The possibility of a transanal tube as an alternative to diverting stoma in terms of preventing severe postoperative ana
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ORIGINAL ARTICLE
The possibility of a transanal tube as an alternative to diverting stoma in terms of preventing severe postoperative anastomotic leakage after laparoscopic low anterior resection Tomoko Matsumoto 1 & Madoka Hamada 1 & Ryo Inada 1 & Terufumi Yoshida 1 & Toshinori Kobayashi 1 & Nobumasa Taniguchi 2 & Masaharu Oishi 1 & Kaori Shigemitsu 1 & Mitsugu Sekimoto 1 Accepted: 14 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The purpose of this study was to reveal whether a transanal tube (TAT) could act as an alternative to a diverting stoma (DS) after laparoscopic low anterior resection. Patients and Methods A total of 89 consecutive rectal cancer patients whose tumors were located within 15 cm from the anal verge who underwent laparoscopic low anterior resection without a DS at our institution between May 12, 2015 and August 31, 2019 were included. All patients received a postoperative Gastrografin enema study (GES) through a TAT between the 3rd and 10th postoperative day. We planned two study protocols. From May 12, 2015 to March 31, 2017, we conducted a second operation including a DS construction immediately when radiological anastomotic leakage (rAL) was detected (Group A, n=46). From April 1, 2017 to August 31, 2019, we continued TAT drainage even if rAL was detected and repeated the GES weekly until the rAL was healed (Group B, n=43). Results In Group A (n=46), 14 cases of rAL were included, 11 of which underwent stoma construction. The remaining 3 patients who refused stoma construction were treated conservatively. In Group B (n=43) rAL was encountered in 10, and 7 of these patients were treated successfully by TAT continuous drainage. The rate of DS in Group B (7.0%) was significantly lower than that in Group A (23.9%) (p=0.028). Conclusions A TAT could act as a DS to mitigate the symptoms of anastomotic leakage after laparoscopic low anterior resection. Keywords Transanal tube . Laparoscopic low anterior resection . Diverting stoma . Anastomotic leakage
Introduction Laparoscopic low anterior resection (LAP LAR) with anastomosis by the double stapling technique (DST) in now widely accepted as curative surgery for rectal cancer [1, 2]. However, anastomotic leakage (AL) is still one of the most serious postoperative complications of these procedures. There have been considerable variations among previous studies in AL rates after anterior resection (1.22-20.5%) because of the definition of AL [3]. According to the grading system
* Madoka Hamada [email protected] 1
Division of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1, Shinmachi, Hirakata, Osaka 573-1191, Japan
2
Department of Surgery, Terada Hospital, Nabari, Mie, Japan
defined by Rahbari et al, most of those studies might have included only Grade B or C as symptomatic AL (sAL) [4]. To reduce the rate of sAL after LAP LAR, a diverting stoma (DS) has been considered to be effective [5–9]. In a Japanese multicenter trial, 36.0% cases who underwent LAP LAR DST for rectal cancer
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