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Original Articles
- Assessment by Using a Water-Soluble Contrast Enema Study of Radiologic Leakage in Lower Rectal Cancer Patients With Sphincter-Saving Surgery
- Seok In Seo, Jong Lyul Lee, Seong Ho Park, Hyun Kwon Ha, Jin Cheon Kim
- Ann Coloproctol. 2015;31(4):131-137. Published online August 31, 2015
- DOI: https://doi.org/10.3393/ac.2015.31.4.131
- 6,033 View
- 57 Download
- 13 Web of Science
- 11 Citations
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Abstract
PDF Purpose This study evaluated the efficacy of a water-soluble contrast enema (WCE) in predicting anastomotic healing after a low anterior resection (LAR).
Methods Between January 2000 and March 2012, 682 consecutive patients underwent a LAR or an ultra-low anterior resection (uLAR) and were followed up for leakage. Clinical leakage was established by using physical and laboratory findings. Radiologic leakage was identified by using retrograde WCE imaging. Abnormal radiologic features on WCE were categorized into four types based on morphology: namely, dendritic, horny, saccular, and serpentine.
Results Of the 126 patients who received a concurrent diverting stoma, only two (1.6%) suffered clinical leakage due to pelvic abscess. However, 37 patients (6.7%) in the other group suffered clinical leakage following fecal diversion (P = 0.027). Among the 163 patients who received a fecal diversion, 20 showed radiologic leakage on the first WCE (eight with and 12 without a concurrent diversion); 16 had abnormal features continuously until the final WCE while four patients healed spontaneously. Eleven of the 16 patients (69%), by their surgeon's decision, underwent a stoma restoration based on clinical findings (2/3 dendritic, 3/4 horny, 5/7 saccular, 1/2 serpentine). After stoma reversal, only 2 of the 11 (19%) complained of complications related to the rectal anastomosis.
Conclusion WCE is helpful for detecting radiologic leakage before stoma restoration, especially in patients suffering clinical leakage after an uLAR. However, surgeons appear to opt for stoma restoration despite the persistent existence of radiologic leakage in cases with particular features on the WCE.
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Citations
Citations to this article as recorded by
- Preoperative anastomotic evaluation prior to ileostomy closure: A 5‐year UK survey, systematic review, and meta‐analysis
D. Atraszkiewicz, T. Shakir, C. Harrington, P. Bassett, B. Soile, H. Mukhtar
Colorectal Disease.2025;[Epub] CrossRef - Technical considerations in stoma reversal
Reece K. DeHaan, Jeremy Lipman
Seminars in Colon and Rectal Surgery.2023; 34(2): 100957. CrossRef - Pictorial review: radiological diagnosis of anastomotic leakage with water-soluble contrast enema after anterior resection of the rectum
Piero Boraschi, Gaia Tarantini, Giuseppe Mercogliano, Luigi Giugliano, Francescamaria Donati
Japanese Journal of Radiology.2022; 40(12): 1235. CrossRef - Flexible endoscopy is enough diagnostic prior to loop ileostomy reversal
S. Lindner, K. von Rudno, J. Gawlitza, J. Hardt, F. Sandra-Petrescu, S. Seyfried, P. Kienle, C. Reissfelder, A. Bogner, F. Herrle
International Journal of Colorectal Disease.2021; 36(2): 413. CrossRef - Out of the Loop: The Value of a Preoperative Loopogram for Colostomy Reversal in Trauma
Nolitha Makapi Tisetso Morare, Meshack Nkosinaye Motha, Maeyane Stephens Moeng
World Journal of Surgery.2021; 45(7): 2009. CrossRef - Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal
Simon Lindner, Steffen Eitelbuss, Svetlana Hetjens, Joshua Gawlitza, Julia Hardt, Steffen Seyfried, Christian Galata, Christoph Reissfelder, Flavius Sandra-Petrescu, Florian Herrle
International Journal of Colorectal Disease.2021; 36(11): 2387. CrossRef - Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma
Henrik Jutesten, Marie-Louise Lydrup, Axel Landberg, Daniel Risberg, Olle Ekberg, Sophia Zackrisson, Pamela Buchwald
Acta Radiologica Open.2020;[Epub] CrossRef - Are radiologic pouchogram and pouchoscopy useful before ileostomy closure in asymptomatic patients operated for ulcerative colitis?
Georgios Exarchos, Linda Metaxa, Antonios Gklavas, Vassilis Koutoulidis, Ioannis Papaconstantinou
European Radiology.2019; 29(4): 1754. CrossRef - Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery
Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
World Journal of Gastroenterology.2018; 24(1): 104. CrossRef - Imaging of the Postoperative Colon
Eugene Huo, Laura Eisenmenger, Stefanie Weinstein
Radiologic Clinics of North America.2018; 56(5): 835. CrossRef - Should a Contrast Enema Be Performed Before Reversal of a Diverting Stoma in Lower Rectal Surgery?
