title: Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection.
abstract: BACKGROUND
  Anastomotic leakage (AL) is a major complication of laparoscopic low anterior resection (LLAR) for rectal cancer. Although several recent reports have suggested that transanal tube placement can prevent AL, this practice is still controversial. Additionally, the mechanism by which a transanal tube prevents AL is unknown. The aim of this study was to evaluate the efficacy of transanal tube placement for prevention of AL following LLAR.
  
  
  METHODS
  This was a retrospective study that included 69 patients who underwent LLAR between February 2012 and January 2016. After an anastomosis using a double stapling technique, a transanal tube was placed in 28 patients. A diverting stoma was created in 26 patients. Univariate and multivariate analyses of clinicopathological characteristics were performed.
  
  
  RESULTS
  The overall incidence of AL was 15.9% (11/69). Univariate analysis showed that transanal tube placement (P = 0.022) and early postoperative diarrhea (P < 0.001) were associated with AL. The duration of the postoperative hospital stay for patients with transanal tube placement (13.1 ± 4.1 days) was significantly shorter than for patients without a transanal tube (22.7 ± 12.3 days; P < 0.001). However, transanal tube placement did not reduce postoperative diarrhea. Creation of a diverting stoma did not affect the incidence of AL. Multivariate analysis revealed that the absence of a transanal tube (odds ratio = 33.5, P = 0.018) and the occurrence of postoperative diarrhea (odds ratio = 86.3, P = 0.001) were independent risk factors for AL.
  
  
  CONCLUSIONS
  Transanal tube placement prevents AL after LLAR. Furthermore, this protective effect may be due to a reduction in the unfavorable incidence of early postoperative diarrhea.
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Obama
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tamaki
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kami
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Takahito
authors.initials: T
authors.lastname: Shono
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Kyoto City Hospital, Kyoto, Japan.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Morimoto
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007440:Intubation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: anastomotic leakage; laparoscopic low anterior resection; transanal tube placement