Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer.

Abstract

BACKGROUND:

Symptomatic anastomotic leakage is the most important surgical complication following rectal resection with intestinal anastomosis. Therefore, the routine use of a protective stoma is suggested by several authors. In our department 2 different techniques are performed to protect the anastomosis. Patients receive either a loop colostomy/ileostomy (C/I) or a tube cecostomy (TC).

HYPOTHESIS:

No significant difference is noted between C/I and TC for protection of a low anastomosis regarding clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, and permanent colostomy rate. By avoiding a second operation (for colostomy closure), median hospital stay should be significantly reduced.

DESIGN:

A retrospective review during 1985 to 1997.

SETTING:

Tertiary care center

PATIENTS:

One hundred fifty-eight patients who had undergone anterior resections for rectal cancer were studied. Protective C/Is were used in 19 patients; a TC was fashioned in 30 patients.

MAIN OUTCOME MEASURES:

Clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, permanent colostomy rate, and median hospital stay.

RESULTS:

The rate of anastomotic leaks (C/I, 16%; TC, 17%), fecal peritonitis (C/I, 0%; TC, 10%), reoperation for anastomotic leaks/fistulas (C/I, 0%; TC, 13%), permanent colostomies (C/I, 0%; TC, 7%), and postoperative mortality (C/I, 5%; TC, 0%) did not differ significantly in both groups. Median hospital stay was significantly reduced in patients with TC (C/I, 28 days; TC, 15 days).

CONCLUSION:

In our patients with low resections for rectal cancer, a C/I for protection of the anastomosis did not improve outcome significantly as compared with a TC. With a properly fashioned TC and adequate postoperative management a second operation (for colostomy closure) can be avoided and the overall hospital stay is significantly reduced.

• Authors: J Tschmelitsch, H Wykypiel, R Prommegger, E Bodner
• Journal: Archives of surgery (Chicago, Ill. : 1960) (Arch Surg) Vol. 134 Issue 12 Pg. 1385-8 (Dec 1999) ISSN: 0004-0010 [Print] United States
• PMID: 10593339 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Anastomosis, Surgical
• Cecostomy
• Colostomy
• Female
• Humans
• Ileostomy
• Male
• Middle Aged
• Postoperative Complications (etiology, prevention & control)
• Rectal Neoplasms (surgery)
• Reoperation