Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer.

摘要: Surgical management of rectal cancer has undergone a significant change during the past two decades. Low anterior resection (LAR) with total mesorectal excision (TME) is, at moment, "gold standard" for carcinoma mid or lower rectum. Because most specific complication following anastomosis is symptomatic leakage, which associated 18% mortality rate, routine formation temporary stoma suitable after sphincter-saving anastomoses situated less than 5cm from anal verge. Actually preferred modes fecal diversion LAR TME are loop ileostomy transverse colostomy. anastomosis, preoperative radiation chemoradiation, presence intraoperative adverse events and male gender independent risk factors anastomotic leakage. A defunctioning classical "protective" colostomy requires subsequent reconstructive surgery postoperative morbidity. For these reasons we use an alternative to protect high fashioning proximal intraabdominal closed called "virtual ileostomy". In seven-year period 1999 2005 107 patients underwent elective rectum carcinoma, in all cases was fashioned virtual ileostomy. The incidence clinically evident leakage 13%; (14 pts) opened reduction originally planned number ileostomies by over 80%. procedure easy perform well accepted patients. It avoids second operation.