Objective:To investigate the reasons of anastomotic leakage following learning curve by laparoscopic anterior resection of rectal cancer.Methods:From December,2011 to March,2015,the clinical information of 179 patients in our hospital who underwent dixon of rectal cancer were collected.The patients were divided into a laparoscopic learning group,a laparotomy group and a laparoscopic group,The reasons of anastomotic leakage for each group were comparatively analyzed.Repeated cutting of anastomotic stoma was compared between the laparoscopic learning group and the laparoscopic group.The male,age,obesity,nutrition complications and the position of anastomotic stoma were compared among the 3 groups.Results:The rate of anastomotic leakage in the laparoscopic learning group was significantly higher than that in the laparotomy group and the laparoscopic group (P＜0.05).Repeated cutting was a significant risk factor in the laparoscopic learning group (P＜0.05),but not in the laparoscopic group.Except obesity,the four factors were significant risk factors in the laparoscopic learning group (P＜0.05).All of the five factors were not the significant risk factors in the laparotomy group and the laparoscopic group (P＞0.05).Conclusion:The operation technical shortcoming is the major factor in the learning of the laparoscopic anterior resection of rectal cancer.In order to reduce the rate of anastomotic leakage in the learning curve period,the selection of patients following the laparoscopic anterior resection of rectal cancer should avoid the following factors:male,older age,the low position of the tumor and the nutrition complications.

OBJECTIVETo evaluate the efficacy of self-made gasbag double-cannula stool drainage device for prevention of anastomotic leakage following anterior resection.

METHODSClinical data of 169 rectal cancer patients in the 8th Affiliated Hospital of Sun Yat-sen University between October 2010 and October 2016 were retrospectively analyzed. Among them, a self-made gasbag double-cannula stool drainage device was placed in 71 patients(stool drainage group), and the remaining 98 patients were taken as control. After an anastomosis, the drainage device was transanally placed by the assistant and the distal tube of drainage device was stretched more than 15 cm from anastomosis. The gasbag was inflated to fully expand the intestine. The main tube was fixed on perianal skin with 7-0 suture, kept more than 3-5 cm outside the anus, and connected to the drainage bag. The incidence of anastomotic leakage was compared between the two groups.

RESULTSThe baseline data were similar between the two groups (all P>0.05). The differences in operative time, intraoperative blood loss, and time to bowel function recovery were not statistically significant (all P>0.05), however, time to oral intake and postoperative stay were shorter in stool drainage group as compared to the control group (both P<0.05). There was no perioperative death in both groups. In stool drainage group, there were 6 cases whose drainage device was pulled out within 48 hours due to intolerance. The ruptured gasbag was replaced 5 times and the tube was clogged by fecal material 21 times. After flushing, the tube did not recanalized and was pulled out in 3 cases. The incidence of anastomotic leakage in stool drainage group was significantly lower than that in the control group (2.8% vs. 11.2%, P=0.043). As for the low anastomosis (the distance to anal verge less than 5 cm), the incidence of anastomotic leakage in stool drainage group was also significantly lower than that in the control group (2.3% vs. 15.4%, P=0.028), while as for the high anastomosis, the difference was not statistically significant (3.6% vs. 3.0%, P=0.906). Logistic regression analysis revealed that the presence of a stool drainage device was an independent protective factor for anastomotic leakage (OR=0.316, 95%CI:0.114 ~ 0.769, P=0.003).

CONCLUSIONSThe self-made gasbag double-cannula stool drainage device effectively prevents anastomotic leakage after anterior resection of rectal cancer. However it is not suitable for those patients with high anastomosis.