Comparison of Anastomosis Evaluation Techniques Before Ileostomy Closure in Rectal Cancer Patients

Abstract

Aim:Postoperative ileus, stricture, abscess, and sepsis can be prevented by ensuring that there is no deterioration in the integrity of the anastomosis before closure of the protective loop ileostomy for rectal cancer. The aim of this study is to investigate which technique is more appropriate to evaluate the anastomosis before ileostomy closure.Materials and Methods:Between 2011 and 2019, patients who underwent elective low anterior resection for rectal cancer and had a concomitant protective loop ileostomy were reviewed retrospectively. The patients included in the study were divided into 2 groups as those whose anastomosis evaluation was performed with digital rectal examination (DRE) alone and those who underwent flexible endoscopy (FE) with DRE.Results:Ninety-nine patients were included in the study. Sixty-one of the patients were male and 38 were female. The mean age of the patients was 59.36±11.47 years. In the preoperative period, DRE+FE was applied to 67 patients and only DRE to 32 patients. Complications were detected in 10 patients after ileostomy closure (stricture and ileus in 6 patients, anastomotic leakage in 3 patients, and surgical site infection in 1 patient). Of 89 patients without complications, 66 were in the DRE+FE group and 23 were in the DRE group (p<0.001).Conclusion:In order to minimize the complications related to the anastomosis, it is recommended to evaluate together with both DRE and FE, although the appropriate examination in the evaluation of anastomosis is still not clear before the protective loop ileostomy is closed.

Keywords

• rectal cancer
• ileostomy reversal
• endoscopy
• digital rectal examination