Defunctioning Stoma in Low Anterior Resection With Colonic Pouch for Rectal Cancer

Abstract

This study suggests that the routine use of diversion does not protect the patient from anastomotic complications or pelvic sepsis and its use requires a second admission for closure.

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

“…The clinical leakage rate of 8.2% reported in this present study is similar to that reported in other larger series (sample size >300 cases) [14,15,16], but relatively lower than that reported in previous studies without a protective stoma [3, 4, 12, 13]. The findings of the present study may be attributed to the fact that some studies without a protective stoma included only extraperitoneal anastomosis, while tension-free anastomosis was strictly performed in the present study by means of complete mobilization of splenic flexure, proximal ligation of inferior mesenteric vessels and no coloplasty or colonic pouch formation.…”

“…However, other investigators [4, 5] failed to show the advantage of protective stoma on the reoperation rate in patients with anastomotic leakage and no published studies [3, 21] have demonstrated the benefit of protective stoma on mortality rate after leakage. Considering that one-fifth of the temporary stoma might never be reversed [6] and that stomal closure is associated with 3% mortality and 20% morbidity [25], surgeons should deliberate over a decision to create a protective stoma.…”

“…Gastinger et al [3] reported that a protective stoma reduced only the rate of anastomotic leakage that required surgical intervention, not the overall leakage rate, and was associated with 20% morbidity for stoma closure. Other clinical trials [4, 5] suggested that it did not improve outcomes such as anastomotic leakage and reoperation rate. Although intended to be temporary, one-fifth of these stomas might never be reversed [6].…”

“…However, there are a limited number of reports regarding the surgical outcomes of sphincter-saving operation for rectal cancer without a protective stoma and a pelvic drainage [4,10,11,12,13]. …”

Diverting Stoma After Low Anterior Resection

“…The existing three studies, published in 1983, 1997, and 2003, were underpowered, with only 50, 38, and 36 patients included, respectively. 9Y11 Other prospective and retrospective studies had indifferent conclusions, some reporting no differences for mortality and morbidity, 9,12,13 others favored a protective ileostomy caused by a decrease of symptomatic anastomotic failures. 14Y17 Therefore, a large, randomized, controlled trial was believed to be overdue to investigate the benefit of a diverting ileostomy.…”