Skip to main content
SpringerLink
Log in

Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Anastomotic leakage is one of the most serious complications following laparoscopic low anterior resection (LAR) for rectal cancers. The purpose of this study was to investigate whether transanal tube placement can reduce anastomotic leakage following laparoscopic LAR.

Methods

Retrospective assessment was performed on 205 patients with rectal cancers who underwent laparoscopic LAR. A transanal tube was placed after anastomosis in 96 patients (group A). Another 109 patients were operated on without a transanal tube (group B). Clinicopathological and operative variables, the frequencies of anastomotic leakage and re-operation after leakage were investigated.

Results

Patient age, gender, body mass index, tumor size, Dukes’ stage, intra-operative blood loss, and the rate of left colic artery preservation were comparable between the two groups. Tumor location was lower and operative time was significantly longer in group A than group B (p < 0.001). Overall rate of leakage was 9.3 % (19/205). The frequency of leakage was 4.2 % (4/96) in group A and was 13.8 % (15/109) in group B. The rate of leakage was significantly lower in group A (p < 0.05). Furthermore, the re-operation rate for symptomatic anastomotic leakage was 0 % (0/4) in group A, while in contrast it was 73.3 % (10/15) in group B. The rate of re-operation was lower in group A than group B (p < 0.05) and all cases with symptomatic leakage in group A were cured by conservative treatment.

Conclusions

Transanal tube placement was effective for prevention of anastomotic leakage following laparoscopic LAR and avoiding re-operation after symptomatic leakage.

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

Similar content being viewed by others

References

  1. Milsom JW, de Oliveira O Jr, Trencheva KI, Pandey S, Lee SW, Sonoda T (2009) Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 52:1215–1222

    Article  PubMed  Google Scholar 

  2. Lam HD, Stefano M, Tran-Ba T, Tinton N, Cambier E, Navez B (2011) Laparoscopic versus open techniques in rectal cancer surgery: a retrospective analysis of 121 sphincter-saving procedures in a single institution. Surg Endosc 25:454–462

    Article  PubMed  Google Scholar 

  3. Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, Yamamoto M, Tanigawa N (2011) Safe anastomosis in laparoscopic low anterior resection for rectal cancer. Asian J Endosc Surg 4:68–72

    Article  CAS  PubMed  Google Scholar 

  4. Asoglu O, Balik E, Kunduz E, Yamaner S, Akyuz A, Gulluoglu M, Kapran Y, Bugra D (2013) Laparoscopic surgery for rectal cancer: outcomes in 513 patients. World J Surg 37:883–892

    Article  PubMed  Google Scholar 

  5. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg 185:105–113

    Article  CAS  PubMed  Google Scholar 

  6. Bertelsen CA, Andreasen AH, Jørgensen T, Harling H, Danish Colorectal Cancer Group (2010) Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 12:37–43

    Article  CAS  PubMed  Google Scholar 

  7. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J (2008) Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 196:592–598

    Article  PubMed  Google Scholar 

  8. Matthiessen P, Hallböök O, Rutegärd J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed Central  PubMed  Google Scholar 

  9. Peng J, Lu J, Xu Y, Guan Z, Wang M, Cai G, Cai S (2010) Standardized pelvic drainage of anastomotic leaks following anterior resection without diversional stomas. Am J Surg 199:753–758

    Article  PubMed  Google Scholar 

  10. Shiomi A, Ito M, Saito N, Ohue M, Hirai T, Kubo Y, Moriya Y (2011) Diverting stoma in rectal cancer surgery. a retrospective study of 329 patients from Japanese cancer centers. Int J Colorectal Dis 26:79–87

    Article  PubMed  Google Scholar 

  11. Yamamoto S, Fujita S, Akasu T, Inada R, Moriya Y, Yamamoto S (2012) Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutaneous Tech 22:239–243

    Article  Google Scholar 

  12. Snijders HS, Wouters MW, van Leersum NJ, Kolfschoten NE, Henneman D, de Vries AC, Tollenaar RA, Bonsing BA (2012) Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 38:1013–1019

    Article  CAS  PubMed  Google Scholar 

  13. Lee WS, Yun SH, Roh YN, Yun HR, Cho YB, Lee WY, Chun HK (2008) Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg 32:1124–1129

