Prospective Evaluation of Selective Defunctioning Stoma for Low Anterior Resection with Total Mesorectal Excision |
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Authors: | Ronnie Tung-Ping Poon Kin-Wah Chu Judy Wai-Chu Ho Cheung-Wah Chan Wai-Lun Law John Wong |
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Institution: | (1) Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong, China, HK |
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Abstract: | Low anterior resection with total mesorectal excision for rectal carcinoma is associated with a high anastomotic leakage
rate, and the effectiveness of a defunctioning stoma in preventing anastomotic leakage remains controversial. In this study
a policy of selective defunctioning stoma for stapled colorectal anastomosis after low anterior resection with total mesorectal
excision in 148 consecutive patients was evaluated prospectively. A defunctioning stoma was performed in 61 patients (41%)
considered at high risk of anastomotic leakage. Clinical leakage occurred in 2 patients (3.3%) with a stoma and 11 patients
(12.6%) without a stoma (p= 0.047). Among those without a stoma, the leakage rate among male patients (20.9%) was significantly higher than that for
female patients (4.5%) (p= 0.022). Leakage subsided with conservative treatment in the two patients with a stoma, but seven patients without a stoma
developed peritonitis requiring laparotomy. No deaths resulted from leakage, and there was one hospital death (0.6%) in the
whole group. Median hospital stay was similar with and without a stoma (13.0 vs. 12.0 days) (p= 0.290). Closure of the stoma was associated with no mortality, a morbidity rate of 8.7%, and a median hospital stay of 6.0
days. In conclusion, a defunctioning stoma is effective in preventing clinical anastomotic leakage after low anterior resection
with total mesorectal excision. The relatively high incidence of leakage in the low risk group indicates the difficulty of
predicting anastomotic leakage and hence the need for more liberal use of a defunctioning stoma especially in male patients. |
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