C Palanivelu, MS, FACS, FRCSEd, DSc, S Rajapandian, MS, FRCS, FMAS, R Parthasarathi, MS, FMAS, P Senthilnathan, MS, FMAS, DNB, Senthil Ganapathy, MS, Manish Jain, MS. GEM Hospital & Research Centre
Introduction: Defunctioning ileostomy, practiced routinely for ultra low anterior resections (ULAR) has its own complications and decrease the quality of life. With experience, the leak rate and complications of stapled anastamosis at the pelvic floor after ultra-low anterior resection has reduced. Hence the role for routine defunctioning ileostomy is becoming questionable. We present our initial experience of ultralow anterior resection without routine ileostomy.
Materials and methods: A prospective non-randomised study of consecutive patients undergoing ultralow anterior resection from January 2013 to June 2016 was performed. Thirty three patients with low rectal tumors who underwent ULAR were classified into two groups based on whether defunctioning ileostomy was performed. A tube drain adjacent to the anastomosis in pelvis was placed in all patients. The leak rates and complications were analyzed in the two groups.
Results: Among the total of 33 patients, 15 had ileostomy and 18 did not have defunctioning ileostomy. Only one patient without ileostomy developed anastomotic leak, requiring laparoscopic peritoneal lavage and diversion ileostomy on post operative day 3. Two among the 15 patients with routine ileostomy had re-operation in the same admission for ileostomy obstruction. Though patients with ileostomy had early return of bowel function, there was no difference in the duration of hospitalization.
Conclusion: Our initial experience of performing ultra-low anterior resection without routine diversion ileostomy has been promising. Early diagnosis of leak and peritoneal lavage with diverting ileostomy in case of a leak is a safe option instead of routine diverting ileostomies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79486
Program Number: P199
Presentation Session: Poster (Non CME)
Presentation Type: Poster