Prevalence of Leak in Rectal Anastomosis Surgery without Diverting Ileostomy: A Case - Control Study Including 32 Patients Who Underwent Low Anterior Resection Surgery
Fakhrosadat Anaraki, Mehrsad Rostam Pour* and Mehdi Tavallaei
Department of Surgery, School of Medicine, Beheshti Medical University, Taleghani Hospital, Tehran, Iran
*Corresponding Author: Mehrsad Rostam Pour, Department of Surgery, School of Medicine, Beheshti Medical University, Taleghani Hospital, Tehran, Iran.
December 14, 2022; Published:
January 23, 2023
Objectives: A case – control study including 32 patients who underwent low anterior resection surgery. Investigating the prevalence of leakage in patients who do not have an ileostomy diverting.
Colorectal carcinoma is the most common malignancy of the digestive tract. The biology of rectal adenocarcinoma is similar to colon adenocarcinoma, and the principles of colon resection surgery, such as complete removal of the tumor along with the lymphatic bed and all involved organs, also apply to rectal carcinoma. Five things that increase the chance of leakage from the anastomosis site include intestinal ischemia due to reduced blood supply to the anastomosis site, receiving neoadjuvant chemoradiotherapy before the operation, excessive tension at the anastomosis site, poor intestinal preparation before the operation, and infection.
Method and Material: 2 out of 16 patients in the case group (without an ileostomy loop insertion) had a leak, and their common risk factor was male gender, and 2 out of 16 patients in the control group (with an ileostomy loop insertion) had a leak from the anastomosis site, which is the same risk factor as the case group. The mutual factor between these two groups is being male. The rate of complications caused by ileostomy loop insertion in this study was reported as a percentage.
Result: In recent studies, it has been noted that ileostomy loop installation does not reduce the possibility of leakage and its existence is associated with complications and morbidity. In this study, the prevalence of leak was 12.5% in the control group and 12.5% in the case group.
Conclusion: It is recommended not to use the diverting ileostomy loop routinely in patients undergoing LAR surgery. This method should be used in patients who have multiple risk factors to increase the possibility of leakage after surgery.
Keywords: Rectal Adenocarcinoma; Protective Ileostomy; Neoadjuvant Treatment; Anastomosis Leaking; Lower Rectal Surgery
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