Abstract: Objective:To investigate the safety and feasibility of the modified terminal cannula ileostomy in laparoscopic anuspreserving operation of low rectal cancer (RC).
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 15 patients who underwent laparoscopic radical resection of RC + terminal cannula ileostomy in the Subei People′s Hospital of Jiangsu Province between September 2016 and June 2017 were collected. The patients underwent laparoscopic low anterior resection of RC, intraabdominal sigmoid colonrectum endtoend anastomosis after extracting tumor specimens, and terminal cannula ileostomy in vitro. Observation indicators: (1) intraoperative situations: operation time, time of cannula ileostomy, volume of intraoperative blood loss, number of lymph node dissected, surgical margin; (2) postoperative situations: time to initial anal exsufflation, recovery time of defecation, time of tube removal, closing time of stoma, postoperative complications, duration of hospital stay; (3) followup situations. Followup using outpatient examination and telephone interview was performed to detect the anastomotic leakagerelated complications up to December 2017. Measurement data with normal distribution were represented as ±s.
Results:(1) Intraoperative situations: all the 15 patients underwent successful laparoscopic radical resection of RC + terminal cannula ileostomy, without conversion to open surgery and death. The operation time, time of cannula ileostomy, volume of intraoperative blood loss and number of lymph node dissected were respectively (170±34)minutes, (23±4)minutes, (59± 27)mL and (13±5)per case. No residual cancer cells were found in resection margins. (2) Postoperative situations: time to initial anal exsufflation and recovery time of defecation in 15 patients were respectively (6± 1)days and (7±1)days. The stoma was automatically closed after tube removal, and time of tube removal and closing time of stoma after tube removal were respectively (23±2)days and (3±1)days. The incidence of postoperative complications was 1/15. One patient with catheterizationrelated complications was improved by strengthening dressing and antibiotic use, and the stoma was healed at 8 days after tube removal. There was no anastomotic leakagerelated complications and death. The duration of hospital stay was (15±3)days. (3) Followup situations: all the 15 patients were followed up for 6-12 months. During the followup, there were no anastomotic leakagerelated complications and death.
Conclusion:The modifyied terminal cannula ileostomy is safe and feasible, and is also an ideal surgical method for preventing anastomotic leakage in the laparoscopic anuspreserving operation of low RC.