title: Regenerated oxidized cellulose reinforcement of low rectal anastomosis: do we still need diversion?
abstract: OBJECTIVE
  The leak rate after low anterior resection is in the region of 10% to 15%. The highest risks of anastomotic leak are in anastomoses less than 5 cm from the anal verge. We evaluated the outcome of oxidized regenerated cellulose reinforcement of low rectal anastomosis.
  
  
  METHODS
  The study group consisted of 108 patients with rectal cancer. Patients with low rectal cancer had low anterior resection with stapled straight low colorectal or coloanal anastomosis without proximal diversion. They were prospectively randomized to either oxidized regenerated cellulose reinforcement or no reinforcement. Data collected included age, sex, hemoglobin percentage, albumin level, histopathologic type of the tumor, anastomotic leak, and stricture.
  
  
  RESULTS
  The mean age of patients was 56 years, and sex was matched in both groups. Clinical leak occurred in 6 of 38 cases (15.7%) in the group that did not undergo reinforcement versus 2 of 33 (6.1%) in the oxidized regenerated cellulose reinforcement group (P < .01). In the case of a leak, diversion was needed in 3 of 6 patients in the group that did not undergo reinforcement vs no patients in the oxidized regenerated cellulose reinforcement group (P = .05). Generalized peritonitis occurred in 3 patients in the group that did not undergo reinforcement versus no patients in the oxidized regenerated cellulose reinforcement group (P < .01). Length of stay was 4.8 days in the oxidized regenerated cellulose reinforcement group versus 5.9 days in the group that did not undergo reinforcement (P = .047), with no mortalities in either group.
  
  
  CONCLUSIONS
  Oxidized regenerated cellulose reinforcement of low rectal anastomosis significantly decreases the risk of postoperative leak in low rectal anastomosis and may reduce the requirement for proximal diversion. Potential benefits include avoidance of a stoma, lower morbidity, shorter hospital stay, and a lower cost of care.
authors.affiliation: Department of Surgery, University of Alexandria, Alexandria, Egypt. khaled.madbouly@alexmed.edu.eg
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Madbouly
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hussein
authors.forename: Waleed
authors.initials: W
authors.lastname: Omar
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farid
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002483:Cellulose, Oxidized / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010538:Peritonitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018709:Statistics, Nonparametric; D017792:Surgical Stapling; D016896:Treatment Outcome
chemical_list: D002483:Cellulose, Oxidized; D006490:Hemostatics