Comparative effectiveness research between application of double-cannula anal canal and prophylactic ostomy of abdominal wall in reconstruction of low rectal anastomosis
Objective To investigate the application potential of the double-cannula anal canal in the reconstruction of the low rectal anastomosis and its feasibility as an alternative to the prophylactic ostomy of the abdominal wall.Methods Clinical data of patients with rectal cancer or presacral cyst admitted to the Affiliated Cancer Hospital of Zheng-zhou University and the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.All 138 patients underwent low rectal anastomosis reconstruction and were divided into two groups according to whether they had an intraop-erative abdominal wall prophylactic ostomy.Among them,63 patients underwent proximal intestinal prophylactic ostomy as the prophylactic ostomy group,while 75 patients did not receive proximal intestinal prophylactic ostomy and indwelled double-cannula anal canal as the double-cannula anal canal group.The incidence of postoperative anastomotic leakage,the incidence of peritonitis,and the anal pain scores of the two groups were analyzed.Results There were 63 cases in the stoma group,12 cases of anastomotic leakage;75 cases in the double anal tube group,8 cases of anastomotic leakage,the percentage of anastomotic leakage in the two groups were 19.05％(12/63),10.67％(8/75),respectively,and there was no statistical difference between the two groups(x2=1.941,P=0.164).Patients with anastomotic leakage that occurred in both groups were not at high risk for pelvic infection and peritonitis after placement of anal canal irrigation.The perianal pain scores of patients in the stoma group on postoperative days 1,3,and 5 were(3.08±1.48,2.94±2.36,and 1.82±2.21),respectively.The perianal pain score of patients in the double anal canal group with placement of anal canal was(3.37±1.31,5.31±2.34,7.35±1.91)on postoperative day 1,3 and 5 respectively.There was no statistically significant comparison between the two groups of pain scores on day 1(day 1,t=1.234,P=0.219);there was a statistically significant comparison between the two groups of pain scores on day 3 and day 5(day 3,t=5.907,P＜0.0001;day 5,t=15.75,P＜0.001).Conclusion The placement of double-cannula anal canal for irrigation and drainage can replace the preventive effect of proximal intestinal prophylactic ostomy,but it is only suitable for some pa-tients with simple low anastomosis reconstruction and increase pain of the perineum.
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