Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Issue 1 (26th July 2016)

• Record Type: Journal Article
• Authors: Ito, Tetsuo; Obama, Kazutaka; Sato, Teruyuki; Matsuo, Koichi; Inoue, Hidenobu; Kubota, Keiko; Tamaki, Nobuyuki; Kami, Kazuhiro; Yoshimura, Naoki; Shono, Takahito; Yamamoto, Eiji; Morimoto, Taisuke
• Is Part Of: Asian journal of endoscopic surgery. Volume 10:Issue 1(2017:Feb.)
• Page Start: 17
• Page End: 22
• Publication Date: 2016-07-26
• Subjects: anastomotic leakage -- laparoscopic low anterior resection -- transanal tube placement; Endoscopic surgery -- Periodicals; Endoscopic surgery -- Asia -- Periodicals; 617.05705
• DOI: 10.1111/ases.12310
• Languages: English
• ISSNs: 1758-5902

Abstract

Abstract: Introduction: Anastomotic leakage (AL) is a major complication of laparoscopic low anterior resection (LLAR) for rectal cancer. Although several recent reports have suggested that transanal tube placement can prevent AL, this practice is still controversial. Additionally, the mechanism by which a transanal tube prevents AL is unknown. The aim of this study was to evaluate the efficacy of transanal tube placement for prevention of AL following LLAR. Methods: This was a retrospective study that included 69 patients who underwent LLAR between February 2012 and January 2016. After an anastomosis using a double stapling technique, a transanal tube was placed in 28 patients. A diverting stoma was created in 26 patients. Univariate and multivariate analyses of clinicopathological characteristics were performed. Results: The overall incidence of AL was 15.9% (11/69). Univariate analysis showed that transanal tube placement ( P = 0.022) and early postoperative diarrhea ( P < 0.001) were associated with AL. The duration of the postoperative hospital stay for patients with transanal tube placement (13.1 ± 4.1 days) was significantly shorter than for patients without a transanal tube (22.7 ± 12.3 days; P < 0.001). However, transanal tube placement did not reduce postoperative diarrhea. Creation of a diverting stoma did not affect the incidence of AL. Multivariate analysis revealed that the absence of a transanal tube (odds ratio = 33.5, P = 0.018) and the occurrence of postoperative diarrhea (odds ratio = 86.3, P = 0.001) were independent risk factors for AL. Conclusion: Transanal tube placement prevents AL after LLAR. Furthermore, this protective effect may be due to a reduction in the unfavorable incidence of early postoperative diarrhea.