Minimally invasive ileostomy as treatment procedure in anastmotic leak management, after elective surgery for rectal carcinoma

Abstract

Background: Anastomotic leakage following elective colorectal surgery is relatively common and serious complication, potentially life-threatening for the patients, leading to distortion in their quality of life. Up to now there aren’t clearly defined reasons why it occurs and many efforts are made to predict and manage it afterwards. Defunctioning ileostomy failed to reduce the rates of anastomotic leaks, but was proven to be effective in developed peritonitis management and local control of the complications. Relaparoscopy and ileostomy in strictly selected patients- without septic complications and who have good compliance, has a potential to me eligible therapeutic modality to treat anastomotic insufficiencies on unprotected colorectal anastomosis. Aims: Sharing one centers experience with patients, managed with re-laparoscopy and defunctioning ileostomy due to anastomotic leak, as effective therapeutic approach after elective anterior resection of the rectum in colorectal cancer patients. Methods: In this retrospective study we elected 12 patients, re-operated after anastomotic leakage, in the Clinic of Endoscopic, Endocrine surgery and Coloproctology in Military Medical Academy- Sofia, for the time period 2018-2021. Indicators for evaluation of the procedure were duration of hospital stay, CRP(C-reactive protein) values and WBC(white blood cells) count on the 1st and 4th day after re-operation, other complications including sepsis, need of ICU treatment, need of re-operation, patients death, possibility and time of GIT passage restoration. A review of literature was made, using PubMed Central database. Results: In the elected patients cohort we observed medium hospital stay of 20 days. On day 3rd to 4th after surgery, drop in laboratory indicators was observed, compared to the values on the day of the leak : mean CRP 265,5mg/l and mean WBC 9,1^109 on day one, to mean CRP 103mg/l and mean WBC 8,81^109 on 3rd to 4th postoperative day after reoperation. One patient was with rapid onset of sepsis on the day of the leak, with need of ICU treatment, but it didn’t have effect on short and long term results of the surgery. Most common observed nonsurgical complications were cardiovascular- arrhythmias in ¼ of the patients. Mortality rate was 0%. Six patients safely underwent GIT passage restoration 3 months after the surgery, 3 patients are still under recovery and 3 were lost to follow up. Conclusions: Laparoscopic ileostomy is a good therapeutic alternative to reduce colorectal anastomotic leak complications. Research limitations come from the small patients sample, retrospective design and loss of long-term follow up on patients. There is a need of bigger randomized controlled trials to determine advantages and disadvantage of the procedure, as well as expected quality of life of the patients. Keywords: Minimally invasive ileostomy, Anastomotic leak. Rectal cancer