DataSheet_1_Trans-Anastomotic Drainage Tube Placement After Hand-Sewn Anastomosis in Patients Undergoing Intersphincteric Resection for Low Rectal Cancer: An Alternative Drainage Method.docx

Anastomotic leakage (AL) is a common complication after intersphincteric resection (ISR). It significantly reduces quality of life and causes great distress to patients. Although traditional drainage (e.g., anal and pelvic catheters) may reduce the impact of AL to some extent, their role in reducing the incidence of AL remains controversial. In this study, we developed a novel drainage technique involving the placement of drainage tubes through the gap between sutures during handsewn anastomosis, to reduce the occurrence of anastomotic leakage. We retrospectively analyzed 34 consecutive patients who underwent intersphincteric resection requiring handsewn anastomosis between February 1, 2017, and January 1, 2021. Patients were classified into the trans-anastomotic drainage tube group (TADT, n = 14) and the non-TADT group (n = 20) based on whether trans-anastomotic tube placement was performed. The incidence of postoperative complications, such as AL, was compared between the two groups, and anal function of patients at 1-year post-ISR was evaluated. Six cases of AL occurred in the non-TADT group, while none occurred in the TADT group; this difference was statistically significant (p=0.031). The TADT group also had a shorter hospital stay (p=0.007). There were no other significant intergroup differences in operation time, blood loss, pain score, anastomotic stenosis, intestinal obstruction, or incidence of wound infection. In the 30 patients (88.2%) evaluated for anal function, there were no significant intergroup differences in stool frequency, urgency, daytime/nocturnal soiling, Wexner incontinence score, or Kirwan grading. Taken together, trans-anastomotic tube placement is a novel drainage method that may reduce AL after ISR requiring handsewn anastomosis and without adversely affecting anal function.

吻合口漏（AL）是肛门括约肌切除术（ISR）后常见的并发症，它显著降低了患者的生活质量，并给患者带来了极大的痛苦。尽管传统引流方法（如肛门和盆腔导管）在一定程度上可以减轻吻合口漏的影响，但其对降低吻合口漏发生率的作用仍存在争议。在本研究中，我们开发了一种新颖的引流技术，即在手工缝合吻合口时，通过缝合线之间的间隙放置引流管，以减少吻合口漏的发生。我们对2017年2月1日至2021年1月1日期间接受ISR手术且需要手工缝合吻合的34名连续患者进行了回顾性分析。根据是否进行经吻合口引流管放置，患者被分为经吻合口引流管组（TADT，n=14）和非TADT组（n=20）。比较了两组术后并发症（如吻合口漏）的发生率，并评估了ISR后1年患者的肛门功能。非TADT组发生吻合口漏6例，而TADT组未发生吻合口漏；这种差异具有统计学意义（p=0.031）。TADT组的住院时间也较短（p=0.007）。两组在手术时间、出血量、疼痛评分、吻合口狭窄、肠梗阻或伤口感染发生率方面没有其他显著的组间差异。在评价肛门功能的30名患者（88.2%）中，两组在排便频率、急迫感、白天/夜间污染、Wexner失禁评分或Kirwan分级方面没有显著的组间差异。综上所述，经吻合口引流管放置是一种新颖的引流方法，可能减少ISR后需要手工缝合吻合的患者发生吻合口漏，且不会对肛门功能产生不利影响。