Clinical Study Of Anastomotic Leak After Total Mesorectal Excision

Background: This study was designed to investigate the causes and treatment of anastomotic stoma fistula and lower the incidence and mortality rate of the anastomotic leak, through conducting retrospective analysis of cases of anastomotic leak after total mesorectal excision.Materials and methods: 275 operations of TME were performed by the Gastroinstinal Surgery at the hospital between January 2000 and January 2010; 12 patients (4.38%) suffered from anastomotic leak after operation. Retrospective analysis was conducted based on parameters such as gender, age, preoperative albumin value, preoperative complications, operative time, size of the tumor, way of anastomosis, location of the stoma, time of the leak, complications, modus of the reoperation, treatment,length of stay and prognosis.Results: Out of 12 patients suffering from anastomosis leak, 9 were male and 3 were female; regarding 3 female patients, 2 of them suffered from rectovaginal fistula. The oldest was 79, and the youngest was 25; 6 patients were over 60 years old; the average age was 58. The preoperative albumin value was 27~45g/L. In terms of preoperative complications, 3 patients suffered from hypertension of which 1 patient suffered from diabetes at the same time, and 1 patient had the complications of grinder's disease and lung tuberculosis ; operative time was 120min~505min,and the average was 244min. As to the size of tumor, the maximum was 10×6×5.5cm, and the minimum was 3×2×1cm. Stapler was used in 11 cases,however, in one case, they used stapler at first and then used handiwork to re-sew the wound which had residual tumor cells. Anastomotic leak usually lasted about 3 to 10 days,and the average was 7.2 days. The leak was 0~10cm away from the anus. 6 patients suffered from peritonitis after operation; 3 patients suffered from stoma bleeding; 6 patients had operations for the second time; 5 patients had colon transversum stoma, and 1 patient had colon sigmoideum. Length of stay was from 14 to 57 days,and the average length was 29.7 days. 10 patients were discharged from hospital after recovery; 1 patient was discharged when she felt better; 1 patient decided to leave the hospital by himself and died after 3 weeks.Conclusions: Factors such as gender, nutritional state,location of the stoma,operative time and the way of anastomosis, had been identified. It is necessary to pay more attention to these factors. Treatment, such as sufficient drainage and anti-inflammatory therapy, and necessary re-operation are all key factors in post-operation rehabilitation.