Applying protective rectal tube in intestinal anastomosis

Introduction
Colorectal resection is used for various diseases, including neoplasms (benign and malignant) and inflammatory bowel disorders. Leakage is one of the complications that increase mortality and morbidity in patients. The beneficial effects of a rectal tube in reducing anastomosis leak are controversial. Ileostomy as diverting stool may reduce risk of anastomosis leak.

Aim
To evaluate the results of rectal tube application to reduce leakage in low pelvic anastomosis.

Material and methods
In a prospective cohort study, 53 patients who were candidates for low anterior resection, extended low anterior resection, and ileal pouch-anal anastomosis, were enrolled in this study. After anastomosis, a large bore Foley was inserted transanally and put in the proximal of the anastomotic site, after fixation; we left it at least for 5 days then removed it if there was any sign of leakage.

Results
In this research, 53 patients were studied; 30 (56.6%) were male and 23 (43%) were female. Among 32 (60%) patients who underwent total proctocolectomy and ileal pouch anal anastomosis, 24 (45%) had ulcerative colitis and 8 (15%) had familial adenomatous polyposis disorder. Among 21 (40%) patients who had rectal cancer, 8 (15%) cases had low anterior resection (LAR) and 13 (25%) underwent extended LAR. Seventeen (32%) patients used ileostomy and 36 (67.9%) patients used a rectal tube. Anastomotic leak occurred in 6 (11%) patients; all of them had ileostomy. No leakage or complication appeared in rectal tube cases. The difference was statistically significant (p < 0.001).

Conclusions
The results of our study suggest that using a rectal tube instead of protective ileostomy may reduce anastomosis leak in the lower pelvis by reducing intraluminal pressure to effect and lower tension at the anastomosis site in low pelvic intestinal anastomosis.