A Decalogue to Avoid Routine Ileostomy in Selected Patients With Border Line Risk to Develop Anastomotic Leakage After Minimally Invasive Low-Anterior Resection: A Pilot Study

摘要: Purpose. Protective ileostomy (PI) during anterior resection (AR) for rectal cancer decreases the incidence of anastomotic leakage (AL) and its subsequent complications, but it may itself be cause morbidity. The aim is to report our protocol in management selected patients with borderline risk develop AL after laparoscopic AR ghost (GI) creation. Methods. Patients who underwent were stratified based on AL. Steps avoid PI splenic flexure mobilization, reduced pelvic bleeding, employ different stapler charge if neoadjuvant chemo-radiotherapy performed, perform a horizontal section rectum, evaluate vascularization fluorescence angiography, side-to-end anastomosis, intraoperative methylene blue test, transanal drainage tubes placement, GI After surgery, inflammatory blood markers monitored detect potential leakages. Results. Twelve included. In one case, specimen proximal was changed angiography. There no conversions this group patients. One postoperative occurred treated radiological not being necessary convert GI. avoided 100% cases. Conclusions. Patients' characteristics cannot changed, several steps used routine present could valuable option Further studies wider sample size, defined criteria stratify AL, are required.