title: Use of Valtrac™-secured intracolonic bypass in laparoscopic rectal cancer resection.
abstract: The occurrence of anastomotic leakage (AL) remains a major concern in the early postoperative stage. Because of the relatively high morbidity and mortality of AL in patients with laparoscopic low rectal cancer who receive an anterior resection, a fecal diverting method is usually introduced. The Valtrac™-secured intracolonic bypass (VIB) was used in open rectal resection, and played a role of protecting the anastomotic site. This study was designed to assess the efficacy and safety of the VIB in protecting laparoscopic low rectal anastomosis and to compare the efficacy and complications of VIB with those of loop ileostomy (LI). Medical records of the 43 patients with rectal cancer who underwent elective laparoscopic low anterior resection and received VIB procedure or LI between May 2011 and May 2013 were retrospectively analyzed, including the patients' demographics, clinical features, and operative data. Twenty-four patients received a VIB and 19 patients a LI procedure. Most of the demographics and clinical features of the groups, including Dukes stages, were similar. However, the median distance of the tumor edge from the anus verge in the VIB group was significantly longer (7.5 cm; inter-quartile range [IQR] 7.0-9.5 cm) than that of the L1 group (6.0 cm; IQR 6.0-7.0 cm). None of the patients developed clinical AL. The comparisons between the LI and the VIB groups were adjusted for the significant differences in the tumor level of the groups. After adjustment, the LI group experienced longer overall postoperative hospital stay (14.0 days, IQR: 12.0, 16.0 days; P < 0.001) and incurred higher costs ($6300 (IQR: $5900, $6600)) than the VIB group (7.0 days, $4800; P < 0.05). Stoma-related complications in the ileostomy group included dermatitis (n = 2), stoma bleeding (n = 1), and wound infection after closure (n = 2). No BAR-related complications occurred. The mean time to Valtrac™ ring loosening was 14.1 ± 3.2 days. The VIB procedure, as a good partner with the laparoscopic rectal cancer resection, appears to be a safe and effective, but time-limited, diverting technique to protect an elective low colorectal anastomosis.
authors.affiliation: From the Department of Colorectal Surgery (FY, DC, DW, JL); and Department of General Surgery, the First Affiliated Hospital, Zhejiang University, No. 79, Qinchun Road, Hangzhou, China (SZ).
authors.forename: Feng
authors.initials: F
authors.lastname: Ye
authors.forename: Dong
authors.initials: D
authors.lastname: Chen
authors.forename: Danyang
authors.initials: D
authors.lastname: Wang
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Lin
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D057868:Anastomotic Leak / Q000517:prevention & control; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000191:economics / Q000601:surgery*; D012189:Retrospective Studies