A comparative Study of leakage from Anastomosis in low anterior resection with or without protective Ileostomy

Abstract

Abstract

Research goals : The research aims to study the comparison of the two methods of surgical removal of surgical rectal tumors with and without ileostomy procedure in terms of: The presence of leakage, leakage management, Affecting factors in the leakage (distance of the anastomosis from the anus, radiotherapy, type of the anastomosis, stapler diameter and     tumor grade)  and The period of stay of patients in the hospital and deaths.

The research background: The difference between an ileostomy procedure or non in the management of low rectal tumors still exists, but the experience of the surgeon and the patient's condition in addition to postoperative care play a role in guiding the surgeon in choosing the best method of treatment.           

Research materials and methods: The study was conducted on 51 patients who visited the surgical division of Damascus University Hospitals (Al-Mouwasat University Hospital, Al-Assad University Hospital, Al-Biruni University Hospital 9 between 2015 and 2018, as these patients who had rectal cancer for a low anterior incision, the number of patients without an ileostomy was 22 patients, while the number of patients with an ileostomy was 28 patients, as one patient died during follow-up due to advanced age.         

Results: This study is expected to recommend the procedure of an ileostomy in high-risk patients (close to the anus, previous radiotherapy, manual anastomosis, advanced age, in case the surgeon doubts the integrity of the anastomosis) and also recommends the use of the stapler of diameter 31, as it has been shown to decrease leakage rate when used in particular, the presence of the stoma significantly reduces leakage and has a role in reducing the surgical reopening when there is leakage, and also reduces the period of stay in the hospital and reduces the rate of morbidity and mortality. 

Conclusion : From the data we have obtained, we find that an ileostomy is recommended in doubtful cases, when there is difficulty during surgery such as incomplete anastomotic rings, or a positive air leakage test, so the ileostomy must be performed according to the patient's condition, the presence of a risk factor for him and the experience of the surgeon.