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A pilot study on prophylactic tube enterostomy for the prevention of anastomotic leakage in patients with high-risk intestinal anastomosis

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Abstract

Background

Anastomotic leakages (ALs) are one of the most serious complications following gastrointestinal anastomosis. Currently, very few operative measures are available for the prevention of ALs. This pilot study aimed to evaluate the safety and efficacy of tube enterostomy (T-E) for the prevention of ALs in patients with high-risk intestinal anastomosis.

Methods

In this retrospective study, demographic data and postoperative outcomes were compared among patients who received T-E and two historical cohorts: one group that underwent primary anastomosis without T-E (non-T-E group) and another that underwent conventional stoma construction without anastomosis (stoma group). The operative procedures were selected according to a scoring system that quantitatively evaluated risk of Als (Zhongnan score).

Results

From March 2017 to March 2020, a total of 45 consecutive patients were enrolled in the T-E group. Among these patients, 53.3% (24/45) were diagnosed with Crohn’s disease (CD), and 66.7% (30/45) of them underwent emergency surgery. After propensity score matching, the demographic data were comparable among the three groups. One case of AL (2.2%) occurred in the T-E group, while four cases of ALs (8.9%, 4/45) were found in the non-T-E group (p = 0.13). Tube feeding was provided to 33.3% (15/45) of the T-E patients. Major tube-related complications included one tube dislocation (2.2%) and 3 (6.7%) minor leakages after tube withdrawal (treated conservatively). One death occurred in the stoma group. In the subgroup analysis of CD patients, lower rates of ALs and abdominal abscesses were observed in the T-E group than in the non-T-E and stoma subgroups, but the differences were not significant.

Conclusions

T-E seems to be a safe and feasible operative method for the protection of high-risk intestinal anastomosis, can be reversed and can provide enteral feeding with acceptable tube-related complications. Further studies are needed to validate the role of T-E.

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Data availability

All original data and materials are available and can be provided to the journal upon request.

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Funding

This study was financed by the Supported Project of Medical Science and Technology Innovation Platform, Health and Family Planning Commission of Hubei Province (PTXM2020011) and the Supported Projects of Science and Technology Innovation Cultivation Fund, Zhongnan Hospital of Wuhan University (znpy2018112).

Author information

Authors and Affiliations

  1. Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China

    Wenhao Chen, Haibo Qin, Zhou Fan, Hang Hu, Congqing Jiang, Qun Qian & Zhao Ding

  2. Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China

    Wenhao Chen, Hang Hu, Qun Qian & Zhao Ding

  3. Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China

    Wenhao Chen, Hang Hu, Congqing Jiang, Qun Qian & Zhao Ding

  4. Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China

    Yichao Zhang

  5. Gastroenterology Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China

    Min Chen

  6. Division of Colon and Rectal Surgery, Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, China

    Zhao Ding

Authors
  1. Wenhao Chen
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  2. Yichao Zhang
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  3. Haibo Qin
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  4. Zhou Fan
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  5. Hang Hu
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  6. Min Chen
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  7. Congqing Jiang
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  8. Qun Qian
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  9. Zhao Ding
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Contributions

Wenhao Chen: Project development, data analysis and manuscript writing; Yichao Zhang: Data analysis and collection and manuscript writing; Haibo Qin: Data collection and analysis; Zhou Fan: Data collection and analysis; Hang Hu: Data collection and analysis; Min Chen: Project development and manuscript editing; Congqing Jiang: Project development and manuscript editing; Qun Qian: Project development and manuscript editing; Zhao Ding: Project development and manuscript editing

Corresponding author

Correspondence to Zhao Ding.

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Ethics approval

The study protocol was approved by the Ethics Committee of Zhongnan Hospital, Wuhan University.

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All participants gave their signed informed consent prior to inclusion.

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The manuscript has not been submitted for publication elsewhere.

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The authors declare no competing interests.

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Cite this article

Chen, W., Zhang, Y., Qin, H. et al. A pilot study on prophylactic tube enterostomy for the prevention of anastomotic leakage in patients with high-risk intestinal anastomosis. Langenbecks Arch Surg 407, 267–275 (2022). https://doi.org/10.1007/s00423-021-02326-2

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  • DOI: https://doi.org/10.1007/s00423-021-02326-2

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