Complete prevention of anastomotic leakage using total enteric flow diversion

Colonic anastomotic leakage (AL) remains a feared complication of colorectal surgery. Usually, a defunctioning stoma or a proximal colostomy is performed to reduce the AL rate but cannot completely prevent AL. Moreover, defunctioning colostomy is associated with high morbidity. This study assessed the feasibility of completely preventing colonic AL using total enteric flow diversion without a defunctioning stoma in a pig model of colonic AL.

To determine the feasibility of preventing colonic AL via total enteric flow diversion in pigs.

A total of 14 pigs underwent surgery to create colon anaesthesia with severe defects for establishing the AL model. The pigs were then randomized into the control group (n = 7), which received no further therapy, and a diversion group (n = 7), which underwent placement of a modified ileostomy tube to divert the enteric contents from the colon externally. The general condition, serum C-reactive protein level, white blood cell count, 5-day incidence of colon AL, and development of abdominal abscesses were evaluated.

A modified ileostomy tube with a balloon was placed and pressurized to 20 kPa at a distance of 10-20 cm proximal to the ileocecal valve, effectively obstructing the intestine without causing injury and efficiently diverting the enteric contents. In the diversion group, no cases of peritonitis or abscess were observed. In contrast, all pigs in the control group developed either abdominal abscesses or peritonitis.

Instead of ileostomy or colostomy, the total enteric flow diversion technique with the placement of a modified ileostomy tube and balloon in the ileum can effectively or completely prevent colon AL.