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A randomised study of colostomies in low colorectal anastomoses
T E Pakkastie1, J T Ovaska, E S Pekkala
1Second Department of Surgery, Helsinki University Central Hospital, Finland.
Objective:
To assess the value of covering colostomy for patients undergoing low anterior resection for rectal neoplasms.
Design:
Prospective randomised study.
Setting:
Two university hospitals, Finland.
Subjects:
38 patients with air-tight stapled end-to-end anastomoses and complete anastomotic tissue rings were randomly allocated to have a covering colostomy (n = 19) or not.
Main Outcome Measures:
Postoperative mortality, anastomotic leaks, reoperations for leaks.
Results:
The clinical leak rate was 24% (9/38) and six patients (16%) had radiological leaks. The total number of leaks (clinical and radiological together) was similar in the two groups, 7/19 compared with 8/19, respectively. There were fewer clinical leaks in the colostomy group (3/19; 16% compared with 6/19; 32%), but the difference was not significant. Reoperations for leaks were necessary more often in patients who did not have a covering colostomy (6/19; 32% compared with 1/19; 5%, p = 0.09). Two patients who did not have a stoma died from the infective complications of their leaks and one died of heart failure in the colostomy group. One patient who had not been given a stoma initially was left with a permanent colostomy after a leak.
Conclusions:
Our results suggest that a covering colostomy does not reduce the leak rate after low anterior resection, but prevents most of the severe infective consequences of the leaks.