Anterior, Low, and Ultra Low Resection of Rectal Cancer With or Without Diverting Ileostomy: Short-Term Outcome

Abstract

Background:

The literature shows that diverting ileostomy reduces the rate of anastomotic leak. However, many others recommend the reverse, making the issue debatable. Hence, this study was designed to overcome this debate and, consequently, to adopt an evidence-based option.

Objectives: This study aimed to evaluate the protective effect of diverting ileostomy in rectal surgery for rectal cancer, namely anterior, low, and ultra-low anterior resection.

Materials and Methods:

This is a prospective study that included 55 patients with rectal cancer in the upper, middle, and lower thirds, as confirmed by histopathology. All of them had undergone anterior, low, and ultra-low anterior resection, respectively, with or without diverting ileostomy.

Results:

This study included 23 patients with anterior resection, and 32 patients with low and ultra-low anterior resection (14 and 18, respectively). It shows that anastomotic leak occurred in eight patients (14.54%) of the 55 patients included in this study. There were seven patients (21.21%) out of 33 without diverting ileostomy who developed anastomotic leak, while there was only one patient (4.54%) out of 22 with diverting ileostomy who developed anastomotic leak. There were five patients (15.62%) out of 32 who had undergone low and ultra-low anterior resection who developed a leak; in comparison, three patients (13.04%) out of 23 who had undergone anterior resection developed a leak. There were two patients out of eight patients with leak, received neoadjuvant chemoradiotherapy, whereas the remaining six patients did not receive. In five patients out of eight patients with a leak, the anastomosis was done by hand sewn, whereas in the remaining three, the anastomosis was performed by stapler. There were three men with a leak out of eight, whereas there were five women with a leak.

Conclusion:

 Diverting ileostomy might decrease the chance of anastomotic leak in rectal surgery for rectal cancer and make a better response to conservative management if it occurs and reduce its serious sequelae.