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Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors

Daichi Kitaguchi, Yuji Nishizawa, Takeshi Sasaki, Yuichiro Tsukada, Koji Ikeda, Masaaki Ito
Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland 2019 June 14

AIM: In patients with a previous history of rectal anastomotic leakage (AL), the surgical indications and timing for closure of a diverting stoma closure have to be carefully judged. Even if AL has apparently healed before stoma closure, re-leakage may occur after closure. The aim of this study was to determine the incidence and risk factors for recurrent anastomotic leakage following stoma closure. We also examined the treatment strategies aimed to minimize the risk of recurrent anastomotic leakage.

METHODS: From January 2009 to December 2016, 1,008 patients underwent sphincter-saving surgery (low anterior resection: LAR; all-sphincter-preserving rectal resection with hand-sewn coloanal anastomosis: CAA; and intersphincteric resection: ISR) for primary rectal cancer with curative intent at our hospital. A total of 69 patients with AL with a Clavien-Dindo grade of III or more who subsequently underwent closure of a diverting stoma were retrospectively reviewed for this study.

RESULTS: The incidence of recurrent leakage after stoma closure in this series was 13% overall with an incidence of 25% in the CAA/ISR group, and 5% in the LAR group. Significant risk factors included hand-sewn anastomosis (P=0.0257) compared to stapled anastomosis, ischemia at the anastomotic site as the cause of initial AL (P<0.001), and a shorter interval between confirmation of healing and stoma closure (P=0.00952).

CONCLUSION: Ischemia at the anastomotic site was the main risk factor for recurrent leakage, particularly after CAA/ISR. Additional treatment options before stoma closure should be considered to avoid re-leakage in such cases. This article is protected by copyright. All rights reserved.


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