Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection
Purpose We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer be...
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| Format: | Article |
| Language: | English |
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Korean Society of Coloproctology
2018-12-01
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| Series: | Annals of Coloproctology |
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| Online Access: | http://coloproctol.org/upload/pdf/ac-2017-10-18.pdf |
| _version_ | 1819274586646118400 |
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| author | Mostafa Shalaby Waleed Thabet Oreste Buonomo Nicola Di Lorenzo Mosaad Morshed Giuseppe Petrella Mohamed Farid Pierpaolo Sileri |
| author_facet | Mostafa Shalaby Waleed Thabet Oreste Buonomo Nicola Di Lorenzo Mosaad Morshed Giuseppe Petrella Mohamed Farid Pierpaolo Sileri |
| author_sort | Mostafa Shalaby |
| collection | DOAJ |
| description | Purpose We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important. |
| first_indexed | 2024-12-23T23:10:47Z |
| format | Article |
| id | doaj.art-d72aee24da7f48dbaf5dcb78176a8e64 |
| institution | Directory Open Access Journal |
| issn | 2287-9714 2287-9722 |
| language | English |
| last_indexed | 2024-12-23T23:10:47Z |
| publishDate | 2018-12-01 |
| publisher | Korean Society of Coloproctology |
| record_format | Article |
| series | Annals of Coloproctology |
| spelling | doaj.art-d72aee24da7f48dbaf5dcb78176a8e642022-12-21T17:26:40ZengKorean Society of ColoproctologyAnnals of Coloproctology2287-97142287-97222018-12-0134631732110.3393/ac.2017.10.181596Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal ResectionMostafa Shalaby0Waleed Thabet1Oreste Buonomo2Nicola Di Lorenzo3Mosaad Morshed4Giuseppe Petrella5Mohamed Farid6Pierpaolo Sileri7 Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, Italy Department General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt Department of General Surgery, Policlinico Tor Vergata Hospital, University of Rome Tor Vergata, Rome, ItalyPurpose We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.http://coloproctol.org/upload/pdf/ac-2017-10-18.pdfanastomosisanastomotic leakagerectal cancertransanal tube drainage |
| spellingShingle | Mostafa Shalaby Waleed Thabet Oreste Buonomo Nicola Di Lorenzo Mosaad Morshed Giuseppe Petrella Mohamed Farid Pierpaolo Sileri Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection Annals of Coloproctology anastomosis anastomotic leakage rectal cancer transanal tube drainage |
| title | Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection |
| title_full | Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection |
| title_fullStr | Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection |
| title_full_unstemmed | Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection |
| title_short | Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection |
| title_sort | transanal tube drainage as a conservative treatment for anastomotic leakage following a rectal resection |
| topic | anastomosis anastomotic leakage rectal cancer transanal tube drainage |
| url | http://coloproctol.org/upload/pdf/ac-2017-10-18.pdf |
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