean +/- SD). Complications included rectocutaneous fistulae (9), perineal infections (13), and incontinence (8). In patients requiring an abdominal-assisted approach for colorectal mobilization, the fistula rate was significantly higher (33% vs 3%; P = 0.007), as were the rates of perineal infections (33% vs 17%) and of initial incontinence (25% vs 7%). The laparoscopic-assisted approach significantly reduced the operating time (272 +/- 72 minutes) compared to the open-assisted approach (498 +/- 138 minutes) (P < 0.001). The traditional Kraske procedure can be utilized in a safe, effective manner for treatment of rectal disease. Knowledge of the increased rate of complications with the abdominal-assisted Kraske approach can guide the patient and physician considering sphincter salvage.
authors.affiliation: Department of Surgery, Wayne State University, Detroit, Michigan, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Harvey
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Young
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Flanigan
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Carlin
authors.forename: Michael T
authors.initials: MT
authors.lastname: White
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: Donald W
authors.initials: DW
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D020380:Needs Assessment; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011336:Probability; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D013997:Time Factors; D016896:Treatment Outcome