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THE ROLE OF TRANSANAL TUBE DRAINAGE TO PREVENT COLORECTAL ANASTOMOTIC LEAKAGE: A CASE CONTROL STUDY
Mostafa Shalaby*2, Ilaria Capuano1, Federica Saraceno1, Sara Mastrovito1, Pietro Mascagni1, Agnese Cianfarani1, Marco G. Muzi1, Oreste C. Buonomo1, Giuseppe Petrella1, Pierpaolo Sileri1
1University of Rome Tor Vergata, Rome, Italy; 2Department of General Surgery "8", Mansoura University, Mansoura, Egypt
BACKGROUND: Anastomotic leak (AL) is a challenging complication increasing postoperative morbidity and mortality after rectal anterior resection (RAR). Recent reports suggest that transanal tube placement may prevent AL, but data is scant and controversial. Moreover, the mechanism of this supposed advantage is unknown.
This study aimed to evaluate the role of transanal drainage tube (TDT) placement to reduce AL after anterior rectal resection.
PATIENTS AND METHODS: between 01/2015 and 10/2017, we prospectively collected data about 56 patients who underwent open or laparoscopic RAR for cancer or deep infiltrating endometriosis located within 15 cm from the anal verge. A 28/32 Fr transanal drainage tube (Petzer tube) was placed after the creation of the anastomosis, secured to the buttocks, and connected to a urine bag. The tube was removed between the 3rd and the 5th post-operative day. Patients who were suspected to have AL had a CT scan with rectal contrast. We compared this results with retrospective data of 56 matched patients who underwent RAR without transanal drainage tube insertion.
RESULTS: Patient demographics, tumor location, preoperative chemoradiation and operative results were similar between the two groups.
TDT group had a AL rate of 3.6% (2/56) while the historical control group had 7.1% (4/56). Despite this trend the difference was not statistically significant. Both patients who developed an AL in the TDT group had a subclinical AL with fecal diversion at the time of the initial procedure and were treated conservatively. On the other hand, among the 4 patients with AL in the NTDT group, all patients required surgery.
CONCLUSIONS: TDT insertion is safe and cheap methods that may reduce AL after RAR. In our experience it seems to mitigate the consequence of anastomotic leak.
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