Application Of Negative Pressure Irrigation Through Intraoperative Pelvic And Transanal Drainage Using Double-Lumen Cannulae In Anastomotic Leakage After Low Anterior Resection

Objective: Anastomotic leakage is the most serious complication after low anterior resection,which can increase mortality,and may associated with local tumor recurrence and decreased long-term survival rate.The aim of this study was to compare the treatment of negative pressure irrigation through Intraoperative pelvic and transanal drainage using double-lumen cannulae and the pelvic negative pressure irrigation,and to explore the effective therapeutic measures for anastomotic leakage after low anterior resection.Methods: Five hundred and sixty-two patients in the same treatment group of general surgery department of our hospital who underwent low anterior resection with anal sphincter-preserving for low rectal cancer between October 2008 to October 2018 were included in the retrospectively analyzed.Pelvic and anal drainage tube were placed routinely postoperative in all patients.The postoperative diagnosis and classification of anastomotic leakage were based on the standards formulated by the international colorectal cancer research group in 2010,CT examination and barium enema using Cardiografin were performed in parallel.According to the different intervention measures,the patients were divided into two groups,pelvic group and combined group.In the pelvic group,the anal drainage tube was removed after postoperative exhaust.If anastomotic leakage occurred after that,the pelvic negative pressure irrigation using double-lumen cannulae was applied.In the combined group,anastomotic leakage was treated by anal and pelvic negative pressure irrigation with double-lumen cannulae.The patients general information(gender,age,BMI,diabetes,cardiovascular disease),preoperative status(hemoglobin level,albumin level,neoadjuvant therapy),tumor characteristics(distance of tumor from the anal verge,maximum diameter,TNM stage),intraoperative defunctionign stoma and postoperative anastomotic leakage(including the incidence,diagnosis time,related complications and healing time),the rate of permanent colostomy and reoperation of the two groups were compared,and the factors related to anastomotic leakage were analyzed.Results: There was no significant difference in General data(gender,age,BMI,diabetes,cardiovascular disease),preoperative status(hemoglobin level,albumin level,neoadjuvant therapy),tumor characteristics(distance of tumor from the anal verge,maximum diameter,TNM stage)and intraoperative defunctionign stoma between the two groups(P>0.05).A total of 59 patients occurrence anastomotic leakage,the incidence of anastomotic leakage was 10.5%(59/562).The incidence of anastomotic leakage was 11.9%(26/218)in pelvic group and 9.5%(33/344)in combined group,and there was no statistical difference between the two groups(P >0.05).The time to diagnosed anastomotic leakage was significantly earlier in the combined group than in the pelvic group(7.38 ± 2.35 d vs.6.24 ± 1.50d;P < 0.05);The incidence of grade A anastomotic leakage in the combined group was higher than that in the pelvic group(75.8% vs.38.5%;P <0.05),but the type of grade C was lower(3.0% vs.42.3%;P < 0.05).Among the complications of anastomotic leakage,the incidence of anastomotic bleeding,anastomotic stenosis,bladder stones and intestinal obstruction was similar between the two groups(P >0.05).However,the pelvic or abdominal infection(4/33 vs.17/26;P <0.05)and urinary tract infection(2/33 vs.9/26;P <0.05)in the combined group was significantly lower than that in the pelvic group.In terms of the outcome of anastomotic leakage,there was no statistical difference between the two groups in the average length of stay and mortality(P >0.05),but the reoperation rate(1/33 vs.11/26;P <0.05)? permanent stoma rate(0/33 vs.7/26;P <0.05)and the average healing time of anastomotic leakage(42.05 ± 14.37 d vs.31.20 ± 11.65d;P < 0.05)in the combined group was significantly lower than that in the pelvic group.Univariate analysis showed that the distance of tumor from the anal verge <5 cm,preoperative hemoglobin level <110 g/L and defunctionign stoma was significantly associated with anastomotic leakage(P<0.05).Multivariate analysis showed that the distance of tumor from the anal verge <5cm(OR=3.200,P <0.05)and preoperative hemoglobin level <110 g/L(OR=3.357,P <0.05)was the risk factors for anastomotic leakage after low anterior resection.Conclusion1.Negative pressure irrigation through Intraoperative pelvic and transanal drainage using double-lumen cannulae can avoid permanent stoma caused by anastomotic leakage after low anterior resection.2.Negative pressure irrigation through Intraoperative pelvic and transanal drainage using double-lumen cannulae can reduce pelvic and abdominal infection,urinary tract infection,and reoperation rate caused by anastomotic leakage after low anterior resection.3.The distance of tumor from the anal verge <5 cm and preoperative hemoglobin level <110 g/L was the risk factors for anastomotic leakage after low anterior resection.