Ann Surg Treat Res.  2015 May;88(5):260-268. 10.4174/astr.2015.88.5.260.

Comparative study between transanal tube and loop ileostomy in low anterior resection for mid rectal cancer: a retrospective single center trial

• Kim MK
• Won DY
• Lee JK
• Kang WK
• Kim JG
• Oh ST

• KMID: 2166994
• DOI: http://doi.org/10.4174/astr.2015.88.5.260

Abstract

PURPOSE
To investigate the efficacy and safety of the transanal tube (TAT) in preventing anastomotic leak (AL) in rectal cancer surgery.
METHODS
Clinical data of the patients who underwent curative surgery for mid rectal cancer from February 2010 to February 2014 were reviewed retrospectively. Rectal cancers arising 5 to 10 cm above the anal verge were selected. Patients were divided into the ileostomy, TAT, or no-protection groups. Postoperative complications including AL and postoperative course were compared.
RESULTS
We included 137 patients: 67, 35, and 35 patients were included in the ileostomy, TAT, and no-protection groups, respectively. Operation time was longer in the ileostomy group (P = 0.029), and more estimated blood loss was observed (P = 0.018). AL occurred in 5 patients (7.5%) in the ileostomy group, 1 patients (2.9%) in the TAT group, and 6 patients (17.1%) in the no-protection group (P = 0.125). Patients in the ileostomy group resumed diet more than 1 day earlier than those in the other groups (P = 0.000). Patients in the no-protection group had about 1 or 2 days longer postoperative hospital stay (P = 0.048). The ileostomy group showed higher late complication rates than the other groups as complications associated with the stoma itself or repair operation developed (P = 0.019).
CONCLUSION
For mid rectal cancer surgery, the TAT supports anastomotic site protection and diverts ileostomy-related complications. Further large scale randomized controlled studies are needed to gain more evidence and expand the range of TAT usage.

Keyword

Surgical stomas; Drainage; Ileostomy; Anastomotic leak; Rectal neoplasms

MeSH Terms

Anastomotic Leak
Diet
Drainage
Humans
Ileostomy*
Length of Stay
Postoperative Complications
Rectal Neoplasms*
Retrospective Studies*
Surgical Stomas

Figure

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  Fig. 1 (A) The custom-fitted transanal rectal tube used in this study. (B) Main drainage portion of the transanal tube (17.5 mm × 7 mm × 150 mm).

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  Fig. 2 Plain x-ray shows the transanal tube (TAT) remaining in the intraluminal space after installation. Main drainage portion of the TAT can be seen between the arrows. Arrowhead is indicating stapler line of anastomosis.

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