The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Cho, Seok Hyeon; Lee, In Kyu; Lee, Yoon Suk; Kim, Min Ki

doi:10.4174/astr.2021.100.2.100

Cited by 12 publications

(9 citation statements)

References 31 publications

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“…In our study, the AL rate in the ISSA group was relatively lower than that of the ASSA group (3.3% vs. 8.9%), although not reaching a statistical significance (P = 0.340). Undoubtedly, tension is one of the most critical factors for intestinal anastomosis [ 29 30 31 ]. Theoretically, if anastomosis tension can be decomposed transversely and longitudinally, additional transverse tension is exerted on ASSA.…”

Section: Discussionmentioning

confidence: 99%

Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease

et al. 2022

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Purpose Increasing evidence has shown an association of surgical technique, particularly anastomotic configuration, with postoperative recurrence of CD. This pilot study aimed to evaluate short-term outcomes of isoperistaltic side-to-side anastomosis (ISSA) employed on Crohn disease (CD) patients. Methods Data were retrieved from a prospectively maintained database. Postoperatively, all patients were followed up with close endoscopic (ileocolonoscopy) surveillance. Results From January 2017 to May 2021, 30 patients diagnosed with CD who underwent ISSA were compared with 45 CD patients who underwent antiperistaltic side-to-side anastomosis (ASSA). The 2 groups were comparable in baseline demographics and clinical characteristics. No significant differences were observed between groups regarding postoperative safety issues, including anastomotic leak, abdominal/pelvic abscess, length of hospital stay, readmission rate within 30 days, etc. At postoperative 24th month, reduced endoscopic recurrence was observed in the ISSA group compared with that in the ASSA group (18 of 24, 75.0%, vs. 36 of 38, 94.7%; P = 0.024). Regarding surgical recurrence, there was 0% in the ISSA group vs. 4.4% (2 of 45) in the ASSA group (P = 0.510). Conclusion In this study, we aimed to explore the influence of ISSA on postoperative recurrence in CD patients, and the preliminary results show that ISSA was technically safe and feasible, and appears to be effective in reducing postoperative recurrence in CD patients. However, our conclusion was underpowered due to small sample size and inadequate follow-up. We proposed ISSA be considered as another alternative option in the toolbox of inflammatory bowel disease surgeons when performing anastomosis on CD patients.

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Section: Discussionmentioning

confidence: 99%

Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease

et al. 2022

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“…5 Although diverting stoma also contributes to reduced AL, the rate of postoperative complications associated with the closure of the diverting loop ileostomy is greater than 10%. 6 Since the effects of decreasing the AL rate between TDT and diverting stoma seem to be comparable, 7 TDT placement instead of diverting stoma is considered a management technique to prevent AL. Table 1 presents a review of the reported cases on intestinal perforation due to TDT.…”

Section: Discussionmentioning

confidence: 99%

Postoperative colon perforation due to the tip of the transanal decompression tube after laparoscopic low anterior resection: A case report

Sato

Kasajima

Imaizumi

et al. 2022

Asian J Endoscop Surgery

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A 66-year-old man underwent laparoscopic low anterior resection for rectal cancer. A transanal decompression tube (24Fr Nelaton catheter) was placed laparoscopically during the surgery. Contrast enema on postoperative day 5 showed perforation of the sigmoid colon around the tip of the tube, and emergency laparotomy was performed. Perforation of the posterior sigmoid colon located on the proximal side of the colorectal anastomosis at the level of the promontorium was identified. Closure of the perforation site, lavage drainage, and a diverting loop ileostomy were performed. Although a transanal decompression tube is useful in preventing anastomotic leakage, tube-related colon perforation should be noted, and controversies about the safety of laparoscopically transanal decompression tube placement should be resolved. Adequate management for tube placement should be discussed.

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“…In the past decade, a positive role of TDTs in AL prevention was proposed by a series of studies . However, this conclusion remained in question.…”

Section: Discussionmentioning

confidence: 99%

Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer

et al. 2021

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Preventing anastomotic leakage (AL) is crucial for colorectal surgery. Some studies have suggested a positive role of transanal drainage tubes (TDTs) in AL prevention after low anterior resection, but this finding is controversial.OBJECTIVE To assess the effect of TDTs in AL prevention after laparoscopic low anterior resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTSThis multicenter randomized clinical trial with parallel groups (TDT vs non-TDT) was performed from February 26, 2016, to September 30, 2020. Participants included patients from 7 different hospitals in China who were undergoing laparoscopic low anterior resection with the double-stapling technique for mid-low rectal cancer; 576 patients were initially enrolled in this study, and 16 were later excluded. Ultimately, 560 patients were randomly divided between the TDT and non-TDT groups.INTERVENTIONS A silicone tube was inserted through the anus, and the tip of the tube was placed approximately 5 cm above the anastomosis under laparoscopy at the conclusion of surgery. The tube was fixed with a skin suture and connected to a drainage bag. The TDT was scheduled for removal 3 to 7 days after surgery. MAIN OUTCOMES AND MEASURESThe primary end point was the postoperative AL rate within 30 days. RESULTSIn total, 576 patients were initially enrolled in this study; 16 of these patients were excluded. Ultimately, 560 patients were randomly divided between the TDT group (n = 280; median age, 61.5 years [IQR, 54.0-68.8 years]; 177 men [63.2%]) and the non-TDT group (n = 280; median age, 62.0 years [IQR, 52.0-69.0 years]; 169 men [60.4%]). Intention-to-treat analysis showed no significant difference between the TDT and non-TDT groups in AL rates (18 [6.4%] vs 19 [6.8%]; relative risk, 0.947; 95% CI, 0.508-1.766; P = .87) or AL grades (grade B, 14 [5.0%] and grade C, 4 [1.4%] vs grade B, 11 [3.9%] and grade C, 8 [2.9%]; P = .43). In the stratified analysis based on diverting stomas, there was no significant difference in the AL rate between the groups, regardless of whether a diverting stoma was present (without stoma, 12 [5.8%] vs 15 [7.9%], P = .41; and with stoma, 6 [8.3%] vs 4 [4.5%], P = .50). Anal pain was the most common complaint from patients in the TDT group (130 of 280, 46.4%). Accidental early TDT removal occurred in 20 patients (7.1%), and no bleeding or iatrogenic colonic perforations were detected. CONCLUSIONS AND RELEVANCEThe results from this randomized clinical trial indicated that TDTs may not confer any benefit for AL prevention in patients who undergo laparoscopic low anterior resection for mid-low rectal cancer without preoperative radiotherapy.

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The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: compared to diverting stoma

Cited by 12 publications

References 31 publications

Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease

Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease

Postoperative colon perforation due to the tip of the transanal decompression tube after laparoscopic low anterior resection: A case report

Transanal Drainage Tube Use for Preventing Anastomotic Leakage After Laparoscopic Low Anterior Resection in Patients With Rectal Cancer

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