Use of Intracolonic Bypass Secured by a Biodegradable Anastomotic Ring to Protect the Low Rectal Anastomosis

Abstract

Because of the relatively high morbidity and mortality of anastomotic leakage in patients with low rectal cancer who receive an anterior resection, many fecal diverting methods have been introduced. This study was designed to assess the efficacy and safety of the Valtrac-secured intracolonic bypass in protecting low rectal anastomosis and to compare the efficacy and complications of Valtrac-secured intracolonic bypass with those of loop ileostomy. From January 2002 to April 2006, 83 patients with rectal cancer who underwent elective low anterior resection received intracolonic bypass or ileostomy. Demographics, clinical features, and operative data were recorded. Forty-four patients (53 percent) received a Valtrac-secured intracolonic bypass and 39 patients (47 percent) a loop ileostomy. The demographics and clinical features of the groups were similar. None of the patients developed clinical anastomotic leakage. Longer overall postoperative hospital stay (21.3 +/- 5.8 days) and higher costs incurred (3.1 +/- 0.9 x $1,000 U.S. dollars) were observed in the ileostomy group than in the intracolonic bypass group (12.5 +/- 6.3 days, 4.4 +/- 1.2 x $1,000 U.S. dollars; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (12.8 percent), bleeding (2.6 percent), and intestinal obstruction after stoma closure (5.1 percent). No complications were observed in the intracolonic bypass group except for the Valtrac ring discharging en bloc, which compromised fecal evacuation in two cases (4.5 percent). The Valtrac-secured intracolonic bypass procedure is a safe, effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis. Valtrac-secured intracolonic bypass, in contrast to loop ileostomy, avoids stoma-related complications or readmission for closure and is associated with decreased hospital time and cost.