Sphincter-preserving operations without defunctioning stoma

Sphincter-preserving operations have increasingly been carried out during the last few decades; nevertheless, temporary defunctioning stoma is still being frequently used for low colorectal anastomosis (LCRA) with staplers and hand-sewn coloanal anastomosis (CAA). From 1994 to 2003, 131 consecutive patients with rectal cancer with tumours within 7 cm from the anal verge underwent LCRA or CAA without defunctioning stoma. Anastomotic complications and treatment were compared between the groups. The median follow up was 31.4 months. Complications related to anastomosis were 10.7% for LCRA with 7.1% of anastomotic leakage (two men and two women) and 13.3% for CAA with 4.0% of anastomotic leakage (three men). Treatments for leakage included colostomy (three LCRA), CAA construction (one LCRA) and conservative treatment (three CAA). Twenty eight percent of CAA received preoperative radiation therapy, and the anastomic leakage developed in 14% of them. Anastomotic leakage and its treatment with CAA are different from those in LCRA, and CAA can safely be used without defunctioning stoma during sphincter-preserving operation for low-lying rectal cancer.