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. 2025 Feb 14;29(1):67.
doi: 10.1007/s10151-024-03103-1.

Transanal repair of anastomotic leakage after oncologic low anterior resection: a prospective cohort

W Lossius  1   2 , T Stornes  3   4 , T E Bernstein  3   4 , A Wibe  3   4
Affiliations

Transanal repair of anastomotic leakage after oncologic low anterior resection: a prospective cohort

W Lossius et al. Tech Coloproctol. .

Abstract

Background: Anastomotic leakage is a common complication after low anterior resection for rectal cancer, often resulting in a permanent stoma. This study aimed to evaluate the effectiveness of early detection, sepsis control, and transanal repair in managing anastomotic leakage.

Methods: In this prospective cohort study conducted from January 2018 to June 2022 at a Norwegian university hospital, patients undergoing resectional surgery for rectal cancer were assessed for anastomotic leaks. Early detection involved CT with rectal contrast and flexible endoscopy. Repair eligibility required involvement of less than half the anastomotic circumference and no ischemia or retraction of the colon. The cavity outside the anastomotic defect was cleaned using a catheter for intermittent irrigation or endoluminal vacuum therapy. A diverting stoma was created, and a transabdominal pelvic drain was inserted if not already present. Once sepsis was controlled and the cavity was clean, the defect was sutured using a transanal minimally invasive surgery access platform or an open transanal technique, based on anastomosis level. Healing was confirmed via computed tomography (CT) with rectal contrast and rigid proctoscopy before reversing diverting stomas, and again at 12 months. A supplementary video demonstrates the technique.

Results: Of 22 identified anastomotic leaks, 11 underwent transanal repair, resulting in healed anastomosis for nine patients and restored bowel continuity for eight. Among these, five reported major low anterior resection syndrome. Median hospital stay was 20 days, with no 90-day mortality.

Conclusions: This anastomosis-preserving approach for treating anastomotic leakage shows promise, potentially preserving bowel function and reducing permanent stoma rates.

Keywords: Anastomotic leak*; Low anterior resection; Rectal cancer; Transanal repair.

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Conflict of interest statement

Declarations. Conflict of interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript. An abstract including the first eight patients in the current study was presented as an e-poster at the ASCRS Annual Scientific Meeting, Seattle, USA, 3–6 June 2023. Ethics approval and Informed consent: Patients suffering an anastomotic leakage treated by secondary transanal suture were asked to provide informed consent and completion of LARS surveys [6] with the assistance of a study nurse. Passive opt-out consent was provided by the remaining patients. The study was approved by the Regional Committee for Medical and Health Research Ethics Central Norway.

Figures

Fig. 1
Fig. 1
Transanal repair. A Anastomotic leak upon first examination, dehiscent from 6 to 10 o’clock (POD 12). B After first EVT (POD 15). C After second EVT (POD 20). D Transanal repair by TAMIS (POD 23). POD postoperative day, EVT endoluminal vacuum therapy
Fig. 2
Fig. 2
Treatment of 22 anastomotic leaks following low anterior resection for rectal cancer. LAR low anterior resection, APR abdominoperineal resection
See this image and copyright information in PMC

References

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