Advances in the application of prophylactic ostomy in radical resection of rectal cancer

Abstract

: Despite of technological improvements in surgical equipment, anastomotic leakage (AL) after anterior rectal resection is still the most important and common complication in laparoscopy and open surgery. According to reports, the clinically obvious leakage rate after laparoscopic anterior rectal resection is 3–19%. AL is associated with high morbidity and mortality, and usually requires re-operation with stoma creation. It significantly increases the length of hospital stay and rehabilitation costs. For a long time, there has been controversy about the role of protective stomas, and there are still controversies. Some authors recommend the routine use of temporary stomas to reduce the incidence and incidence of AL. On the contrary, other authors discourage the regular use of temporary stomas, and preferring selective use. For these authors, a protective stoma can only reduce the catastrophic clinical consequences of AL and decrease the burden of stoma-related complications. The conventional method of temporarily using the stoma reduces the advantages of the laparoscopic technique, so it is advisable to use it selectively. The difficulty in choosing to use temporary stoma is related to the necessity of effective anastomotic cracking risk stratification, which is not yet available today. In this article, we reviewed literatures regarding the indications of prophylactic ostomy, stoma-associated complications, timing of reversal, and surgical complications, aimed at providing useful summary of experience for early stoma closure, and thus reduce stoma-associated complications and ultimately improve the quality of life of patients.