Affiliation:
1. Colorectal Research Unit, Basingstoke District Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK
Abstract
Abstract
Over 14 years 276 patients with rectal cancer underwent surgery; 219 who underwent low anterior resection of the rectum with total mesorectal excision were studied. There were 24 (11·0 per cent) major anastomotic leaks associated with peritonitis or a pelvic collection and 14 (6·4 per cent) minor leaks that were asymptomatic and detected by contrast enema. All major leaks occurred at an anastomotic height of less than 6cm (P = 0·08). The abdominoperineal excision rate was 9·1 per cent. Major leaks were associated with failure to defunction in 11 of 62 patients and with a defunctioning colostomy in 13 of 157 (P = 0·03). Of the 24 patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis (P = 0·002), and three died (P = 0·02). Use of the sigmoid colon led to major leakage in seven of 32 patients compared with 17 of 187 when the splenic flexure was employed (P = 0·05). There was no increase in the local recurrence rate but only nine patients with major leakage and a temporary stoma have had these closed. Key technical factors incude: a clean dry pelvie cavity, pulsatile colonic blood supply, suction drainage started during closure and mobilization of ample tissue to fill the pelvic space.
Publisher
Oxford University Press (OUP)
Cited by
497 articles.
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