title: Defunctioning cannula ileostomy after lower anterior resection of rectal cancer.
abstract: OBJECTIVE
  Most surgeons suggest the use of fecal diversion in patients undergoing low anterior resections of rectal tumors at high risk for anastomotic leakage. We describe an exploratory study to evaluate the efficacy and safety of a new diversion method called a spontaneously closing cannula ileostomy, which was designed to protect rectal anastomoses in patients at high risk for anastomotic leakage. The outcomes of patients treated with cannula ileostomy were compared to those of patients treated with loop ileostomy.
  
  
  METHODS
  Outcomes included the rates of anastomotic leakage, reoperation and other complications, as well as length of hospital stay and cost.
  
  
  METHODS
  From January 2011 to December 2012, 294 patients undergoing low colorectal or coloanal anastomosis were treated with ileum diversion using cannula ileostomy or traditional loop ileostomy. Demographics, clinical features, and operational data were recorded.
  
  
  RESULTS
  The anastomotic leakage rates were 8.1% (12/149) in the cannula ileostomy group and 8.3% (12/145) in the loop ileostomy group (p = 1.0). The reoperation rate was 3% (4/149) in patients treated with a cannula ileostomy and 3.4% (5/145) in those who underwent a loop ileostomy (p = 0.75). The median length of the hospital stay was 8.6 days in the cannula ileostomy group and 17.1 days (p < 0.01) in the loop ileostomy group, including time for the initial and reversal operations. In the cannula ileostomy group, the median time to defecation from the anus was 16.5 days after the operation. During the follow-up period, 13 patients in the loop ileostomy group retained their stoma, as compared to 2 in the cannula ileostomy group (p < 0.01).
  
  
  CONCLUSIONS
  This study was a nonrandomized design and lacked contrast enema data to identify anastomotic leaks.
  
  
  CONCLUSIONS
  Cannula ileostomy is a safe and effective diverting technique that protects low colorectal and coloanal anastomoses. Patients receiving a cannula ileostomy had shorter hospital stays and lower rates of permanent stoma than those receiving a loop ileostomy.
authors.affiliation: Department of Colorectal Surgery, First Affiliated Hospital, Zhejiang University, Zhejiang, China.
authors.forename: Hanju
authors.initials: H
authors.lastname: Hua
authors.forename: Jiahe
authors.initials: J
authors.lastname: Xu
authors.forename: Wenbin
authors.initials: W
authors.lastname: Chen
authors.forename: Xile
authors.initials: X
authors.lastname: Zhou
authors.forename: Jinhai
authors.initials: J
authors.lastname: Wang
authors.forename: Qinsong
authors.initials: Q
authors.lastname: Sheng
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Lin
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D057785:Catheters; D015331:Cohort Studies; D003672:Defecation; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D054047:Surgical Stomas; D013997:Time Factors; D016896:Treatment Outcome