Protection of an anastomosis in rectal cancer surgery

Abstract

The incidence of anastomotic leakage (AL) after low or ultralow rectal resections ranges between 1.8% and 24%, although, postoperative mortality associated with AL can reach up to 32%. Preventive enterostomy reduces rate and degree of surgical complications by almost three times. However, both stoma-related problems and following stoma closure disasters may occur later on. The given literature review explores the relevance of the topic. It does not analyze rectal diverting stomas only, but also other alternative ways to protect the anastomosis. It has been marked that ileostomy, colostomy, ghost ileostomy, additional reinforcement and transanal decompression methods reduce the incidence of AL and give similar results comparing to diverting stoma. The reason why these methods, despite being easy to perform, have not been widely adopted in coloproctology, might be conservatism of surgeons or relative lack of literature. The use of several protection methods (VIB-valtrac secured intracolonic bypass G C-seal) is limited due to the peculiar properties of the bioconfigured devices, the technical features of the implementation, the absence of randomized controlled trials (RCT). Unfortunately, the literature on combined use of different anastomotic protective methods, depending on specific intraoperative events, is not widely available. The introduction of prospective RCT would allow a more reasonable approach to indications for both the anastomotic protection and diverting stoma creation.