    Article  PubMed  Google Scholar 

  14. Park JS, Choi GS, Kim SH, Kinm HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257:665–671

    Article  PubMed  Google Scholar 

  15. Lange MM, Martz JE, Ramdeen B, Brooks V, Boachie-Adjei K, van de Velde CJ, Enker WE (2013) Long-term results of rectal cancer surgery with a systematical operative approach. Ann Surg Oncol 20:1806–1815

    Article  PubMed  Google Scholar 

  16. Kulu Y, Ulrich A, Bruckner T, Contin P, Welsch T, Rahbari NN, Büchler MW, Weitz J, International Study Group of Rectal Cancer (2013) Validation of the International study group of rectal cancer definition and severity grading of anastomotic leakage. Surgery 153:753–761

    Article  PubMed  Google Scholar 

  17. Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60

    Article  PubMed  Google Scholar 

  18. Maggiori L, Bretagnol F, Lefevre JH, Ferron M, Vicaut E, Panis Y (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13:632–637

    Article  CAS  PubMed  Google Scholar 

  19. Seo SI, Yu CS, Kim GS, Lee JL, Yoon YS, Kim CW, Lim SB, Kim JC (2013) The role of diverting stoma after an ultra-low anterior resection for rectal cancer. Ann coloproctol 29:66–71

    Article  PubMed Central  PubMed  Google Scholar 

  20. Güenaga KF, Lustosa SA, Saad SS, Saconato H, Matos D (2008) Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Systematic review and meta-analysis. Acta Cir Bras 23:294–303

    Article  PubMed  Google Scholar 

  21. Hinoi T, Okajima M, Shimomura M, Egi H, Ohdan H, Konishi F, Sugihara K, Watanabe M (2013) Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer. World J Surg. doi:10.1007/s00268-013-2194-3

    PubMed  Google Scholar 

  22. Zhao WT, Hu FL, Li YY, Li HJ, Luo WM, Sun F (2013) Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg 37:227–232

    Article  PubMed  Google Scholar 

  23. Xiao L, Zhang W, Jiang P, Bu X, Yan Q, Li H, Zhang Y, 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 

  24. Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N (2011) Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 25:2972–2979

    Article  PubMed  Google Scholar 

  25. Baek SJ, Kim J, Kwak J, Kim SH (2013) Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J Gastroenterol 19:5309–5313

    Article  PubMed Central  PubMed  Google Scholar 

  26. Van Koperen PJ, Van Berge Henegouwen MI, Slors JF, Bemelman WA (2008) End-sponge treatment of anastomotic leakage after ileo-anal pouch anastomosis: report of two cases. Colorectal Dis 10:943–944

    PubMed  Google Scholar 

  27. Chopra SS, Mrak K, Hünerbein M (2009) The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 145:182–188

    Article  PubMed  Google Scholar 

  28. Glitsch A, von Bemstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD (2008) Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy 40:192–199

    Article  CAS  PubMed  Google Scholar 

  29. Srinivasamurthy D, Wood C, Slater R, Garner J (2013) An initial experience using transanal vacuum therapy in pelvic anastomotic leakage. Tech Coloproctol 17:275–281

    Article  CAS  PubMed  Google Scholar 

  30. Sirois-Giguère E, Boulanger-Gobeil C, Bouchard A, Gagnè JP, Grégoire RC, Thibault C, Bouchard P (2013) Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 56:586–592

    Article  PubMed  Google Scholar 

Download references

Disclosures

Drs. Eiji Hidaka, Fumio Ishida, Shumpei Mukai, Kenta Nakahara, Daisuke Takayanagi, Chiyo Maeda, Yusuke Takehara, Jun-ichi Tanaka, and Shin-ei Kudo have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan

    Eiji Hidaka, Fumio Ishida, Shumpei Mukai, Kenta Nakahara, Daisuke Takayanagi, Chiyo Maeda, Yusuke Takehara, Jun-ichi Tanaka & Shin-ei Kudo

Authors
  1. Eiji Hidaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fumio Ishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shumpei Mukai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kenta Nakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daisuke Takayanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chiyo Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yusuke Takehara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun-ichi Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shin-ei Kudo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eiji Hidaka.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hidaka, E., Ishida, F., Mukai, S. et al. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc 29, 863–867 (2015). https://doi.org/10.1007/s00464-014-3740-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3740-2

Keywords

Search

Navigation