Laparoscopic low anterior resection for rectal carcinoma: Complications and management in 132 consecutive patients

Table 1 Category, management and prognosis of intraoperative complications

Intraoperative complications	n (%)	Management	Prognosis
Anastomotic rupture	1	Intermittent suturing with absorbable sutures under laparoscopy	Anastomotic hemorrhage and leakage
Hemorrhage	2	Hemostat with Hem O-lok clip intraoperatively; Hemostat with titan clips under colonoscopy after completion of operation	Recovered
Ureter injury	2	Intraoperative cannulation of double J catheter under cystoscopy, saturation of the ends with absorbable sutures, extubation no earlier than 2 mo after operation	Recovered
Deferent duct injury	1	Occlusion of the distal end under laparoscopy by titan clips	Partial sexual dysfunction
Bladder injury	1	Intermittent suturing with absorbable sutures under laparoscopy	Recovered
Total	7 (5.3)

Table 2 Category, management and prognosis of postoperative complications

Postoperative complications		n (%)	Management	Prognosis
Short-term complications	Cardiopulmonary dysfunction	1	Cardiopulmonary resuscitation and tracheal intubation, the patient was transferred to SICU emergently	Dead
	Urinary retention and infection	2	Proper antibiotics and functional exercise	Recovered
	Incisional infection and colliquation	2	Frequent dressing	Recovered
	Anastomotic leakage	12	1 patient underwent proximal colostomy; others received abdominal lavage and intravenous fluid support	Recovered
	Anastomotic hemorrhage	7	Fluid expansion and proper hemostatics: 2 patients with detainment of anal tubes received irrigation of ice-cold saline dissolving noradrenaline, 2 patients with relative severe hemorrhage received a colonoscopy and finally the bleeding points were stopped using titanic clips	Recovered
Total (%)		24 (18.2)
Long-term complication	Anastomotic stricture	2	Periodic distension under colonoscopy	Improved
Total (%)		2 (1.5)

SICU: Intensive Care Unit of Surgery.

Table 3 Univariate analysis of factors for low anterior resection complications

Variables	n	Complication n (%)	χ2 value	P value
Gender
Male	80	20 (15.15)	3.743	0.053
Female	52	7 (5.30)
Age (yr)
≥ 55	104	21 (15.9)	0.021	0.886
< 55	28	6 (4.54)
Tumor size (cm)
Φ≥ 3	86	24 (18.2)	8.424	0.004
Φ < 3	46	3 (2.30)
Pathological type
Mucinous adenocarcinoma	9	3 (2.30)	2.440	0.486
Tubular adenocarcinoma	36	5 (3.80)
Papillary adenocarcinoma	31	8 (6.06)
Adenocarcinoma	56	11 (8.33)
Tumor location (anal verge) (cm)
> 6	88	10 (7.58)	6.615	0.010
≤ 6	44	17 (12.88)
TNM staging
Stage I	46	2 (1.52)	11.46	0.003
Stage II	51	14 (10.61)
Stage III	35	11 (8.33)
Preoperative nutritious status (g/L)
HB > 100 and Ag > 32	76	11 (8.33)	3.938	0.047
HB ≤ 100 or Ag ≤ 32	56	16 (12.12)

Table 4 Multivariate analysis of factors for low anterior resection complications

Variables	Coefficient	Standard error	Wald statistics	Degree of freedom	P value	Exp (coefficient)
Location	-0.595	0.193	9.453	1	0.002	0.552
Size	0.139	0.039	12.989	1	< 0.001	1.149
Nutritious status	0.705	0.616	1.308	1	0.253	2.023
TNM staging	1.035	0.456	5.159	1	0.023	2.816