Prevention of anastomotic leakage after low anterior resection in rectal cancers.
OBJECTIVE
To review the available data on the efficacy of the measures that are directed towards prevention of anastomotic leakage after low anterior resection and introduce a promising method based on our own experience.


METHODS
The Medline database was searched for studies on the prevention of anastomotic leak after low anterior resection in rectal cancers.


RESULTS
Two meta-analyses of the results indicate that a routine defunctioning stoma reduces the rate of clinically relevant anastomotic leakages and is thus recommended in such patients. However, the morbidity of the stoma itself, as well as the morbidity and mortality of its closure should also be considered and pending further trials to clarify its role. Studies suggested that omentoplasty may reduce the leakage rate, but there is a paucity of large randomized trials. A non-randomized trial together with our clinical experience indicated Valtrac-secured intracolonic bypass (VIB) may be a promising method in prevention of anastomotic leakage in rectal cancers.


CONCLUSIONS
VIB appears so far to be a promising method for the prevention of anastomotic leak after low anterior resection in rectal cancers. However, further randomized controlled studies are still required to determine its clinical efficacy.
Chang
Dongmin
D
Department of Surgical Oncology, Comprehensive Cancer Center, First Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, China. sage2001china@yahoo.com.cn
Zhang
Yong
Y
Dang
Chengxue
C
Zhu
Kun
K
Li
Kang
K
Chen
Deqiang
D
Chen
Wuke
W
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D006801:Humans; D009852:Omentum / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*