Anastomotic leakage (AL) is a severe surgical complication for mid-low rectal cancers. The efficacy of transanal drainage tube (TDT) has rarely been reported.

To evaluate the efficacy of TDT after AL.

A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection (LAR) and developed ALs. Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present. In each patient, the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus. The clinical outcomes of the patients following transanal drainage were analyzed.

A total of 43 patients received TDT treatment, while 25 patients did not receive TDT treatment. Among the patients in the TDT group, 9 required reoperation compared to 12 in the non-TDT group. In the TDT group, 76.74% of the patients were able to restore intestinal continuity, whereas only 40% of the patients in the non-TDT group achieved restored intestinal continuity. In the TDT group, 48.48% of patients developed LAR syndrome (LARS), whereas in the non-TDT group, 90% of patients developed LARS. The median drainage time was 7 days, the median postoperative hospital stay was 21 days, the median fasting time was 6.5 days, and the median hospitalization cost was 109205.93 RMB.

TDT use lowered reoperation rate but did not increase hospitalization expenses. After ≥ 1 year of follow-up, its use improved intestinal patency rate and reduced the incidence of LARS.

• Rectal cancer
• Anastomotic leakage
• Transanal drainage tube
• Low anterior resection syndrome
• Therapy

• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/etiology
• Anastomotic Leak/prevention & control
• Anastomotic Leak/surgery
• Laparoscopy/adverse effects
• Rectal Neoplasms/surgery
• Rectal Neoplasms/complications
• Retrospective Studies
• Organ Sparing Treatments

• Anastomotic leakage
• Laparoscopic surgery
• Low anterior resection
• Rectal cancer

• Anastomotic leakage
• Diverting stoma
• Laparoscopic low anterior resection
• Transanal tube

Anastomotic leakage is a serious, sometimes critical complication of upper gastrointestinal (GI) surgery. The cavity and target drainage tubes are difficult to reach; therefore, a nasogastric tube (NGT) and fasting are required for an extended period. We successfully treated and managed two patients with anastomotic leakage using percutaneous transesophageal gastro-tubing (PTEG).

In case 1, a 79-year-old man with gastric cancer underwent total gastrectomy; 1 week later, he underwent emergent open laparotomy due to panperitonitis attributed to anastomotic leakage-related jejunojejunostomy. We resected the portion between esophagojejunostomy and jejunojejunostomy and reconstructed it using the Roux-en-Y technique. On postoperative day (POD) 9, anastomotic leakage was diagnosed at the esophagojejunostomy site and jejunotomy staple line. After using a circular stapler for jejunojejunostomy, a stapled jejunal closure was added. We inserted an NGT and performed aspiration for bowel decompression. As he did not improve within 2 weeks, we decided to perform PTEG to free him of the NGT. We kept performing intermittent aspiration; leakage stopped shortly after, due to effective inner drainage. The PTEG catheter was removed after oral intake was restarted. In case 2, an 81-year-old man with esophagogastric junction cancer underwent resection of the distal esophagus and proximal stomach. After shaping the remnant stomach, esophagogastrostomy was performed under the right thoracotomy. On POD 11, anastomotic leakage was identified, along with a mediastinal abscess. We inserted an NGT into the abscess cavity through the anastomotic leakage site. On POD 25, we performed PTEG and inserted a drainage tube, instead of an NGT. Although the abscess cavity disappeared, anastomotic leakage persisted as a fistula. We exchanged the PTEG with a double elementary diet (W-ED) tube with jejunal extension, with the side hole located near the anastomosis. The anastomotic fistula disappeared after treatment. Dysphagia persisted due to disuse atrophy of swallowing musculature; PTEG was useful for enteral feeding, even after the leakage occurred.

Patients are sometimes forced to endure pain for a long time for transnasal inner drainage. Using PTEG, patients will be free of sinus pain and discomfort; PTEG should be helpful for patients withstanding NGT.

