title: Fecal Volume after Laparoscopic Low Anterior Resection Predicts Anastomotic Leakage.
abstract: OBJECTIVE
  Anastomotic leakage (AL) is a major complication after laparoscopic low anterior resection (Lap-LAR). Many surgeons encounter AL following severe postoperative diarrhea. However, little is known about the relationship between postoperative fecal volume and AL. This study determined whether postoperative fecal volume can predict AL.
  
  
  METHODS
  A retrospective assessment was performed with data from 176 patients with rectal cancers who underwent Lap-LAR between April 2011 and August 2015. A transanal tube was routinely placed in all cases. The fecal volume from the transanal tube was measured daily. The total fecal volume for 3 days after surgery was compared between the AL and non-AL groups.
  
  
  RESULTS
  AL occurred in 11 patients. There were 3 patients with a fecal volume ≥1,000 mL for 3 days after surgery. AL occurred in these 3 patients. In patients with a fecal volume <1,000 mL, the total fecal volume was significantly greater in the AL group than that in the non-AL group (p = 0.0003). The cut-off value of the total fecal volume in AL was 118 mL.
  
  
  CONCLUSIONS
  The volume of fecal discharge for 3 days after surgery is associated with the incidence of AL, and a fecal volume ≥118 mL may be a reliable predictor for AL.
authors.affiliation: Digestive Disease Center, Showa University Northern Yokohama Hospital, Tsuzuki-ku, Yokohama, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hidaka
authors.forename: Chiyo
authors.initials: C
authors.lastname: Maeda
authors.forename: Kenta
authors.initials: K
authors.lastname: Nakahara
authors.forename: Shoji
authors.initials: S
authors.lastname: Shimada
authors.forename: Shumpei
authors.initials: S
authors.lastname: Mukai
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Sawada
authors.forename: Fumio
authors.initials: F
authors.lastname: Ishida
authors.forename: Shin-Ei
authors.initials: SE
authors.lastname: Kudo
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D019540:Area Under Curve; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005243:Feces; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies
keywords: Anastomotic leakage; Fecal volume; Laparoscopic low anterior resection; Rectal cancers; Transanal tube