Transanal repair of anastomotic leakage after oncologic low anterior resection: a prospective cohort

Anastomotic leakage is a common complication after low anterior resection for rectal cancer, often resulting in a permanent stoma. This study aimed to evaluate the effectiveness of early detection, sepsis control, and transanal repair in managing anastomotic leakage.

In this prospective cohort study conducted from January 2018 to June 2022 at a Norwegian university hospital, patients undergoing resectional surgery for rectal cancer were assessed for anastomotic leaks. Early detection involved CT with rectal contrast and flexible endoscopy. Repair eligibility required involvement of less than half the anastomotic circumference and no ischemia or retraction of the colon. The cavity outside the anastomotic defect was cleaned using a catheter for intermittent irrigation or endoluminal vacuum therapy. A diverting stoma was created, and a transabdominal pelvic drain was inserted if not already present. Once sepsis was controlled and the cavity was clean, the defect was sutured using a transanal minimally invasive surgery access platform or an open transanal technique, based on anastomosis level. Healing was confirmed via computed tomography (CT) with rectal contrast and rigid proctoscopy before reversing diverting stomas, and again at 12 months. A supplementary video demonstrates the technique.

Of 22 identified anastomotic leaks, 11 underwent transanal repair, resulting in healed anastomosis for nine patients and restored bowel continuity for eight. Among these, five reported major low anterior resection syndrome. Median hospital stay was 20 days, with no 90-day mortality.

This anastomosis-preserving approach for treating anastomotic leakage shows promise, potentially preserving bowel function and reducing permanent stoma rates.