title: Transanal drainage tube reduces rate and severity of anastomotic leakage in patients with colorectal anastomosis: A case controlled study.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical usefulness of the placement of a transanal drainage tube to prevent anastomotic leakage in colorectal anastomoses.
  
  
  METHODS
  This single-center retrospective trial included all patients treated with surgery for benign or malign colorectal disease between January 2009 and December 2012. The transanal drainage tube was immediately placed after colorectal anastomosis until day five and was routinely used since 2010. Patients treated with a transanal drainage tube were compared with the control group. Statistical analysis was performed using Fisher's exact or Chi-square tests for group comparison and a linear regression model for multivariate analysis.
  
  
  RESULTS
  This study included 242 patients (46% female; median age 63 years; range 18-93); 34% of the patients underwent a laparoscopic procedure, and 57% of the patients received a placement of a transanal drainage tube. Anastomotic leakage occurred in 19 patients (7.9%). Univariate analysis showed a higher rate of anastomotic leakage in patients with an ASA score 4 (p = 0.02) and a lower rate in patients with transanal drainage placement (3.6% vs. 13.6%; p = 0.007). The grading of the complication of anastomotic leakage was reduced with transanal drainage (e.g., Dindo ≧ 3b: 20.0% vs. 92.9%; p = 0.006), and the hospital stay was shortened (17.6 ± 12.5 vs. 22.1 ± 17.6 days; p = 0.02). Multivariate analysis revealed that transanal drainage was the only significant factor (HR = -2.90; -0.168 to -0.032; p = 0.007) affecting anastomotic leakage.
  
  
  CONCLUSIONS
  Placement of a transanal drainage tube in patients with colorectal anastomoses is a safe and simple technique to perform and reduces anastomotic leakage, the severity of the complication and hospital stay.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University, Innsbruck, Austria; Department of General, Visceral, Thoracic and Vascular Surgery, Charité Campus Mitte, Universitätsmedizin Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Brandl
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University, Innsbruck, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Czipin
authors.affiliation: Department of General and Visceral Surgery, Hospital Klagenfurt, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Mittermair
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University, Innsbruck, Austria; Department of General, Visceral, Thoracic and Vascular Surgery, Charité Campus Mitte, Universitätsmedizin Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Weiss
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University, Innsbruck, Austria; Department of General, Visceral and Transplant Surgery, Charité Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University, Innsbruck, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Kafka-Ritsch
keywords: Anastomotic leakage; Colorectal surgery; Diagnostic tool; Protective device; Sigmoid resection; Transanal tube