Surgical skills in the prevention of anastomotic leakage after rectal neoplasm surgery
10.3760/cma.j.issn.1671-0274.2018.04.008
- VernacularTitle: 预防直肠癌术后吻合口漏的操作技巧
- Author:
Qianqian SHAO
1
;
Guole LIN
Author Information
1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Publication Type:Journal Article
- Keywords:
Rectal neoplasms;
Anastomotic leakage;
Surgical skills;
Prevention
- From:
Chinese Journal of Gastrointestinal Surgery
2018;21(4):399-403
- CountryChina
- Language:Chinese
-
Abstract:
For colorectal surgeons, how to reduce anastomotic leakage after laparoscopic rectal cancer surgery remains to be challenging. We provide a brief discussion regarding the surgical skills required to prevent anastomotic leakage after rectal cancer surgery, such as the following: 1) Low ligation of inferior mesenteric vessel during laparoscopic total mesorectal excision can improve anastomotic tension and blood supply, thus reducing the risk of anastomotic leakage.While high ligation of inferior mesenteric artery resultsin poor blood supply and high tension in atastomotic site, thus increasing the risk of anastomotic leakage. 2) Protective enterostomy is recommended for patients with high risk of developing anastomotic leakage. 3) Use of abdominal/pelvic drains after colorectal anastomosis is recommended to decrease the incidence of anastomotic leakage, early detect anastomotic leakage, and conservativdy manage anastomotic leackage through drainage of pelvic effusion. 4) Laparoscopic reinforcing sutures should be used if anastomotic tension and blood supply are unsatisfactory, including continuous suture with 3-0 or 4-0 absorbable suture and 2-needle interrupted suture in the weak anastomosis. However, these sutures should be performed by experienced surgeons. For male patients with narrow pelvis and those with low rectal cancer, laparoscopic reinforcing sutures should be performed carefully due to the limited operative space. 5) Intraoperative air leak test is recommended to identify the anastomotic integrity for those with suspicious mechanically insufficient rectal anastomosis. 6) Experienced surgeon can reduce the incidence of anastomotic leakage after rectal cancer operation.
