Protective stoma in anterior resection of the rectum: when, how and why?
BACKGROUND
The use of protective stoma in anterior resection (AR) is controversial. Neoadjuvant therapy, TME and laparoscopy seem to increase the rate of anastomotic dehiscences (a.d.).


METHODS
In a prospective study, 219 patients were submitted to elective open AR (109 patients), open AR+TME nerve-sparing (110 patients), 35 of which had intrasphinteric anastomosis. Fifty-five patients were treated by neoadjuvant therapy. Primary stoma was not performed.


RESULTS
We had 15 (6.8%) a.d.: 5 (2.3%) major and 10 (4.4%) minor. In the five major a.d. an immediate colostomy was performed with one death. In the 10 minor the a.d. was cured conservatively.


CONCLUSIONS
A protective stoma is necessary in less than 10% of the patients treated with AR, so avoiding further surgery, mortality, morbidity and higher medical costs in most patients.
Pappalardo
Giuseppe
G
Department of General Surgery, Surgical Specialties and Organ Transplantation P.Stefanini, Division of General Surgery I, University of Rome La Sapienza, Italy. giuseppe.pappalardo@uniroma1.it
Spoletini
Domenico
D
Proposito
Delia
D
Giorgiano
Fabio
F
Conte
Anna Maria
AM
Frattaroli
Fabrizio Maria
FM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003125:Colostomy; D005260:Female; D006801:Humans; D008297:Male; D008643:Mesentery / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D054047:Surgical Stomas