Abstract
Background
Although a few reports have suggested transanal drainage tube (TDT) can reduce the pressure in the anastomotic portion, it remains unclear whether TDT can prevent anastomotic leakage (AL). In addition, little is known about the relationship between AL and daily fecal volume through TDT. This study investigated the role of TDT for the prevention of AL following laparoscopic low anterior resection (LAR).
Methods
This is a retrospective analysis of a prospectively maintained database of 201 rectal cancer patients who underwent laparoscopic LAR. The relationship between AL and daily fecal volume through TDT was examined.
Results
AL occurred in 25 patients. Based on the TDT grouping, AL occurred in 10.7% (19/178) of the TDT group, whereas it occurred in 26.1% (6/23) of the non-TDT group (P = 0.046). In the 178 patients with TDT placement, the daily fecal volumes on postoperative days (PODs) 2–5 were significantly higher compared with those on POD 1 (P < 0.05). The daily fecal volume was observed to be gradually increasing until POD 3 or 4 (median, 25 or 23 ml/day, respectively) and then significantly decreasing on POD 5 (10 ml/day) (P < 0.05). The AL rate of the patients whose daily fecal volume exceeded 100 ml/day in two or more days was significantly higher than that of those in 0 or 1 day (26.9 vs. 7.9%; P < 0.01).
Conclusions
TDT could be efficient to prevent AL following laparoscopic LAR. Postoperative fecal volume may be a reliable predictor of AL.
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Acknowledgements
The authors thank medical staffs and residents of Kyoto University Hospital gastrointestinal surgery for their participation in this study. We could not have completed the study without their diligence and support.
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Contributions
Study concept and design: KK
Acquisition of data: KK, RT, and KH
Analysis and interpretation of data: KK
Drafting of the manuscript: KK
Revising of the manuscript: RT, KH, and YS
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The study protocol was approved by the institutional review board of Kyoto University Hospital (R0882).
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The authors declare that they have no conflicts of interest.
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Kawada, K., Takahashi, R., Hida, K. et al. Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection. Int J Colorectal Dis 33, 337–340 (2018). https://doi.org/10.1007/s00384-017-2952-z
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DOI: https://doi.org/10.1007/s00384-017-2952-z