Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Article Volume 6 Issue 2

Prevalence of Leak in Rectal Anastomosis Surgery without Diverting Ileostomy: A Case - Control Study Including 32 Patients Who Underwent Low Anterior Resection Surgery

Fakhrosadat Anaraki, Mehrsad Rostam Pour* and Mehdi Tavallaei

Department of Surgery, School of Medicine, Beheshti Medical University, Taleghani Hospital, Tehran, Iran

*Corresponding Author: Mehrsad Rostam Pour, Department of Surgery, School of Medicine, Beheshti Medical University, Taleghani Hospital, Tehran, Iran.

Received: December 14, 2022; Published: January 23, 2023

Abstract

Objectives: A case – control study including 32 patients who underwent low anterior resection surgery. Investigating the prevalence of leakage in patients who do not have an ileostomy diverting.

Colorectal carcinoma is the most common malignancy of the digestive tract. The biology of rectal adenocarcinoma is similar to colon adenocarcinoma, and the principles of colon resection surgery, such as complete removal of the tumor along with the lymphatic bed and all involved organs, also apply to rectal carcinoma. Five things that increase the chance of leakage from the anastomosis site include intestinal ischemia due to reduced blood supply to the anastomosis site, receiving neoadjuvant chemoradiotherapy before the operation, excessive tension at the anastomosis site, poor intestinal preparation before the operation, and infection.

Method and Material: 2 out of 16 patients in the case group (without an ileostomy loop insertion) had a leak, and their common risk factor was male gender, and 2 out of 16 patients in the control group (with an ileostomy loop insertion) had a leak from the anastomosis site, which is the same risk factor as the case group. The mutual factor between these two groups is being male. The rate of complications caused by ileostomy loop insertion in this study was reported as a percentage.

Result: In recent studies, it has been noted that ileostomy loop installation does not reduce the possibility of leakage and its existence is associated with complications and morbidity. In this study, the prevalence of leak was 12.5% in the control group and 12.5% in the case group.

Conclusion: It is recommended not to use the diverting ileostomy loop routinely in patients undergoing LAR surgery. This method should be used in patients who have multiple risk factors to increase the possibility of leakage after surgery.

Keywords: Rectal Adenocarcinoma; Protective Ileostomy; Neoadjuvant Treatment; Anastomosis Leaking; Lower Rectal Surgery

References

  1. Lei Niu., et al. “Protective ileostomy does not prevent anastomotic leakage after anterior resection of rectal cancer”. Journal of International Medical Research8 (2019): 1-10.
  2. Liming Wang., et al. “Diverting Stoma Versus No Diversion in Laparoscopic Low Anterior Resection: A Single-center Retrospective Study in Japan”. In Vivo 33 (2019): 2125-2131.
  3. Eugenia Claudia Marinescu., et al. “Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery”. Diagnostics 11 (2021): 2382.
  4. Hiroki Shimizu., et al. “Who needs diverting ileostomy following laparoscopic low anterior resection in rectal cancer patients? Analysis of 417 patients in a single institute”. Surgical Endoscopy2 (2020): 839-846.
  5. Wei Zhang., et al. “Multicenter analysis of risk factors for anastomotic leakage after middle and Low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients”. International Journal of Colorectal Disease 10 (2017): 1431-1437.
  6. F Charles brunicardi., et al. “Schwartz,s Principles of Surgery”. 11th. ed, McGraw Hill/Medical (2019).
  7. Michael J Zinner., et al. “Maingots Abdominal operation”. 13th. ed, McGraw Hill/Medical (2019).
  8. Courteny M Townsend., et al. “The Biological Basis of Surgical Practice”. 21st. ed, Elsevier, Canada (2021)
  9. Nasir Zaheer Ahmad., et al. “A meta-analysis of the role of diverting ileostomy after rectal cancer surgery”. International Journal of Colorectal Disease3 (2021): 445-455.
  10. Mehraneh D Jafari., et al. “Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program”. American Surgery (2013).
  11. E Efstathiou., et al. “The role of a diverting ileostomy in patients with low rectal cancer treated with a low anterior resection”. European Journal of Surgical Oncology 45 (2019): e25-e158.
  12. Evangelos Messaris., et al. “Is a diverting ostomy needed in mid-high rectal cancer patients undergoing a low anterior resection after neoadjuvant chemoradiation?” Surgery (2015).
  13. Sean Maroney., et al. “Complications of Diverting Ileostomy after Low Anterior Resection for Rectal Carcinoma”. American Surgery (2016) oct.
  14. K Anderin., et al. “The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program”. European Journal of Oncology (2015).
  15. Law WL., et al. “Anastomotic leakage is associated with poor long- term outcome in patient after curative colorectal resection for malignancy”. Journal of Gastrointestinal Surgery 11 (2007): 8-15.
  16. Hallook O and Sjodahi R. “Anastomotic leakage and functional outcome after anterior resection of the rectum”. British Journal of Surgery 83 (1996): 60-62.
  17. Ginger D Salvadalena. “The Incidence of Stoma and Peristomal Complication During the First 3 Months After Ostomy Creation”. Journal of Wound Ostomy and Continence Nursing (2013).
  18. Andreas M Kaiser., et al. “Morbidity of Ostomy Takedown”. Journal of Gastrointestinal Surgery (2008).
  19. Dale M Mosdell MD and Raymond C. “Morbidity and Mortality of Ostomy Closure”. The American Journal of Surgery 162 (1991).
  20. Traci L Hedrick., et al. “Anastomotic Leak and the Loop Ileostomy: Friend or Foe”. The American Society of Colon and Rectal Surgeon, Dallas, Texas, May 8 to 13 (2004).
  21. E Soltani., et al. “Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients”. Indian Journal of Surgery (2015).
  22. Karl Mark., et al. “Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial”. Journal of Surgery 11 (2015): 6.
  23. Chude GG., et al. “Defunctiong Loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study”. Hepatogastroenterology 55 (2008): 86-87.

Citation

Citation: Mehrsad Rostam Pour., et al. “Prevalence of Leak in Rectal Anastomosis Surgery without Diverting Ileostomy: A Case - Control Study Including 32 Patients Who Underwent Low Anterior Resection Surgery". Acta Scientific Gastrointestinal Disorders 6.2 (2023): 22-27.

Copyright

Copyright: © 2022 Mehrsad Rostam Pour., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is April 30th, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue".
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US