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Tube caecostomy to protect rectal anastomoses
W H Thomson1, S White, D P O'Leary
1Gloucester Gastroenterology Group, Gloucestershire Royal Hospital, UK.
The British Journal of Surgery
|November 21, 1998
Summary
Tube caecostomy offers little protection against rectal anastomotic leakage, with a 14.9% leak rate in low anterior resections. Complications were frequent and potentially life-threatening, questioning its utility.
Area of Science:
- Colorectal Surgery
- Surgical Techniques
- Anastomotic Leakage Management
Background:
- Low rectal anastomoses carry a significant risk of anastomotic leakage.
- Tube caecostomy is a proposed method for protecting these anastomoses.
Purpose of the Study:
- To evaluate the effectiveness of tube caecostomy in protecting low rectal anastomoses.
- To assess the incidence of anastomotic leakage and complications associated with tube caecostomy.
Main Methods:
- Retrospective review of 226 patients undergoing restorative rectal resection with tube caecostomy.
- Analysis of clinical anastomotic leakage, need for stoma, and tube caecostomy complications.
Main Results:
- An overall clinical anastomotic leakage rate of 11.1% was observed.
- In patients with low anterior resection and caecostomy, the leak rate was 14.9%, with 10.1% requiring reoperation and stoma.
- Complications of tube caecostomy occurred in 4.4% of patients, with 6.6% experiencing prolonged drainage and two cases of life-threatening infection.
Conclusions:
- Tube caecostomy is an inadequate method for protecting rectal anastomoses.
- The procedure is associated with a high rate of complications, some of which are life-threatening.