title: Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study.
abstract: BACKGROUND
  Anastomotic leakage (AL) is a major complication of colorectal surgery. The leakage is classified as grade B when the patient's clinical condition requires an active therapeutic intervention but does not require further surgery. The management of grade B AL commonly includes administration of antibiotics and/or the placement of a pelvic drainage performed under radiological guidance or transanal drain. The objective of this study was to evaluate the feasibility and the efficacy of endoscopic transanastomotic drainage using double-pigtail stents (DPSs) in the management of grade B AL in colorectal surgery.
  
  
  METHODS
  Between September 2011 and December 2014, 650 patients underwent a colorectal procedure in our university hospital; 8.7 % presented with AL, including 42.8 % with grade B. Fourteen patients required endoscopic management and constituted the study population. The study's primary objective was to assess the feasibility and efficacy of DPS placement for the treatment of grade B AL after colorectal surgery. The secondary endpoints were the requirement for radiological drainage, the DPS placement failure rate, the rate of stoma closure and, lastly, feasibility of chemotherapy (if indicated).
  
  
  RESULTS
  DPS placement was feasible in 92.8 % of the 14 patients (n = 13). The overall success rate for endoscopic management was 78.5 % (n = 11). The median length of hospitalization after DPS placement was 5 days (3-17). The average duration of drainage through a DPS was 62 days (28-181). Five patients (35.7 %) also underwent drainage with radiological guidance. Of the 10 patients with stoma, closure occurred in 80 %. All patients that required adjuvant chemotherapy were able to receive it.
  
  
  CONCLUSIONS
  The treatment of AL requires multidisciplinary collaboration to save the anastomosis. DPS placement under endoscopic control is associated with AL healing, good clinical tolerance and the ability to undergo chemotherapy and is an alternative to repeat laparotomy when radiological drainage is unfeasible or inefficient.
authors.affiliation: Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.|Jules Verne University of Picardie, Amiens Cedex 01, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Blot
authors.affiliation: Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.|Jules Verne University of Picardie, Amiens Cedex 01, France.|INSERM Unit 1088, Amiens Cedex 01, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.|Jules Verne University of Picardie, Amiens Cedex 01, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Brazier
authors.affiliation: Department of Radiology, Amiens University Hospital, Amiens Cedex 01, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Chivot
authors.affiliation: Jules Verne University of Picardie, Amiens Cedex 01, France.|Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.affiliation: Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.|Jules Verne University of Picardie, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.|EA4294, Jules Verne University of Picardie, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.|Clinical Research Centre, Amiens University Hospital, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D054047:Surgical Stomas; D016896:Treatment Outcome
keywords: Conservative management; Double pigtail drains; Leak; Rectum