Sciuto Antonio, Peltrini Roberto, Andreoli Federica, Di Santo Albini Andrea Gianmario, Di Nuzzo Maria Michela, Pirozzi Nello, Filotico Marcello, Lauria Federica, Boccia Giuseppe, D'Ambra Michele, Lionetti Ruggero, De Werra Carlo, Pirozzi Felice, Corcione Francesco
Department of General Surgery, Santa Maria delle Grazie Hospital, 80078 Pozzuoli, Italy.
Department of Electrical Engineering and Information Technology, University of Naples Federico II, 80125 Naples, Italy.
J Clin Med. 2022 May 7;11(9):2632. doi: 10.3390/jcm11092632.
Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses.
吻合口漏是直肠手术最令人担忧的并发症。经肛门装置已被建议用于吻合口保护，作为功能性造口的替代方法，尽管证据存在矛盾，且没有单一装置在临床实践中被广泛使用。本文的目的是研究经肛门导管在预防腹腔镜直肠癌切除术后漏出方面的安全性和有效性。在低位结直肠或结肠肛管吻合的全直肠系膜切除、环周切缘未受损且术中漏气试验阴性的病例中使用经肛门导管。经肛门导管保留至术后第7天。从一个前瞻性手术数据库中检索出195例连续患者并纳入研究。其中，71.8%接受了术前放化疗。围手术期死亡率为1.0%。19例患者发生吻合口漏，发生率为9.7%。其中，13例患者接受了再次腹腔镜检查和回肠造口术，6例患者接受了保守治疗。总体而言，造口率为6.7%。使用经肛门导管可能是直肠癌根治性切除术后吻合口保护的一种合适策略。这种方法可以避免在低位吻合的特定患者中造口的负担。
