Fecal Volume after Laparoscopic Low Anterior Resection Predicts Anastomotic Leakage

Abstract

Background/Aim: Anastomotic leakage (AL) is a major complication after laparoscopic low anterior resection (Lap-LAR). Many surgeons encounter AL following severe postoperative diarrhea. However, little is known about the relationship between postoperative fecal volume and AL. This study determined whether postoperative fecal volume can predict AL. Methods: A retrospective assessment was performed with data from 176 patients with rectal cancers who underwent Lap-LAR between April 2011 and August 2015. A transanal tube was routinely placed in all cases. The fecal volume from the transanal tube was measured daily. The total fecal volume for 3 days after surgery was compared between the AL and non-AL groups. Results: AL occurred in 11 patients. There were 3 patients with a fecal volume ≥1,000 mL for 3 days after surgery. AL occurred in these 3 patients. In patients with a fecal volume <1,000 mL, the total fecal volume was significantly greater in the AL group than that in the non-AL group (p = 0.0003). The cut-off value of the total fecal volume in AL was 118 mL. Conclusions: The volume of fecal discharge for 3 days after surgery is associated with the incidence of AL, and a fecal volume ≥118 mL may be a reliable predictor for AL.

Impact of Early Postoperative Diarrhea on Anastomotic Leakage after Laparoscopic Low Anterior Resection for Rectal Cancer

“…The intraluminal pressure at the anastomotic site might increase when a lot of watery stool fills the remnant rectum, causing anastomotic disruption. There are only a few reports discussing the relationship between early postoperative diarrhea and AL after LAR [24][25][26] . Hidaka et al concluded that a fecal volume of ≥118 mL for 3 days after surgery may be a reliable predictor of the development of AL 24) .…”

“…There are only a few reports discussing the relationship between early postoperative diarrhea and AL after LAR [24][25][26] . Hidaka et al concluded that a fecal volume of ≥118 mL for 3 days after surgery may be a reliable predictor of the development of AL 24) . Ito and Hiraki et al reported that early postoperative diarrhea, defined as at least 1 passage of more than approximately 50 mL of watery stools within 7 days after surgery, was associated with AL 25,26) .…”

“…Recently, a retrospective study reported that postoperative diarrhea may be associated with superficial surgical site infection (SSI) 29) . Furthermore, another retrospective study revealed that a total fecal volume of >118 mL for 3 consecutive days after surgery may be a reliable predictor of the development of AL 24) . A transanal drainage tube is often used for the purpose of decreasing the intraluminal pressure at the site of anastomosis and preventing the occurrence of AL 14,25) .…”

The effects of preoperative intestinal dysbacteriosis on postoperative recovery in colorectal cancer surgery: a prospective cohort study

“…Diarrhoea has also been reported as a potential risk for anastomotic leakage in recent years. Hidaka et al [ 26 ] demonstrated that a faecal volume over 118 ml within 3 days after colorectal surgery may be a reliable predictor for anastomotic leakage. Li et al [ 44 ] found that the incidence of anastomotic leakage was higher in patients with early postoperative diarrhoea after rectal cancer surgery than in those without (16.2% vs. 5.2%, P < 0.05).…”

“…Postoperative symptoms or clinical features, such as early postoperative diarrhoea [ 26 ], and hypoalbuminemia [ 27 ], that might be associated with outcomes were also recorded. Early postoperative diarrhoea was defined as three or more unusually loose or liquid stools per day [ 28 ], occurring within 7 days after surgery.…”