Experience of laparoscopic peritoneal lavage for rectal anastomotic leakage

Daisuke Yamamoto, Hiroyuki Bando, Naohiro Ota, Noriyuki Inaki, Tetsuji Yamada. Ishikawa Prefectural Central Hospital

INTRODUCTION: Rectal anastomotic complications are associated with an increased patient mortality and morbidity, including the potential need for emergent reoperation and prolonged hospitalization. The gold standard of surgical treatment of rectal anastomotic leakage is abdominal drainage of collected fluid and stoma formation. Our standard surgery for colorectal cancer is laparoscopic approach. Not to eliminate the benefit of it, we prefer to minimally invasive surgery for the leakage.   

METHODS AND PROCEDURES: The previous trocar sites are used for the camera port. Laparoscopic observation reveals peritonitis caused by rectal anastomotic leakage obviously. Small bowel adhesions and expansion caused by peritonitis are usually mild in early postoperative period. The abdomen is irrigated with lots of isotonic saline solution. After adequate drainage of pelvic collection, a drain tube is placed across the anastomosis site of the pelvic region through the port site. Finally, the loop ileostomy is elevated. Among 467cases who underwent rectal anterior resection or rectal low anterior resection in our institution from January 2010 to August 2015 (laparotomy 40 cases, and  laparoscopic 427 cases),anastomotic leakage was occurred 31 cases (6.6%). 16 of 31 cases were required reoperation and we performed laparoscopic peritoneal lavage in 7 cases (1.4%) of them. We investigated those 7 cases retrospectively.

RESULTS: Patients had a median age of 66.7(range 60–76) years, and a male to female ratio was 6:1. Mean operative time was 119 minutes, and average blood loss was 5ml. Three patients needed polymixin B hemoperfusion. Six cases was discharged from the hospital on postoperative day in 31.3days average without any complication including surgical site infection. One patient died of multiple organ failure from sepsis after surgery 92days. Ileostomy was closed 3-6month later of all 6 patients.

CONCLUSION: Laparoscopic peritoneal lavage for rectal anastomotic leakage could help for diagnosis and reduce the risk of surgical site infection. Consequently this approach should be considered for the patients with suspect of peritonitis by rectal anastomotic leakage. 

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