Skip to main content
SpringerLink
Log in

Efficacy of transanal drainage tube placement in preventing anastomotic leakage after ileal pouch–anal anastomosis in patients with ulcerative colitis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Transanal drainage tube (TDT) is used to prevent anastomotic leakage after surgery for rectal cancer. However, it remains unclear whether intraoperative TDT placement is also useful in preventing anastomotic leakage after ileal pouch–anal or ileal pouch–anal canal anastomosis (IPAA) in patients with ulcerative colitis (UC). This study aimed to evaluate the efficacy of intraoperative TDT placement in preventing anastomotic leakage after IPAA in patients with UC.

Methods

Patients with UC who underwent proctectomy with IPAA in the study institution between January 2000 and December 2021 were enrolled in this retrospective cohort study. The relationship between TDT placement and anastomotic leakage was evaluated by logistic regression analysis.

Results

The study population included 168 patients. TDT was placed intraoperatively in 103 of the 168 patients (61.3%). The rate of anastomotic leakage was significantly lower in the TDT group than in the non-TDT group (7.8% vs 18.5%, p = 0.037). Reoperation was not needed in any patient in the TDT group whereas two reoperations were necessary in the non-TDT group (3.1%). By logistic regression analysis, intraoperative TDT placement was an independent protective factor for anastomotic leakage.

Conclusions

TDT placement was significantly associated with anastomotic leakage of IPAA in patients with UC undergoing surgery. Although two-stage surgery with ileostomy is usually preferred in UC surgery, our findings suggest that TDT placement might contribute to the improvement of postoperative outcomes after UC surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF (2017) Ulcerative colitis. Lancet 389:1756–1770

    Article  PubMed  Google Scholar 

  2. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, D’Haens G, Dotan I, Dubinsky M, Feagan B, Fiorino G, Gearry R, Krishnareddy S, Lakatos PL, Loftus EV Jr, Marteau P, Munkholm P, Murdoch TB, Ordás I, Panaccione R, Riddell RH, Ruel J, Rubin DT, Samaan M, Siegel CA, Silverberg MS, Stoker J, Schreiber S, Travis S, Van Assche G, Danese S, Panes J, Bouguen G, O’Donnell S, Pariente B, Winer S, Hanauer S, Colombel JF (2015) Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 110:1324–1338

    Article  CAS  PubMed  Google Scholar 

  3. Magro F, Rodrigues A, Vieira AI, Portela F, Cremers I, Cotter J, Correia L, Duarte MA, Tavares ML, Lago P, Ministro P, Peixe P, Lopes S, Garcia EB (2012) Review of the disease course among adult ulcerative colitis population-based longitudinal cohorts. Inflamm Bowel Dis 18:573–583

    Article  PubMed  Google Scholar 

  4. Øresland T, Bemelman WA, Sampietro GM, Spinelli A, Windsor A, Ferrante M, Marteau P, Zmora O, Kotze PG, Espin-Basany E, Tiret E, Sica G, Panis Y, Faerden AE, Biancone L, Angriman I, Serclova Z, de van Overstraeten AB, Gionchetti P, Stassen L, Warusavitarne J, Adamina M, Dignass A, Eliakim R, Magro F, D’Hoore A (2015) European evidence based consensus on surgery for ulcerative colitis. J Crohns Colitis 9:4–25

    Article  PubMed  Google Scholar 

  5. Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST (2013) Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg 257:679–685

    Article  PubMed  Google Scholar 

  6. Lovegrove RE, Constantinides VA, Heriot AG, Athanasiou T, Darzi A, Remzi FH, Nicholls RJ, Fazio VW, Tekkis PP (2006) A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients. Ann Surg 244:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yang Y, Shu Y, Su F, Xia L, Duan B, Wu X (2017) Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a meta-analysis. Surg Endosc 31:1513–1523

    Article  PubMed  Google Scholar 

  8. Zhao WT, Li NN, He D, Feng JY (2017) Transanal tube for the prevention of anastomotic leakage after rectal cancer surgery: a systematic review and meta-analysis. World J Surg 41:267–276

    Article  PubMed  Google Scholar 

  9. Shigeta K, Okabayashi K, Baba H, Hasegawa H, Tsuruta M, Yamafuji K, Kubochi K, Kitagawa Y (2016) A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer. Surg Endosc 30:543–550

    Article  PubMed  Google Scholar 

  10. Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55:749–753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351

