Anastomotic protection with a transanal tube after rectum resection and total mesorectal excision

Between October 1998 and December 1999 50 patients with a primary cancer of the rectum were treated by sphincter saving anterior resection of the rectum and total mesorectal excision. Eight patients were given a ncoadjuvant combined radio-chemotherapy. The anastomoses were performed in the triple-stapling technique with a Premium Plus CEEA stapling device (Fa. Tyco Health Care, Tonisvorst, Germany) or with a Proximate ILS curved stapling device (Fa. Ethicon Endo Surgery, Norderstedt, Germany). The anastomoses were situated in 7 cm or in lower distance from the anal skin. In all patients with complete anastomotic tissue rings the anastomoses were protected with the transanal tube. The integrity of the anastomosis (n = 48) was checked for completeness in the 2nd and 12th postoperative week. The patients were sigmoidoscoped and the anastomoses were controlled by transanal ultrasonography. During the hospital stay 2 patients (4.2%) with a clinically evident anastomotic leakage were detected. 3 patients (6.2%) with an asymptomatic anastomotic leakage were detected by computertomography. The anastomoses of 27 patients (56.2%) were clinically and by ultrasonographical examination intact. In these patients a postoperative radiogram was not indicated. Relaparotomy was necessary in one patient for bleeding, in two patients for anastomotic leaks and in three patients for ileus (12.5%). Because of low anastomotic leakage rate and low morbidity we find the transanal tube to be at least equivalent to conventional colostoma for anastomotic protection.