Anastomosenprotektion durch transanale Drainage? - Klinische Erfahrung bei 50 Patienten nach Rektumresektionen mit totaler mesorektaler Exzision und tiefen Anastomosen -

Abstract

Between October 1998 and December 1999 50 patients with a primary cancer of the rectum were treated by sphincter saving anterior resection of the rectum and total mesorectal excision. Eight patients were given a neoadjuvant combined radio-chemotherapy. The anastomoses were performed in the triple-stapling technique with a Premium Plus CEEA stapling device (Fa. Tyco Health Care, Tönisvorst, Germany) or with a Proximate ILS curved stapling device (Fa. Ethicon Endo Surgery, Norderstedt, Germany). The anastomoses were situated in 7 cm or in lower distance from the anal skin. In all patients with complete anastomotic tissue rings the anastomoses were protected with the transanal tube. The integrity of the anastomosis (n = 48) was checked for completeness in the 2nd and 12th postoperative week. The patients were sigmoidoscoped and the anastomoses were controlled by transanal ultrasonography. During the hospital stay 2 patients (4.2 %) with a clinically evident anastomotic leakage were detected. 3 patients (6.2 %) with an asymptomatic anastomotic leakage were detected by computertomography. The anastomoses of 27 patients (56.2 %) were clinically and by ultrasonographical examination intact. In these patients a postoperative radiogram was not indicated. Relaparotomy was necessary in one patient for bleeding, in two patients for anastomotic leaks and in three patients for ileus (12.5 %). Because of low anastomotic leakage rate and low morbidity we find the transanal tube to be at least equivalent to conventional colostoma for anastomotic protection.

Transanal Tube as a Means of Prevention of Anastomotic Leakage after Rectal Cancer Surgery

“…In Germany, Sterk et al [ 24 ] used a 40-cm long transanal rubber drain in 50 patients. 10% of the patients developed an anastomotic leakage, 4% with a clinically evident anastomotic leakage and 6% with an asymptomatic anastomotic leakage detected by CT.…”

“…10% of the patients developed an anastomotic leakage, 4% with a clinically evident anastomotic leakage and 6% with an asymptomatic anastomotic leakage detected by CT. The authors consider the transanal drain as at least equivalent to a conventional colostomy in terms of reducing symptomatic anastomotic leakage [ 24 ].…”

Mortality risk analysis following routine vs selective defunctioning stoma formation after total mesorectal excision for rectal cancer

“…Thirty‐nine observational studies met the inclusion criteria [20–58]. These studies reported data on 4059 patients after TME for rectal cancer.…”

No Coil® Placement in Patients Undergoing Left Hemicolectomy and Low Anterior Resection for Colorectal Cancer

“…longer hospital stay, reversal procedure, greater inpatient costs, permanent stoma, stoma-related complications, and patient discomfort) [14,15]. Given the evidence that increased intraluminal rectal pressure is among the major contributors to AL [16][17][18][19], several endorectal devices (e.g. transanal tube cuff rectum, drainage tube, silicone transanal tube) have been proposed as promising alternatives to defunctioning stoma [13,[20][21].…”