Clinical Value of Preventative Ileostomy Following Ultra-Low Anterior Rectal Resection
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TRANSLATIONAL BIOMEDICAL RESEARCH
Clinical Value of Preventative Ileostomy Following Ultra-Low Anterior Rectal Resection Hai Gong • Yifeng Yu • Yong Yao
Published online: 18 October 2012 Ó Springer Science+Business Media New York 2012
Abstract The objective was to evaluate the clinical value of preventative ileostomy following ultralow anterior rectal resection in decreasing the incidence of anastomotic leakage. For this purpose, 62 cases that had undergone ultralow anterior rectal resection during the period from June 2007 to June 2008 were included in this study. Preventative ileostomy was performed in 36 cases (group A) and 26 cases with no preventative ileostomy performed were included as controls (group B). The incidence rate of anastomotic leakage in both groups was compared. The results show that five cases in group A reported anastomotic leakage while no anastomotic leakage was reported in group B. Therefore, it was concluded that preventative ileostomy could effectively decrease the incidence of anastomotic leakage. Keywords Ileostomy
Rectal cancer Ultralow anterior resection
Introduction With the development of rectal cancer and the improvement of medical instruments, together with higher requirements by patients for the quality of post-surgical life, ultralow anterior rectal resection has become the major low sphincter preserving procedure [1]. However, the incidence rate of anastomotic leakage was reported as 10–20 % for low anterior rectal resection [2, 3] and the
H. Gong (&) Y. Yu Y. Yao Department of Colorectal Surgery, Jiangyin People’s Hospital of Southeast University, 163# Shoushan Road, Jiangyin 214400, Jiangsu Province, China e-mail: [email protected]
higher rate, as high as 48 %, was reported for ultralow anterior resection [4] which retarded developments of this surgical procedure. Therefore, in this study, we evaluated outcomes of the preventative ileostomy via retrospective medical record review of two groups of patients; especially to assess its effectiveness in decreasing the incidence rate of anastomotic leakage.
Materials and Methods Patients and Clinical Characteristics Ultralow double stapling procedure was performed in 62 patients with rectal cancer. Group A (experimental group) comprised 26 patients with preventative ileostomy and group B (control group) comprised 36 patients without preventative ileostomy. There were 36 males and 26 females with a median age of 62.6 (range: 38–76) years. Based on lump classification, 15 cases were protrusive type, 37 cases were ulcerative type and ten cases were narrowing type. Regarding histological classification, 33 cases belonged to tubular adenocarcinoma, 23 cases belonged to papillary carcinoma and six cases belonged to mucinous adenocarcinoma. As for Duck staging, 11 cases were Duck stage A, 28 cases were stage B and 23 cases were stage C. The distance between tumor and anus were 4.26 ± 0.87 cm for ileostomy group and 4.56 ± 0.67 cm for control group. Comparison of the clinical characteristics between two groups is given in Ta
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