Abstract:

Objective: In laparoscopic distal colon surgery, diverting ileostomy is often used to improve the anastomosis leakage and eliminate the need for secondary surgery. However, complications related to the stoma and its closure have led to new searches. The rectal tube has started to be used as another method to reduce the anastomosis leakage by reducing intestinal pressure and providing drainage. In this study, we aimed to compare the effect of the rectal tube and diverting ileostomy on the outcomes of patients who underwent laparoscopic pelvic subperitoneal surgery. Methods: Retrospective information was obtained from 66 patients who underwent laparoscopic pelvic subperitoneal surgery in our clinic between 2013 and 2019. The patients were evaluated in two groups: ileostomy and rectal tube. Demographic data, operation findings, pathological results, and follow-up information were evaluated. Results: Fourty-one of 66 patients who underwent colorectal pelvic peritoneal surgery were in the rectal tube group and 25 were in the ileostomy group. The majority of the patients in the ileostomy group were males (22-88% vs 23-56%, p=0.007); however, there was no difference between the two groups in terms of age, body mass index, comorbidity, and the previous abdominal operation. In the rectal tube group, the number of patients who were diagnosed as having rectal tumors and consequently underwent low anterior resection was higher. In the ileostomy group, the operation time was longer (476±130 vs. 341±114 mins, p=0.0001) and amount of peroperative bleeding was higher (261±260 vs 128±98 mL, p=0.02). Intraoperative and postoperative complications of the patients were similar in both groups. The pain scale on the postoperative second day was lower in the rectal tube group (2.8±1.5 vs. 4.7±2.9, p=0.008). Although the pain scales on day 1 and day 3 were lower in the rectal tube group, there was no statistically significant difference between the two groups. The oncological results were similar during the average follow-up period of 28.3±18.5 months. The cosmetic scores of the patients were better in the rectal tube group (9.3±0.9 vs. 7.2±1.9, p=0.001). Conclusion: In laparoscopic pelvic subperitoneal colorectal surgeries; it has been observed that the results of the rectal tube are not worse than ileostomy, it can be preferred in appropriate cases and reduce stoma-related problems.

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