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Updated evidence of the effectiveness and safety of transanal drainage tube for the prevention of anastomotic leakage after rectal low anterior resection: a systematic review and meta-analysis.
Tamura, K; Uchino, M; Nomura, S; Shinji, S; Kouzu, K; Fujimoto, T; Nagayoshi, K; Mizuuchi, Y; Ohge, H; Haji, S; Shimizu, J; Mohri, Y; Yamashita, C; Kitagawa, Y; Suzuki, K; Kobayashi, M; Kobayashi, M; Yoshida, M; Mizuguchi, T; Mayumi, T; Kitagawa, Y; Nakamura, M.
Afiliación
  • Tamura K; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan. tamura.koji.589@m.kyushu-u.ac.jp.
  • Uchino M; Division of Inflammatory Bowel Disease, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan.
  • Nomura S; Department of Surgery, Hayamizu-Park Clinic, Miyazaki, Japan.
  • Shinji S; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
  • Kouzu K; Department of Surgery, National Defence Medical College, Saitama, Japan.
  • Fujimoto T; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
  • Nagayoshi K; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
  • Mizuuchi Y; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
  • Ohge H; Department of Infectious Disease, Hiroshima University Hospital, Hiroshima, Japan.
  • Haji S; Department of Surgery, Soseikai General Hospital, Kyoto, Japan.
  • Shimizu J; Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
  • Mohri Y; Department of Gastrointestinal Surgery, Mie Prefectural General Medical Center, Mie, Japan.
  • Yamashita C; Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Aichi, Japan.
  • Kitagawa Y; Department of Gastrointestinal Surgery, National Center for Geriatrics and Gerontology, Aichi, Japan.
  • Suzuki K; Department of Infectious Disease Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
  • Kobayashi M; Department of Anesthesiology, Hokushinkai Megumino Hospital, Hokkaido, Japan.
  • Kobayashi M; Department of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University, Kanagawa, Japan.
  • Yoshida M; Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan.
  • Mizuguchi T; Department of Nursing, Surgical Sciences, Sapporo Medical University, Hokkaido, Japan.
  • Mayumi T; Department of Intensive Care Unit, Japan Community Health Care Organization Chukyo Hospital, Aichi, Japan.
  • Kitagawa Y; School of Medicine, Keio University, Tokyo, Japan.
  • Nakamura M; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan. nakamura.masafumi.861@m.kyushu-u.ac.jp.
Tech Coloproctol ; 28(1): 71, 2024 Jun 25.
Article en En | MEDLINE | ID: mdl-38916755
ABSTRACT
BACKGROUNDS Anastomotic leakage (AL) represents a major complication after rectal low anterior resection (LAR). Transanal drainage tube (TDT) placement offers a potential strategy for AL prevention; however, its efficacy and safety remain contentious.

METHODS:

A systematic review and meta-analysis were used to evaluate the influence of TDT subsequent to LAR as part of the revision of the surgical site infection prevention guidelines of the Japanese Society of Surgical Infectious Diseases (PROSPERO registration; CRD42023476655). We searched each database, and included randomized controlled trials (RCTs) and observational studies (OBSs) comparing TDT and non-TDT outcomes. The main outcome was AL. Data were independently extracted by three authors and random-effects models were implemented.

RESULTS:

A total of three RCTs and 18 OBSs were included. RCTs reported no significant difference in AL rate between the TDT and non-TDT groups [relative risk (RR) 0.69, 95% confidence interval (CI) 0.42-1.15]. OBSs reported that TDT reduced AL risk [odds ratio (OR) 0.45, 95% CI 0.31-0.64]. In the subgroup excluding diverting stoma (DS), TDT significantly lowered the AL rate in RCTs (RR 0.57, 95% CI 0.33-0.99) and OBSs (OR 0.41, 95% CI 0.27-0.62). Reoperation rates were significantly lower in the TDT without DS groups in both RCTs (RR 0.26, 95% CI 0.07-0.94) and OBSs (OR 0.40, 95% CI 0.24-0.66). TDT groups exhibited a higher anastomotic bleeding rate only in RCTs (RR 4.28, 95% CI 2.14-8.54), while shorter hospital stays were observed in RCTs [standard mean difference (SMD) -0.44, 95% CI -0.65 to -0.23] and OBSs (SMD -0.54, 95% CI -0.97 to -0.11) compared with the non-TDT group.

CONCLUSIONS:

A universal TDT placement cannot be recommended for all rectal LAR patients. Some patients may benefit from TDT, such as patients without DS creation. Further investigation is necessary to identify the specific beneficiaries.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Canal Anal / Recto / Ensayos Clínicos Controlados Aleatorios como Asunto / Drenaje / Fuga Anastomótica / Proctectomía Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Tech Coloproctol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Italia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Canal Anal / Recto / Ensayos Clínicos Controlados Aleatorios como Asunto / Drenaje / Fuga Anastomótica / Proctectomía Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Tech Coloproctol Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Japón Pais de publicación: Italia