Department of Surgical and Biomedical Sciences, School of Medicine, University of Perugia, Perugia, Italy.
General and Specialized Surgery Unit, "Santa Maria" Hospital, Via T. Di Joannuccio, 1, 05100, Terni, Italy.
Surg Today. 2023 Feb;53(2):163-173. doi: 10.1007/s00595-021-02423-1. Epub 2022 Jan 8.
Anastomotic leakage (AL) is the most fearsome complication in low rectal resection. The temporary diverting stoma (DS) is recommended to prevent AL, but it may cause relevant morbidity and needs a second surgical procedure to be closed. Therefore, the use of a transanal drainage tube (TDT) has been proposed as an alternative. We performed a systematic review and meta-analysis concerning the peri-operative outcomes in patients undergoing elective anterior rectal resection (ARR) with TDT alone or DS alone. Six studies were meta-analyzed, including a total of 735 patients. The meta-analysis showed that the incidences of AL, surgery-related complications, infective complications, and 30-day reoperation after ARR with low colorectal or coloanal anastomosis did not differ significantly between patients undergoing positioning of TDT and those undergoing DS. Furthermore, overall complications were significantly rarer in patients undergoing TDT. A meta-analysis of the randomized control trial (RCT) and no-RCT subgroups did not detect any statistically significant differences in any outcomes. These results suggest that it might be reasonable to employ a TDT in place of a DS to protect low colorectal and coloanal anastomosis, with consequent considerable advantages in terms of the short- and long-term post-operative outcomes. However, more well-designed RCTs are needed to definitively assess this issue.
吻合口漏（AL）是低位直肠切除术后最可怕的并发症。临时转流造口（DS）被推荐用于预防 AL，但它可能会导致相关发病率，并需要进行第二次手术来关闭。因此，已经提出使用经肛门引流管（TDT）作为替代方法。我们进行了一项系统评价和荟萃分析，涉及单独使用 TDT 或单独使用 DS 进行选择性前直肠切除术（ARR）的围手术期结果。共有 6 项研究进行了荟萃分析，包括总共 735 名患者。荟萃分析显示，低位直肠结肠或结肠直肠吻合术的 ARR 后 AL、手术相关并发症、感染性并发症和 30 天再次手术的发生率在接受 TDT 定位和接受 DS 的患者之间没有显著差异。此外，接受 TDT 的患者总体并发症明显较少。对随机对照试验（RCT）和非 RCT 亚组的荟萃分析未发现任何结局存在统计学差异。这些结果表明，使用 TDT 代替 DS 来保护低位直肠结肠和结肠直肠吻合可能是合理的，这在短期和长期术后结果方面具有显著优势。然而，需要更多设计良好的 RCT 来明确评估这个问题。
