Application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage

Abstract

To explore the application of protective appendicostomy after sphicter-preserving surgery for patients with low rectal carcinoma who are at high-risk of anastomotic leakage. Clinical data of 74 low rectal cancer cases with high-risk anastomotic leakage undergoing laparoscope-assisted total mesorectal excision(TME) sphincter-preserving operation in our department from September 2013 to September 2014 were analyzed retrospectively. Patients were randomly divided into two groups: 36 patients received appendicostomy and catheter was removed 4 to 6 weeks after operation when sinus tract formation in abdominal wall was identified; 38 patients received traditional ileostomy and stoma closure was performed 3 to 6 months after operation. The operation time was (149.2±9.4) min vs. (146.7±12.7) min, postoperative complication morbidity was 8.3%(3/36) vs. 13.2%(5/38), anastomotic leakage rate was 2.8%(1/38) vs. 2.6%(1/36), mean drainage volume of 1-week stoma was (203.2±76.9) ml vs. (195.8±76.5) ml, intestinal function recovery time was (25.5±5.6) h vs. (24.0±5.8) h in intubation colostomy group and ileostomy group respectively, and these differences were not significant (all P>0.05). While total hospital stay was shorter and cost was less in intubation colostomy group as compared to ileostomy group [(8.8±1.7) d vs. (18.0±1.7) d, (32 000±3000) yuan vs. (51 000±4000) yuan], and these differences were significant (all P<0.05). For low rectal cancer patients who are at high-risk of developing anastomotic leakage undergoing sphincter-preserving anterior resection, protective appendicostomy can decrease anastomotic leakage rate, avoid second stoma closure, shorten hospital stay and reduce hospital cost.