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Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The aim of this study is to compare surgical, functional, physiologic outcomes and QOL after low anterior resection (LAR) with andside-to-end or straight colorectal anastomosis.

Method

Between 2012 and 2015, 86 patients with mid and low rectal tumors were enrolled into randomized trial. Wexner score, number of defecations, use of antidiarrheal medicine or laxatives, enemas, pads, episodes of nocturnal incontinence, and urgency were recorded. The Fecal Incontinence Quality of Life (FIQL) scale was used for assessment of QOL. Anal manometry and volumetric examination were performed.

Results

Six patients were excluded from the study. There was no mortality. The morbidity rate was 6 (14.6 %) for side-to-end vs. 8 (20.0 %) for straight anastomosis (p = 0.57). The median Wexner score was 5 vs. 6 (p = 0.033), 4 vs. 5 (p = 0.006), and 2 vs. 3 (p = 0.1) at 1, 3, and 6 months after stoma reversal, respectively. Side-to-end anastomosis resulted in a fewer mean numbers of bowel movements per day at the same check points of follow-up: 5.8 ± 0.14 vs. 6.4 ± 0.15 (p = 0.006), 3.7 ± 0.1 vs. 4.2 ± 0.1 (p = 0.003), and 2.5 ± 0.1 vs. 3.0 ± 0.10 (p = 0.0002), correspondingly. Maximal tolerated volume was higher for side-to-end anastomosis at 3 and 6 months of follow-up: 152.0 vs. 137.8 cm3 (p = 0.002) and 180.5 vs. 167.0 cm3 (p = 0.006), respectively. Better FIQL score was found at 1 and 3 months in the side-to-end group.

Conclusion

Better functional outcomes and QOL were observed in a short period after stoma closure, but at 6 months of follow-up, the only benefit of side-to-end anastomosis was a lower number of bowel movements.

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Authors and Affiliations

  1. Department of Oncoproctology, State Scientific Centre of Coloproctology, Saliama Adila 2, Moscow, Russia, 123423

    E. G. Rybakov, D. Yu Pikunov & S. V. Chernyshov

  2. Laboratory of clinical pathophysiology State Scientific Centre of Coloproctology, Moscow, Russia

    O. Yu Fomenko

  3. Director of State Scientific Centre of Coloproctology, Moscow, Russia

    Yu A. Shelygin

Authors
  1. E. G. Rybakov
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  2. D. Yu Pikunov
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  3. O. Yu Fomenko
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  4. S. V. Chernyshov
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  5. Yu A. Shelygin
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Corresponding author

Correspondence to E. G. Rybakov.

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Funding

It was institutional trial with no external funding. The State Scientific Center of Coloproctology registration number of the trial is #012/2012. All authors contributed to the design of the study, acquisition of data, analysis of results, and revised intellectual content of the manuscript.

Conflict of interest

The authors of the article have no financial or other conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were done in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Rybakov, E.G., Pikunov, D.Y., Fomenko, O.Y. et al. Side-to-end vs. straight stapled colorectal anastomosis after low anterior resection: results of randomized clinical trial. Int J Colorectal Dis 31, 1419–1426 (2016). https://doi.org/10.1007/s00384-016-2608-4

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  • DOI: https://doi.org/10.1007/s00384-016-2608-4

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