Biomedical Research

Leakage of low rectal anastomosis is a potentially life threatening complication. Conven-tionally, in those patients who can tolerate a major operation, resection of anastomosis with end stoma is attempted. This management leads to permanent stoma in many patients. We try to show that in a defined group of patients, with overtly symptomatic clinical leak man-dating surgical intervention, the primary anastomosis may be saved. One hundred and fifty seven patients who underwent low rectal anastomosis during 7 years were followed post-operatively for leak. Patients with low rectal anastomosis disruption of less than a quarter of circumference, estimated by digital rectal examination, were selected. Proximal loop diver-sion with complete on-table wash out of distal limb and temporary closure of efferent open-ing plus peritoneal irrigation and drainage was performed as salvage procedure. Fifteen patients (9.5%) with major leakage and small anastomotic disruption, 10 males (66.6%) and 5 females (33.3%) were enrolled. The indication of primary operation was low rectal cancer in 12 (80%) patients and ulcerative colitis in 3 (20%) patients. Management was successful in 12 (80%) patients leading to preservation of their low rectal anastomosis and control of sepsis. Salvage procedure failed in three (20%) patients leaving no option but discontinuing the pelvic anastomosis in favor of end colostomy. There was one in-hospital death (6.66%). Patients with small disruption at low rectal anastomosis may be managed without resection of primary anastomosis. Controlling peritoneal infection and inhibiting ongoing contamination by proximal diverting stoma will help small deep pelvic leaks heal.

Author(s): Faramarz Karimian, Karim Darbanian*, Ali Aminian, Rasoul Mirsharifi, Farhad Mehrkhani, Farshad Gharaee
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