The Usefullness of Transanal Rectal Decompression by a Penrose Drain After Laparoscopic Low Anterior Resection of the Rectum

Iwao Kitazono1, Jun Kadono1, Akira Furoi2, Shunsuke Motoi1, Tomohisa Futawatari2, Hizuru Kumemura2, Maki Inoue2, Teruhiko Watanabe3, Masahiko Osako3, Naoki Ishizaki3, Teruo Kumagae4, Imoto Yutaka1. 1Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 2Department of Surgery, Kirishima Medical Association Hospital, 3Department of Surgery, Kagoshima Medical Association Hospital, 4Department of Surgery, Kagoshima Teishin Hospital

[INTRODUCTION] Anastomotic leakage after laparoscopic low anterior resection of the rectum is a critical complication. Many procedures have been applied to prevent leakage. We retrospectively evaluate the usefulness of transanal rectal decompression by a Penrose drain for preventing anastomotic leakage in our department.

[PATIENTS AND METHODS] Seventy-five patients underwent elective laparoscopic low anterior resection for rectal cancer at our department and affiliated hospitals were included for this study. The rectal anastomosis was performed by end-to-end double-stapled technique (DST) using Intraluminal anastomosis (ILS). Patients with covering stoma were excluded. The 41 patients were introduced transanal decompression by a 12 mm Penrose drain and 34 patients were not. Patient related factors (age, gender, body mass index), operative factors (operation time, amount of blood loss, ILS size, transanal decompression) and tumor related factors (site of tumor; Ra/Rb, depth of tumor invasion; ~MP/SS~ ) were analyzed. Statistical analysis was performed using Fisher’s exact test, theχ2 test, and Mann-Whitney’s U-test for univariate analysis. For multivariate analysis, we used 0.10 as cutoff p value to select the analyzed factors from the univariate analysis results. A probability of p<0.05 was considered statistically significant. 

[RESULTS] Anastomotic leakage was observed in 11 of the 75 patients (14.6%). Amount of blood loss (P=0.053), site of tumor; (Rb, p=0.055), depth of tumor invasion; (SS?, p=0.071), and transanal decompression (P=0.049) on univariate analysis were chosen for multivariate analysis. Site of tumor (Rb, OR 0.156, p=0.022), depth of tumor invasion (SS~, OR 0.122, p=0.025), and transanal decompression (OR 0.119, p=0.013) were independent predictors on multivariate analysis.

[CONCLUSION] Transanal rectal decompression by a Penrose drain is a useful technique for preventing anastomotic leakage after laparoscopic low anterior resection of the rectum for rectal cancer.                                                         

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