Abstract
Purpose
We introduce a novel transanal tube (TAT), named the “WING DRAIN”, designed to prevent anastomotic leakage after rectal cancer surgery, and report the fundamental experiments that led to its development.
Materials and methods
We performed the basic experiments to evaluate the effect of TATs on intestinal decompression, the changes they make in patterns of watery fluid drainage, the changes in their decompression effect when the extension tube connecting the TAT to the collection bag fills with watery drainage fluid, and the variations in intestinal contact and crushing pressure made by some types of TAT.
Results
Any type of TAT contributed to decompression in the intestinal tract. Watery drainage commenced from when the water level first rose to the hole in the tip of drain. The intestinal pressure increased with the length of the vertical twist in an extension tube. The crushing pressures of most types of TAT were high enough to cause injury to the intestine.
Conclusions
We resolved the problems using an existing TAT for the purpose of intestinal decompression and by creating the first specialized TAT designed to prevent anastomotic leakage after rectal cancer surgery in Japan.
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References
Saito N, Ito M, Kobayashi A, Nishizawa Y, Kojima M, Nishizawa Y, et al. Long-term outcomes after intersphincteric resection for low-lying rectal cancer. Ann Surg Oncol. 2014;21(11):3608–15.
Saito N, Moriya Y, Shirouzu K, Maeda K, Mochizuki H, Koda K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49(10 Suppl):S13–22.
Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81(9):1376–8.
Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94(10):1272–7.
Hasegawa S, Takahashi R, Hida K, Kawada K, Sakai Y. Transanal total mesorectal excision for rectal cancer. Surg Today. 2016;46(6):641–53.
Odermatt M, Flashman K, Khan J, Parvaiz A. Laparoscopic-assisted abdominoperineal resection for low rectal cancer provides a shorter length of hospital stay while not affecting the recurrence or survival: a propensity score-matched analysis. Surg Today. 2016;46(7):798–806.
Tortorelli AP, Alfieri S, Sanchez AM, Rosa F, Papa V, Di Miceli D, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg. 2015;81(1):41–7.
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85(3):355–8.
Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg. 2000;179(2):92–6.
Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92(2):211–6.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85.
Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96(5):462–72.
Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg. 2015;220(2):186–94.
Nishigori H, Ito M, Nishizawa Y, Nishizawa Y, Kobayashi A, Sugito M, et al. Effectiveness of a transanal tube for the prevention of anastomotic leakage after rectal cancer surgery. World J Surg. 2014;38(7):1843–51.
Xiao L, Zhang WB, Jiang PC, Bu XF, Yan Q, Li H, et al. Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg. 2011;35(6):1367–77.
Cong ZJ, Fu CG, Wang HT, Liu LJ, Zhang W, Wang H. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg. 2009;33(6):1292–7.
Patrascu T, Doran H, Musat O. Protective transanal tube in colo-rectal anastomosis. Chirurgia (Bucur). 2004;99(1):75–8.
Sterk P, Schubert F, Gunter S, Klein P. Anastomotic protection with a transanal tube after rectum resection and total mesorectal excision. Zentralbl Chir. 2001;126(8):601–4.
Montemurro S, De Luca R, Caliandro C, Ruggieri E, Rucci A, Sciscio V, et al. Transanal tube NO COIL(R) after rectal cancer proctectomy. The “G. Paolo II” Cancer Centre experience. Tumori. 2012;98(5):607–14.
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Drs. Hideaki Nishigori, Masaaki Ito, and Yuji Nishizawa have no conflicts of interest or financial ties to disclose.
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Nishigori, H., Ito, M. & Nishizawa, Y. A novel transanal tube designed to prevent anastomotic leakage after rectal cancer surgery: the WING DRAIN. Surg Today 47, 513–520 (2017). https://doi.org/10.1007/s00595-016-1392-7
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DOI: https://doi.org/10.1007/s00595-016-1392-7