TY - JOUR AU - Thakur, Binay AU - Devkota, Mukti AU - Li, Zuosheng AU - Sharma, Amit AU - Regmi, Yogesh PY - 2017/09/26 Y2 - 2024/03/28 TI - Low rectal resection without a diverting stoma JF - Nepalese Journal of Cancer JA - Nep. J. Cancer VL - 1 IS - 1 SE - Original Articles DO - 10.3126/njc.v1i1.25621 UR - https://www.nepjol.info/index.php/njc/article/view/25621 SP - 8-12 AB - <p><strong>Background: </strong>A diverting stoma is a usual practice after low and ultralow rectal resections in a fear to minimize the morbidities related to anastomotic leak. We tried to explore not to use a prophylactic diverting stoma and to assess the rate of leak.</p><p><strong>Methods: </strong>Patients undergoing total proctocolectomy (18%)/ low anterior resection of rectum (LAR) (59%)/ ultralow LAR (18%) and intersphincteric LAR (5%) for colorectal adenocarcinoma were analyzed. In all the cases, total mesorectal excision (TME) approach was used. CT/ MRI was used for proper staging and clinically locally advanced tumors were subjected to neoadjuvant chemoradiation (23%). Anastomosis was performed using circular stapler for colorectal or ileorectal anastomosis (94%) and hand-sewn for coloanal anastomosis (6%). Integrity and adequate vascularity of anastomosis was checked using air leak test and excising epiploica at the region of anastomosis.</p><p><strong>Results: </strong>Seventeen patients with mean age of 52 years were analyzed. Mean distance of tumor from the anal verge was 7 cm. Open and Laparoscopic resections were done in 82% and 18%, respectively. Average height of anastomosis was 3.5 cm from the anal verge. Superficial surgical site infection, intraabdominal abscess requiring prolonged intravenous antibiotics and urinary retention were observed in 41%, 6%, and 6%, respectively. There was one anastomotic leak (6%), which led to post operative death of the patient.</p><p><strong>Conclusion: </strong>Low rectal resections may be carried out without a diverting stoma with an acceptable anastomotic leak rate. In a well-performed ileorectal/ colorectal/ coloanal anastomosis with a good vascularity at the site of anastomosis, routine use of diverting stoma may not be justified, though a randomized controlled trial with larger sample is needed.</p> ER -