WAYS TO PREVENTE PURULENT-INFLAMMATORY COMPLICATIONS AFTER LAPAROSCOPIC ANTERIOR LOW RESECTIONS FOR RECTAL CANCER

Abstract

Purpose of the work: to develop surgical tactics for prevention of purulent-septic complications in the area of colorectal anastomosis based on the analysis of immediate results of laparoscopic anterior low and ultra-low rectal resections. Material and methods: the results of surgical treatment of 8 patients who underwent laparoscopic anterior rectal resection with low and ultra-low formation of colorectal anastomosis were analyzed. There were 5 mens (62.5%), 3 women (37.5%). The average age of patients was 62 years (37-76 years). Stage III rectal cancer was established in 5 (62.5%) patients, stage II – in 2 (25%) and stage I – in 1 (12.5%). Rectal cancer localization: lower ampullary region – 1 (12.5%), middle ampullary region – 3 (37.5%), upper ampullary region – 2 (25%), rectosigmoid region – 2 (25%). Histomorphological picture of the macropreparation: adenocarcinoma of varying degrees of differentiation. Results and discussion: all patients were discharged from the hospital without fatal outcomes. The average duration of hospitalstay was 12 bed-days (10-17 days). In 3 patients (37.5%), colorectal anastomosis suture failure developed on days 3-5 of the postoperative period. Two patients were re-operated (1 – laparotomy,
colostomy, 1 – laparotomy, extraperitonization and extraperitoneal drainage of the anastomosis area). Conclusions: surgical treatment of operable rectal cancer is preferably performed laparoscopically. The incidence of colorectal anastomosis failure increases with low tumor localization. The methodology of laparoscopic anterior rectal resection suggests performing the following stages of the operation: application of a preventive colostomy, extraperitonization of the colorectal anastomosis by suturing the pelvic peritoneum, drainage of the anastomosis zone with an extraperitoneal drainage in the left iliac region.