Lossius W, Stornes T, Bernstein T E, Wibe A
Department of Surgery, St. Olav's University Hospital, Trondheim University Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway.
Norwegian Research Center for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Tech Coloproctol. 2025 Feb 14;29(1):67. doi: 10.1007/s10151-024-03103-1.
Anastomotic leakage is a common complication after low anterior resection for rectal cancer, often resulting in a permanent stoma. This study aimed to evaluate the effectiveness of early detection, sepsis control, and transanal repair in managing anastomotic leakage.
In this prospective cohort study conducted from January 2018 to June 2022 at a Norwegian university hospital, patients undergoing resectional surgery for rectal cancer were assessed for anastomotic leaks. Early detection involved CT with rectal contrast and flexible endoscopy. Repair eligibility required involvement of less than half the anastomotic circumference and no ischemia or retraction of the colon. The cavity outside the anastomotic defect was cleaned using a catheter for intermittent irrigation or endoluminal vacuum therapy. A diverting stoma was created, and a transabdominal pelvic drain was inserted if not already present. Once sepsis was controlled and the cavity was clean, the defect was sutured using a transanal minimally invasive surgery access platform or an open transanal technique, based on anastomosis level. Healing was confirmed via computed tomography (CT) with rectal contrast and rigid proctoscopy before reversing diverting stomas, and again at 12 months. A supplementary video demonstrates the technique.
Of 22 identified anastomotic leaks, 11 underwent transanal repair, resulting in healed anastomosis for nine patients and restored bowel continuity for eight. Among these, five reported major low anterior resection syndrome. Median hospital stay was 20 days, with no 90-day mortality.
This anastomosis-preserving approach for treating anastomotic leakage shows promise, potentially preserving bowel function and reducing permanent stoma rates.
吻合口漏是直肠癌低位前切除术后的常见并发症，常导致永久性造口。本研究旨在评估早期检测、脓毒症控制及经肛门修复在处理吻合口漏方面的有效性。
在2018年1月至2022年6月于挪威一家大学医院进行的这项前瞻性队列研究中，对接受直肠癌切除手术的患者进行吻合口漏评估。早期检测包括直肠造影CT和软性内镜检查。修复的条件是吻合口周长受累小于一半且无结肠缺血或回缩。使用导管进行间歇性冲洗或腔内负压治疗来清洁吻合口缺损外的腔隙。建立转流造口，若尚未置入则插入经腹盆腔引流管。一旦脓毒症得到控制且腔隙清洁，根据吻合口水平采用经肛门微创手术接入平台或开放经肛门技术缝合缺损。在回纳转流造口之前，通过直肠造影CT和硬式直肠镜检查确认愈合情况，并在12个月时再次确认。一段补充视频展示了该技术。
在22例确诊的吻合口漏病例中，11例接受了经肛门修复，9例患者吻合口愈合，8例恢复了肠道连续性。其中，5例报告有严重的低位前切除综合征。中位住院时间为20天，90天内无死亡病例。
这种保留吻合口治疗吻合口漏的方法显示出前景，有可能保留肠道功能并降低永久性造口率。
