Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option.

BACKGROUND

Anastomotic leaks after low anterior resection for rectal cancer remain a major cause of morbidity and mortality. Few studies have focused on their management, particularly on the technique of transanal drainage.

OBJECTIVE

The aim of this study was to assess the short- and long-term outcomes according to the initial management of clinical leaks.

DESIGN AND SETTINGS

This study is a retrospective review of a single institution experience.

PATIENTS

All patients treated for a symptomatic anastomotic leak after low anterior resection for rectal cancer between January 2000 and March 2011 were included.

MAIN OUTCOME MEASURES

The primary outcomes were mortality attributed to the leak, sepsis control, stoma closure rate, and functional results.

RESULTS

A total of 37 patients (35 men/2 women) developed a symptomatic leak. Leaks were initially managed by transanal drainage in 16 patients, abdominal reintervention in 12 patients, and medical treatment in 9 patients. The only death attributed to the leak occurred in the abdominal reintervention group. In the transanal drainage group, antibiotics were administered for a median length of 9 days, and the drain was left in place for a median length of 30 days. One patient underwent percutaneous drainage of a collection in addition to transanal drainage, but no patient required abdominal reintervention. Of the treatment modalities applied, transanal drainage was associated with the highest stoma closure rate (93%), after a median postoperative time of 7 months. Complications observed after transanal drainage were anastomotic strictures in 33% and the creation of a permanent stoma due to poor function in 13%.

LIMITATIONS

This study was limited by its nonrandomized retrospective design and the presence of selection bias.

CONCLUSIONS

: For the management of low anastomotic leaks, transanal drainage allows preservation of the anastomosis and sepsis control with a high rate of ileostomy closure. It is a valuable option in patients with a diverting ileostomy.