title: Efficacy of transanal drainage for anastomotic leakage after laparoscopic low anterior resection of the rectum.
abstract: BACKGROUND
  Anastomotic leakage remains a devastating complication following low anterior resection of the rectum. Our aim was to retrospectively assess the efficacy of transanal drainage.
  
  
  METHODS
  Twenty-five patients with anastomotic leakage after laparoscopic low anterior resection (using the double-stapling technique) were reviewed. Transanal drainage was performed when an abscess was localized within the pelvic cavity, and any leakage was detected through radiological study and digital examination. In each patient, the fistula was dilated with a forefinger, and the abscess was drained into the rectum. A suction drain tube was indwelled transanally when the abscess cavity was large or unstable. Clinical outcomes of patients after transanal drainage were then analyzed.
  
  
  RESULTS
  Nine of the 25 patients required an emergency operation. The remaining 16 cases with localized disease were treated conservatively as an initial treatment. This included 12 patients treated by transanal drainage, 10 of whom were successfully cured. Two eventually required a defunctioning ileostomy because of fistula formation with other organs (treatment success rate: 83.3%). The median duration of drain placement, fasting and postoperative hospitalization were 10, 10 and 45 days, respectively.
  
  
  CONCLUSIONS
  Transanal drainage may be a viable option for the treatment of anastomotic leakage after low anterior resection of the rectum.
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. kae_md@kuhp.kyoto-u.ac.jp
authors.forename: Kae
authors.initials: K
authors.lastname: Okoshi
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Masano
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Koya
authors.initials: K
authors.lastname: Hida
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawada
authors.forename: Akinari
authors.initials: A
authors.lastname: Nomura
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D057868:Anastomotic Leak / Q000175:diagnosis / Q000628:therapy*; D003661:Decision Support Techniques; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome