[Treatment of anastomotic leakage following low anterior resection for rectal adenocarcinoma]

Abstract

Background: The most important complication after low anterior resection for rectal cancer is the anastomotic leakage. Its frequency ranges between 0%-17% and, it's associated mortality ranges between 0%-25%.

Objective: To analyze the treatment results of the above mentioned complication.

Material and methods: Between January 1990 and July 1998, 176 patients with rectal cancer underwent low anterior resection. 13 (7.3%) of them developed anastomotic leakage. The results of the treatment due to, this surgical complication were analyzed.

Results: There were 9 males and 4 females with a mean age of 64.3 years. Seven of these patients received preoperative radiotherapy. The tumor mean size was 5.5 cm. The tumor and distance of the anastomoses were located at a mean distance of 8 cm and 5 cm respectively, above the anal verge. All patients presented one or more of the following symptoms: increase of drainage (n = 10); prolonged ileus and abdominal pain (n = 9), fever and leucocytosis (n = 8). The surgical treatments were: drainage of abdominal or pelvic cavity (n = 11); loop transversostomy (n = 9); end colostomy, and Hartmann's procedure (n = 3). One patient received only enteral nutrition. In eight patients, the surgical treatment was performed during the first 24 hours of the initial symptoms and in four after 24 hours. The mean hospital stay in the former groups was 9.2 days vs 26.8 days of the later group (p = 0.02). No mortality was observed.

Conclusion: The early diagnosis of the following symptoms: drainage increase; prolonged ileus; postoperative abdominal pain; fever, and leucocytosis after low anterior resection, should guide us to the diagnosis of anastomotic leakage and therefore, to initiate surgical treatment during the first 24 hours as to avoid major morbidity and mortality.