外科ジャーナル

Fistulas after Low Anterior Resection with TME

Abstract

Ștefan Morărașu, Tudor Frunză, Alexandru Rotundu, Sorinel Luncă, Gabriel Dimofte

Despite advances in modern anastomotic techniques for colorectal surgery, anastomotic fistulas are still considered a dreaded complication, with a reported rate varying from 2 to 25%. Although fistulas can appear after any bowel anastomosis, it seems that low colorectal anastomosis are the most prone to such complications. Herein we aim to provide a review on our own experience with postoperative anastomotic fistulas after low colorectal anastomosis. Between 1998 and 2016, 62 patients had a LAR procedure with TME and low colorectal anastomosis. The mean age was 62.29 years. Triple stapled side to end colorectal anastomosis was the preferred technique with protective ileostomy. We report a fistula rate of 9.67% (6 cases) after Low Anterior Resection including blind fistula seen on first month follow-up endoscopic evaluation. While blind fistulas generated little morbidity, clinically manifested fistulas posed significant management challenge. Nevertheless we report no mortality related to fistula. Indubitably, more research is needed to establish a proper prevention guideline for anastomotic leaks, a “golden-standard” anastomotic technique and ideal management criteria for fistulas.