A randomised study of colostomies in low colorectal anastomoses.

OBJECTIVE

To assess the value of covering colostomy for patients undergoing low anterior resection for rectal neoplasms.

DESIGN

Prospective randomised study.

SETTING

Two university hospitals, Finland.

SUBJECTS

38 patients with air-tight stapled end-to-end anastomoses and complete anastomotic tissue rings were randomly allocated to have a covering colostomy (n = 19) or not.

MAIN OUTCOME MEASURES

Postoperative mortality, anastomotic leaks, reoperations for leaks.

RESULTS

The clinical leak rate was 24% (9/38) and six patients (16%) had radiological leaks. The total number of leaks (clinical and radiological together) was similar in the two groups, 7/19 compared with 8/19, respectively. There were fewer clinical leaks in the colostomy group (3/19; 16% compared with 6/19; 32%), but the difference was not significant. Reoperations for leaks were necessary more often in patients who did not have a covering colostomy (6/19; 32% compared with 1/19; 5%, p = 0.09). Two patients who did not have a stoma died from the infective complications of their leaks and one died of heart failure in the colostomy group. One patient who had not been given a stoma initially was left with a permanent colostomy after a leak.

CONCLUSIONS

Our results suggest that a covering colostomy does not reduce the leak rate after low anterior resection, but prevents most of the severe infective consequences of the leaks.