Comparison of incidence of anastomotic leak & low anterior resection syndrome between end & side to end colorectal anastomosis after low anterior resection for Rectal cancer

Author(s): Haque AA, Ovi MRA, Jalal MT

Introduction: Functional disturbances and anastomotic leakage are common consequences of end-to-end colorectal anastomosis (EEA) following low anterior resection for low rectal cancer. To overcome this, a side-to-end colorectal anastomosis (SEA) has been advocated in low colorectal and coloanal anastomosis.
Aim of the study: The aim of the study was to compare the incidence of anastomotic leakage and functional disturbances (Low Anterior Resection Syndrome) after side-to-end and end to end anastomosis in low anterior resection for low rectal cancer.
Methods: This prospective observational study was conducted in the Department of Colorectal Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March 2023 to November 2023. A total of 44 patients were selected. Equal halves were randomly assigned to side-to-end (Group B) or end-to-end (Group A) group preoperatively. In our study sample selection was carried out using purposive sampling, with participants chosen based on specific criteria relevant to the research objectives. Anastomotic integrity was checked by DRE & functional outcome was evaluated by LARS score at the 14th POD, 1st, 3rd, and 6th postoperative month. Participants were selected following inclusion and exclusion criteria. Data were collected and analyzed on SPSS (statistical package and subjected to Students version-25).
Result: Functional outcome measured by LARS score was compared between Group B and Group A. According to LARS score the groups were divided into: Major LARS was 5(39%) in Group B vs 8(61%) in Group A (p<0.05), Minor LARS was 10(48%) in Group B vs 11(52%) in Group A(p<0.05), No LARS was 5(50%) in Group B vs 5(50%) in Group A(p<0.05). Anastomotic integrity was checked by DRE and assigned 'no leak', 'partial leak', and 'complete leak'. 3(13%) patients in Group A &1(5%) patient in Group B had partial anastomotic disruption(p<0.05).
Conclusion: Side-to-end (Group B) colorectal anastomosis provides a simple, alternative way for reconstruction with better short-term functional outcomes compared to end-to-end (Group A) anastomosis after low anterior resection. Although the side-to-end anastomosis provides a reservoir, the construction requires additional technical steps with an added staple line, additional length, and expense & is difficult to fit into a narrow pelvis.

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