Prevention and Management of Leakage After Rectal Resection with Extraperitonization of Drainage and Anastomosis

Abstract

Background: The aim of surgical treatment in cases of carcinoma of the distal rectum is to save the anal sphincter, decrease the number of postoperative complications and limit the risk of reoperation. Therefore, mechanical /stapler/ anastomosis is currently widely used. In our study we discussed the complications and the preconditions leading to them, when manual and mechanical anastomosis are performed. We clarified the role of extraperitonization of anastomosis and drainage. Aim: To analyze the early postoperative results - the leakage rate when performing manual and mechanical anastomosis following resection of the lower rectum. We aimed to estimate the significance of extraperitonization of the anastomosis and the drainage in the postoperative period. Materials and Methods: In the period January 1, 1995 - December 31, 2015, in the Clinic of General and Liver-Pancreatic Surgery, 389 patients with rectal carcinoma, who suffered frontal rectal resection, were operated on.Results: Out of the 389 patients, 216 /55.52%/ were male and 173 /44.48%/ - females. Mechanical suture anastomosis was performed on 183 /47.04%/, and a handmade one - on 206 /52.96%/. Anastomosis leakage was registered in 58 cases /14.91%/. From those, with mechanical suturing were 34 /18.57%/, and with handmade anastomosis - 14 /6.79%/. There were two cases of relaparotomy and no deceased patients with this complication for the researched period.Conclusions: Mechanical staplers give the opportunity to keep anastomosis at the possible lower limit, almost impossible for manual suturing. But even with mechanical suturing, we face the risk of anastomosis leakage. This is why we think that the extraperitonization of anastomosis is a reliable prevention of reoperation and fecal peritonitis