Transanal tube placement prevents anastomotic leakage after laparoscopic low anterior resectionOutstanding Poster Award

Background: Anastomotic leakage (AL) is a major complication after laparoscopic low anterior resection (LLAR) for rectal cancer. Although several reports described the usefulness of transanal tube placement, this is still a controversial issue and the mechanisms of the tube to prevent AL are still unknown. The aim of this study is to evaluate the effect of transanal tube placement for prevention of AL after LLAR.Methods: A retrospective study was performed in 69 patients who received LLAR. After the anastomosis by double stapling technique (DST), a transanal tube was placed in 28 patients, but not in remaining 41 patients. Univariate and multivariate analyses for clinicopathological characteristics were performed.Results: The overall AL incidence was 15.9% (11/69). The univariate analysis showed that transanal tube placement (p=0.022) and early postoperative diarrhea (p<0.001) were associated with AL. Postoperative hospital stay of the patients with transanal tube (13.1±4.1 days) was significantly shorter than that without transanal tube (22.7±12.3 days; p<0.001). Transanal tube placement did not reduce postoperative diarrhea. The multivariate analysis revealed that absence of transanal tube (OR=16.8, p=0.002) and postoperative diarrhea (OR=64.5, p<0.001) were independent risk factors for AL. Conclusions: Transanal tube placement would prevent AL after LLAR using DST, and this may be explained by reduction of the unfavorable effects of early postoperative diarrhea.