• Anastomotic leakage
• Double-lumen feeding tube
• Percutaneous transesophageal gastro-tubing
• Transnasal drainage
• Upper GI surgery

• OTSC
• VAC
• anastomotic leakage
• endoscopic treatment
• fibrin glue
• low anterior resection

• Rectal cancer
• anastomotic leak
• interventional radiology
• minimally invasive
• surgery

• anastomosis resuturing
• anastomotic leakage
• hirschsprung disease
• ileostomy
• rectal examination

• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/diagnosis
• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Child
• Child, Preschool
• Hirschsprung Disease/surgery
• Humans
• Ileostomy/adverse effects
• Ileostomy/methods
• Infant
• Male
• Retrospective Studies
• Treatment Outcome

• Anastomotic leak
• Anterior resection
• Rectal cancer
• Transanal tube

• anastomotic failure
• colorectal surgery
• endoscopic vacuum therapy

Colorectal resection is used for various diseases, including neoplasms (benign and malignant) and inflammatory bowel disorders. Leakage is one of the complications that increase mortality and morbidity in patients. The beneficial effects of a rectal tube in reducing anastomosis leak are controversial. Ileostomy as diverting stool may reduce risk of anastomosis leak.

To evaluate the results of rectal tube application to reduce leakage in low pelvic anastomosis.

In a prospective cohort study, 53 patients who were candidates for low anterior resection, extended low anterior resection, and ileal pouch-anal anastomosis, were enrolled in this study. After anastomosis, a large bore Foley was inserted transanally and put in the proximal of the anastomotic site, after fixation; we left it at least for 5 days then removed it if there was any sign of leakage.

In this research, 53 patients were studied; 30 (56.6%) were male and 23 (43%) were female. Among 32 (60%) patients who underwent total proctocolectomy and ileal pouch anal anastomosis, 24 (45%) had ulcerative colitis and 8 (15%) had familial adenomatous polyposis disorder. Among 21 (40%) patients who had rectal cancer, 8 (15%) cases had low anterior resection (LAR) and 13 (25%) underwent extended LAR. Seventeen (32%) patients used ileostomy and 36 (67.9%) patients used a rectal tube. Anastomotic leak occurred in 6 (11%) patients; all of them had ileostomy. No leakage or complication appeared in rectal tube cases. The difference was statistically significant (p < 0.001).

The results of our study suggest that using a rectal tube instead of protective ileostomy may reduce anastomosis leak in the lower pelvis by reducing intraluminal pressure to effect and lower tension at the anastomosis site in low pelvic intestinal anastomosis.

• ileostomy
• rectal anastomosis
• rectal tube

• Anastomotic leakage
• Anterior resection
• Transanal drainage tube

Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

• Risk factor
• Laparoscopic low anterior resection
• Anastomotic leakage

• Anastomosis, Surgical/methods
• Anastomotic Leak/epidemiology
• Anti-Bacterial Agents/therapeutic use
• Blood Loss, Surgical
• Chemoradiotherapy/statistics & numerical data
• Colostomy/statistics & numerical data
• Digestive System Surgical Procedures/methods
• Drainage
• Drug Therapy/statistics & numerical data
• Gastrointestinal Microbiome
• Humans
• Intraoperative Care
• Neoadjuvant Therapy/statistics & numerical data
• Obesity/epidemiology
• Operative Time
• Postoperative Care
• Preoperative Care
• Radiotherapy/statistics & numerical data
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/blood supply
• Rectum/surgery
• Risk Factors
• Sex Factors
• Surgical Stapling/methods
• Tumor Burden

• Anastomotic leakage
• Anterior resection
• Colorectal cancer
• Transanal tube

• Anastomosis, Surgical
• Anastomotic Leak/prevention & control
• Drainage/instrumentation
• Drainage/methods
• Humans
• Odds Ratio
• Rectal Neoplasms/surgery
• Rectum/surgery
• Reoperation
• Surgical Stapling/methods
• Treatment Outcome

Laparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis.

This was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL.

The overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25–12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22–17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period.

Using appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings.

• Adult
• Aged
• Aged, 80 and over
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Anastomotic Leak/etiology
• Female
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Lymph Node Excision
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Operative Time
• Rectal Neoplasms/pathology
• Rectal Neoplasms/surgery
• Rectum/pathology
• Rectum/surgery
• Retrospective Studies
• Risk Factors
• Surgical Stapling/adverse effects
• Surgical Stapling/methods