Feasibility of terminal intestinal exteriorization in laparoscopic anterior resection for anterior cancer
10.3760/cma.j.issn.1671-0274.2015.05.013
- VernacularTitle:末端回肠外置术在腹腔镜直肠癌前切除术中应用的可行性
- Author:
Qianjin ZHANG
1
;
Yuanchao HU
;
Minkang ZHANG
;
Qingzhong TIAN
;
Guangwei XIE
;
Hao GUO
;
Jin LI
;
Yun WANG
;
Qingliang MENG
Author Information
1. 221009,江苏省徐州市中心医院肿瘤外科二病区
- Keywords:
Rectal neoplasms;
Laparoscopy;
Anterior resection;
Terminal intestinal exteriorization;
Ileostomy
- From:
Chinese Journal of Gastrointestinal Surgery
2015;(5):450-453
- CountryChina
- Language:Chinese
-
Abstract:
Objective To discuss the feasibility of terminal intestinal exteriorization (exteriorization without ileostomy) in laparoscopic anterior resection for rectal cancer. Methods Clinicopathological data of 77 patients undergoing laparoscopic anterior resection for low rectal cancer in our department from January 2011 to December 2013 were retrospectively analyzed. After laparoscopic rectal resection, 32 patients received terminal intestinal exteriorization (exteriorization group) and 45 patients received preventive ileostomy (ileostomy group). Anastomosis-related, stoma-related and intestinal stoma closure-related morbidity was compared between the two groups. Results There were no significant differences in operative time, blood loss and overall hospital stay between the two groups (all P>0.05). The total hospital cost was (5.39 ±1.74) ×104 yuan in the exteriorization group, and (6.98 ±1.37) ×104 yuan in the ileostomy group (P<0.01). The incidences of postoperative anastomotic fistula was not significantly different between the two groups(P>0.05). Three patients(9.4%) developed anastomotic leak in the exteriorization group and 2(4.4%) in the ileostomy group. The anastomotic leak was managed by opening the external intestinal wall and maturating an ileostomy under local anaesthesia. All these 5 patients were cured with nutritional support, antibiotics, continuous local drainage. In the exteriorization group, 5 patients had complications related to stoma and intestinal stoma closure operation (15.6%), which was lower than (42.2%) in the ileostomy group (P=0.013). Conclusion Terminal intestinal exteriorization in laparoscopic anterior resection is a safe and feasible surgical procedure with little trauma and less hospital cost, which can be an alternative as a prophylactic treatment for patients with high risk of anastomotic leak.
