Ann Coloproctol.  2018 Dec;34(6):317-321. 10.3393/ac.2017.10.18.

Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection

• Shalaby M
• Thabet W
• Buonomo O
• Di Lorenzo N
• Morshed M
• Petrella G
• Farid M
• Sileri P

• KMID: 2434379
• DOI: http://doi.org/10.3393/ac.2017.10.18

Abstract

PURPOSE
We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL).
METHODS
Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL.
RESULTS
Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20-35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4-12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation.
CONCLUSION
These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

Keyword

Anastomosis; Anastomotic leakage; Rectal cancer; Transanal tube drainage

MeSH Terms

Abscess
Anastomotic Leak*
Anti-Bacterial Agents
Body Mass Index
Colostomy
Constriction, Pathologic
Diagnosis
Drainage*
Endoscopy
Female
Follow-Up Studies
Humans
Ileostomy
Male
Neoadjuvant Therapy
Patient Selection
Prospective Studies
Rectal Neoplasms
Reoperation
Retrospective Studies
Sigmoidoscopy
Anti-Bacterial Agents