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. 2022 May 7;11(9):2632.
doi: 10.3390/jcm11092632.

Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases

Antonio Sciuto  1   2 , Roberto Peltrini  3 , Federica Andreoli  4 , Andrea Gianmario Di Santo Albini  3 , Maria Michela Di Nuzzo  3 , Nello Pirozzi  3 , Marcello Filotico  3 , Federica Lauria  3 , Giuseppe Boccia  3 , Michele D'Ambra  3 , Ruggero Lionetti  3 , Carlo De Werra  3 , Felice Pirozzi  1 , Francesco Corcione  3
Affiliations

Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases

Antonio Sciuto et al. J Clin Med. .

Abstract

Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses.

Keywords: anastomotic leakage; colorectal cancer; colorectal surgery; defunctioning stoma; laparoscopy; low anterior resection; postoperative outcomes; transanal stent; transanal tube.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Technical features of the No Coil tube.
Figure 2
Figure 2
After the anastomosis has been performed, the lubricated tube (A) is inserted into the anal canal and placed to coat the anastomotic area, until the tube’s tongues contact the perineal skin (B). The proper position of the tube is checked by means of concomitant laparoscopic view (C). Final view after securing the tube to the perianal skin by two silk stitches (D).
Figure 3
Figure 3
Anastomotic leakage after laparoscopic TME and transanal tube: clinical presentation and management.
See this image and copyright information in PMC

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