Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior...

Anastomotic leakage (AL) is a serious and challenging complication following low anterior resection (LAR) for low rectal cancer. This case series presents the successful management of AL in three patients using a combined approach of transanal opening of the intersphincteric space (TROPIS) surgery and adjuvant Kangfuxin liquid enema therapy.

Three male patients underwent laparoscopic LAR with diverting ileostomy for low rectal cancer. Case 1: A 39-year-old, presented with fever and abdominal distension 2 weeks after discharge. A digital rectal examination revealed partial anastomotic separation. Case 2: A 74-year-old, developed abdominal pain and fever on postoperative day 5, with fecal discharge through the pelvic drain, and computed tomography scan confirmed AL. Case 3: A 51-year-old, was asymptomatic but diagnosed with AL 1 week after discharge; despite 1 year of conservative management, the leakage failed to heal. All three patients were subsequently treated with TROPIS surgery combined with twice-daily Kangfuxin liquid enemas, resulting in complete resolution of AL in each case.

The combination of TROPIS and Kangfuxin enema appears to be a safe and effective approach for managing AL following LAR. This minimally invasive strategy offers a promising alternative to conventional surgical interventions. Further studies with larger cohorts are warranted to validate these findings.