Application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer        ZHANG Qing-tong*, LIU Ya-li, WANG Yong-peng, et al. *Department of Large-intestine Surgery, Liaoning Province Cancer Hospital, Shenyang 110042, China
Corresponding author: SONG Chun, E-mail: csong882002@yahoo.com.cn
Abstract    Objective    To study the feasibilitiy of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer. Methods    The clinical data of 65 cases of preventive ileum fungating double-cavity fistulation after laproscopic TME and 85 cases not performed fistulation in the same period between April 2006 and March 2010 in Department of Large-intestine Surgery, Liaoning Province Cancer Hospital were analyzed retrospectively. For fistulation group, the surgical method was as following: after finished lower/ ultra lower anastomosis, made ileum fungating double-cavity fistulation with the ileum 30-40 cm to ileocecus on the place of the external 1/3 line from umbilicus to the right anterior superior spine in fistulation group; made vertical incision of 1/2 circle of ileum along with the vertical axis, and made fungi nipple higher than 0.5 cm of skin on proximal ileum, and sutured distal ileum to skin flat; put dual-drainage tube to the anterior sacrum for 3-5 months after operation, then closed the fistula. For non-fistulation group, dual-drainage tube was put to the anterior sacrum only. Results    In fistulation group, feces diverted thoroughly; all the cases had no skin serious corrosion and intolerance surrounding fistula; neither deaths nor anastomotic leakage occurred. In non-fistulation group, 5 cases appeared anastomotic leakage. Among them, 3 cases healed after 4 to 8 weeks and 2 cases were performed colostomy. No death occurred. Conclusion The application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer is feasible with convenient ostomy care, small trauma of closing fistula and thorough feces diversion .