Ji Yeon Kim
Annals of Coloproctology.2015; 31(4): 117. CrossRef
- Preoperative anastomotic evaluation prior to ileostomy closure: A 5‐year UK survey, systematic review, and meta‐analysis
- The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer
- Seok In Seo, Chang Sik Yu, Gwon Sik Kim, Jong Lyul Lee, Yong Sik Yoon, Chan Wook Kim, Seok-Byung Lim, Jin Cheon Kim
- Ann Coloproctol. 2013;29(2):66-71. Published online April 30, 2013
- DOI: https://doi.org/10.3393/ac.2013.29.2.66
- 9,960 View
- 52 Download
- 37 Citations
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Abstract
PDF
Purpose A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer.
Methods Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups.
Results Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246).
Conclusion The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.
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Citations
Citations to this article as recorded by- Anastomotic leak in colorectal surgery: Current evidence on risk, diagnosis, preventive measures and management
Ali Akbar Shah, Gevorg Manoukian, Omar Yasin, Amy Jacob, Timothy M. Kopah, Jas Simran Gill, Ruthel Rose, Bashayer Khaled Alharbi, Sana Zafar
Surgical Practice.2026;[Epub] CrossRef - Patient selection and operative strategies for laparoscopic intersphincteric resection without diverting stoma
Gang Hu, Ji Ma, Wen-Long Qiu, Shi-Wen Mei, Meng Zhuang, Jun Xue, Jun-Guang Liu, Jian-Qiang Tang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef - Risk factors for permanent stoma following sphincter-preserving anterior resection in rectal cancer: A retrospective multicenter observational study
Pere Planellas, Nair Fernandes, Sandra Alonso-Gonçalves, Thomas Golda, Júlia Gil, Garazi Elorza, Esther Kreisler, Mayra Rebeka Abad-Camacho, Lidia Cornejo, Franco Marinello
Cirugía Española (English Edition).2025; 103(6): 800095. CrossRef - Risk factors for permanent stoma following sphincter-preserving anterior resection in rectal cancer: A retrospective multicenter observational study
Pere Planellas, Nair Fernandes, Sandra Alonso-Gonçalves, Thomas Golda, Júlia Gil, Garazi Elorza, Esther Kreisler, Mayra Rebeka Abad-Camacho, Lidia Cornejo, Franco Marinello
Cirugía Española.2025; 103(6): 800095. CrossRef - Comparison of hand-sewn anterior repair, resection and hand-sewn anastomosis, resection and stapled anastomosis techniques for the reversal of diverting loop ileostomy after low anterior rectal resection: a randomized clinical trial
Seyed Mostafa Meshkati Yazd, Reza Shahriarirad, Mohammad Reza Keramati, Mehdi Fallahi, Soheila-sadat Nourmohammadi, Alireza Kazemeini, Mohammad Sadegh Fazeli, Amir Keshvari
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Ly Huu Phu, Ho Tat Bang, Ung Van Viet, Hoang Danh Tan, Nguyen Trung Tin
Cureus.2024;[Epub] CrossRef - Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases
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Journal of Clinical Medicine.2022; 11(9): 2632. CrossRef - Cecostomy vs ileostomy for protection of anastomoses in colorectal surgery
Dan Bratu, Alin Mihețiu, Radu Chicea, Alexandru Sabău
Romanian Journal of Military Medicine.2022; 125(1): 128. CrossRef - A diversion stoma after anterior resection for rectal cancer
Yury V. Ivanov, Aishe A. Keshvedinova, Alexander V. Smirnov
Journal of Clinical Practice.2022; 13(3): 56. CrossRef - Preservation of the Arterial Arc Formed by Left Colic Artery, Proximal Inferior Mesenteric Artery, and the First Branch of Sigmoid Arteries in Anus Saving Treatment of Low Rectal Cancer
Zakari Shaibu, Zhi-hong Chen, Acquah Theophilus, Said A. S. Mzee
The American Surgeon™.2021; 87(12): 1956. CrossRef - Current Treatment Approaches and Outcomes in the Management of Rectal Cancer Above the Age of 80
Ali P. Mourad, Marie Shella De Robles, Soni Putnis, Robert D.R. Winn
Current Oncology.2021; 28(2): 1388. CrossRef - Laparoscopic anterior resection
Senthil Kumar Ganapathi, Rajapandian Subbiah, Sathiyamoorthy Rudramurthy, Harish Kakkilaya, Parthasarathi Ramakrishnan, Palanivelu Chinnusamy
Journal of Minimal Access Surgery.2021; 17(3): 356. CrossRef - The multidisciplinary management of rectal cancer
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European Journal of Surgical Oncology.2019; 45(8): 1301. CrossRef - Preventive strategies for anastomotic leakage after colorectal resections: A review
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Annals of Surgical Treatment and Research.2017; 92(1): 35. CrossRef - Is Fecal Diversion Needed in Pelvic Anastomoses During Hyperthermic Intraperitoneal Chemotherapy (HIPEC)?
Matthew D. Whealon, John V. Gahagan, Sarath Sujatha-Bhaskar, Michael P. O’Leary, Matthew Selleck, Sinziana Dumitra, Byrne Lee, Maheswari Senthil, Alessio Pigazzi
Annals of Surgical Oncology.2017; 24(8): 2122. CrossRef - Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study
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- Anastomotic leak in colorectal surgery: Current evidence on risk, diagnosis, preventive measures and management
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