Diseases of the Colon & Rectum

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Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0b013e31827687a4
Original Contribution: Colorectal/Anal Neoplasia

Transanal Drainage to Treat Anastomotic Leaks After Low Anterior Resection for Rectal Cancer: A Valuable Option

Sirois-Giguère, Élise M.D.1; Boulanger-Gobeil, Cindy M.D.1; Bouchard, Alexandre M.D.2; Gagné, Jean-Pierre M.D.2; Grégoire, Roger C. M.D.2; Thibault, Claude M.D.2; Bouchard, Philippe M.D.2

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BACKGROUND: Anastomotic leaks after low anterior resection for rectal cancer remain a major cause of morbidity and mortality. Few studies have focused on their management, particularly on the technique of transanal drainage.

OBJECTIVE: The aim of this study was to assess the short- and long-term outcomes according to the initial management of clinical leaks.

DESIGN AND SETTINGS: This study is a retrospective review of a single institution experience.

PATIENTS: All patients treated for a symptomatic anastomotic leak after low anterior resection for rectal cancer between January 2000 and March 2011 were included.

MAIN OUTCOME MEASURES: The primary outcomes were mortality attributed to the leak, sepsis control, stoma closure rate, and functional results.

RESULTS: A total of 37 patients (35 men/2 women) developed a symptomatic leak. Leaks were initially managed by transanal drainage in 16 patients, abdominal reintervention in 12 patients, and medical treatment in 9 patients. The only death attributed to the leak occurred in the abdominal reintervention group. In the transanal drainage group, antibiotics were administered for a median length of 9 days, and the drain was left in place for a median length of 30 days. One patient underwent percutaneous drainage of a collection in addition to transanal drainage, but no patient required abdominal reintervention. Of the treatment modalities applied, transanal drainage was associated with the highest stoma closure rate (93%), after a median postoperative time of 7 months. Complications observed after transanal drainage were anastomotic strictures in 33% and the creation of a permanent stoma due to poor function in 13%.

LIMITATIONS: This study was limited by its nonrandomized retrospective design and the presence of selection bias.

CONCLUSIONS: For the management of low anastomotic leaks, transanal drainage allows preservation of the anastomosis and sepsis control with a high rate of ileostomy closure. It is a valuable option in patients with a diverting ileostomy.

© The ASCRS 2013


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