Will Trans-Anal Tube Prevent Anastomotic Leak After Sphincter Preserving Surgery For Rectal Cancer? : Our Initial Experience.

Background: Clinically significant leak rates after low anterior resection(LAR) are reportedly 8-10% resulting in permanent stoma and inferior outcomes. Aiming to decrease intraluminal pressures so that tension on the anastomotic line is reduced, we propose placement of a transanal tube(TAT) after LAR, until healing is achieved. Materials and Methods: Single-centre prospective observational study of 114 patients over 4 years, 54 of whom underwent intra-operative TAT placement, with its tip kept 3-5 cms proximal to the anastomotic line. All patients who underwent diversion stoma were excluded. Anastomotic leak was observed by feculent discharge from drain/ wound, rectovaginal/rectovesical fistula, pelvic collection on imaging or contrast extravasation when given through TAT. Two groups TAT and non-TAT control groups were compared using chi-square test. P value <.05 was considered significant. Results: 54 patients underwent TAT placement compared to 60 controls. Age, comorbidities, neoadjuvant treatment, anastomotic technique and distance from anal verge were similar in both groups. Overall leak rate was 9.8%(11/114). Leak rates were significantly lower in the TAT group(3.7% vs 15%, p<0.05). In the non-TAT group, 66.7%(6/9) patients required exploration and stoma. There was no mortality in either group. Conclusion: This study indicates placement of a transanal tube may lead to reduced leak rates after low anterior resection. This sets the stage for a prospective randomised trial to derive more concrete results. [ABSTRACT FROM AUTHOR]