    Article  PubMed  Google Scholar 

  12. Zhao S, Zhang L, Gao F, Wu M, Zheng J, Bai L, Li F, Liu B, Pan Z, Liu J, Du K, Zhou X, Li C, Zhang A, Pu Z, Li Y, Feng B, Tong W (2021) Transanal drainage tube use for preventing anastomotic leakage after laparoscopic low anterior resection in patients with rectal cancer: a randomized clinical trial. JAMA Surg 156:1151–1158

    Article  PubMed  PubMed Central  Google Scholar 

  13. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102:462–479

    Article  CAS  PubMed  Google Scholar 

  14. Lin X, Li J, Chen W, Wei F, Ying M, Wei W, Xie X (2015) Diabetes and risk of anastomotic leakage after gastrointestinal surgery. J Surg Res 196:294–301

    Article  PubMed  Google Scholar 

  15. Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J (2014) Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 16:662–671

    Article  CAS  PubMed  Google Scholar 

  16. Karjalainen EK, Renkonen-Sinisalo L, Mustonen HK, Färkkilä M, Lepistö AH (2021) Restorative proctocolectomy in ulcerative colitis: effect of preoperative immunomodulatory therapy on postoperative complications and pouch failure. Scand J Surg 110:51–58

    Article  CAS  PubMed  Google Scholar 

  17. Dhaliwal A, Quinlan JI, Overthrow K, Greig C, Lord JM, Armstrong MJ, Cooper SC (2021) Sarcopenia in inflammatory bowel disease: a narrative overview. Nutrients 13:7

    Article  Google Scholar 

  18. Ahmad NZ, Abbas MH, Khan SU, Parvaiz A (2021) A meta-analysis of the role of diverting ileostomy after rectal cancer surgery. Int J Colorectal Dis 36:445–455

    Article  PubMed  Google Scholar 

  19. Karjalainen EK, Renkonen-Sinisalo L, Mustonen HK, Lepistö AH (2019) Morbidity related to diverting ileostomy after restorative proctocolectomy in patients with ulcerative colitis. Colorectal Dis 21:671–678

    Article  CAS  PubMed  Google Scholar 

  20. Zerhouni S, Kirsch R, Bakonyi A, O’Connor B, Huang H, Cohen Z (2015) Severity of inflammation as a risk factor for ileo-anal anastomotic leak after a pouch procedure in ulcerative colitis. Int J Colorectal Dis 30:1375–1380

    Article  PubMed  Google Scholar 

  21. Matsuda M, Tsuruta M, Hasegawa H, Okabayashi K, Kondo T, Shimada T, Yahagi M, Yoshikawa Y, Kitagawa Y (2016) Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today 46:613–620

    Article  PubMed  Google Scholar 

  22. Xiao L, Zhang WB, Jiang PC, Bu XF, Yan Q, Li H, Zhang YJ, Yu F (2011) Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study. World J Surg 35:1367–1377

    Article  PubMed  Google Scholar 

  23. Zhao S, Hu K, Tian Y, Xu Y, Tong W (2022) Role of transanal drainage tubes in preventing anastomotic leakage after low anterior resection: a meta-analysis of randomized controlled trials. Tech Coloproctol 26:931–939

    Article  CAS  PubMed  Google Scholar 

  24. Kawada K, Takahashi R, Hida K, Sakai Y (2018) Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection. Int J Colorectal Dis 33:337–340

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from any funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Junya Tsunoda, Kohei Shigeta, Ryo Seishima, Koji Okabayashi & Yuko Kitagawa

Authors
  1. Junya Tsunoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kohei Shigeta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryo Seishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Okabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kohei Shigeta.

Ethics declarations

Disclosures

Kitagawa reports grants and personal fees from Chugai Pharmaceutical Co. Ltd. and Taiho Pharmaceutical Co. Ltd and grants from Asahi KASEI Co. Ltd., Otsuka Pharmaceutical Co. Ltd., Tsumura & Co., Ono Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd., Otsuka Pharmaceutical Factory Inc., Eisai Co. Ltd., and Bayer Yakuhin Ltd. outside of the submitted work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsunoda, J., Shigeta, K., Seishima, R. et al. Efficacy of transanal drainage tube placement in preventing anastomotic leakage after ileal pouch–anal anastomosis in patients with ulcerative colitis. Surg Endosc 38, 837–845 (2024). https://doi.org/10.1007/s00464-023-10594-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10594-w

Keywords

Search

Navigation