Transanal Tube Drainage as a Conservative Treatment for Anastomotic Leakage Following a Rectal Resection

Mostafa Shalaby; Waleed Thabet; Oreste Buonomo; Nicola Di Lorenzo; Mosaad Morshed; Giuseppe Petrella; Mohamed Farid; Pierpaolo Sileri

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저자정보: Mostafa Shalaby (University of Rome Tor Vergata) Waleed Thabet (Mansoura University) Oreste Buonomo (University of Rome Tor Vergat) Nicola Di Lorenzo (University of Rome Tor Vergata) Mosaad Morshed (Mansoura University) Giuseppe Petrella (University of Rome Tor Vergat) Mohamed Farid (Hospitals Mansoura University) Pierpaolo Sileri (University of Rome Tor Vergata)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.34 No.6

발행연도: 2018.1

수록면: 317 - 321 (5page)

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Purpose: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

참고문헌 (30)

참고문헌 신청

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Phitayakorn R / 2008 / Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery / World J Surg 32:1147~1156

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