대한대장항문학회

This is a retrospective clinical analysis of the usefulness of loop ileostomy for the<br>prevention of anastomotic leakage in patients with low rectal cancer when the low<br>anterior resection or coloanal anastomosis is performed. We reviewed 54 cases of low<br>rectal cancer from January 1994 to May 1996 at Department of Surgery, Wonju College<br>of Medicine, Yonsei University.<br>In 54 cases of low rectal cancer, 28 cases were ileostomy group and 17 cases were no<br>stoma group. There were no differences in clinical characteristics such as age and sex<br>distribution. Most patients were classified into stage B or C by modified Astler-Coiler<br>classification but 2 cases of stage D that simultaneous liver resection was performed<br>were in no stoma group. Tumor locations from the anal verge were 6.8 and 10.3 cm by<br>mean in ileostomy and no stomp group, respectively(P < 0.05). Heights of anastomosis<br>were 3.7 and 6.8 cm by mean from the anal verge in ileostomy and no stoma group,<br>respectively(P <0.05). Double stapling technique was used for anastomosis in most<br>patients but hand-sewn technique was also carried out in 1 case in ileostomy group.<br>The most common postoperative minor complication was wound infection in<br>both<br>groups. Anastomotic leakage rate was higher in no stoma group(4 of 17, 23.5%) than<br>that of ileostomy group (1 of 28, 3.6%) but statistical comparison could not be<br>confirmed(P=0.00). But interestingly, such complications as stoma perforation, stoma<br>prolapse and parastomal hernia were developed in ileostomy group and that all<br>complications should be corrected by ileostomy repair.<br>As forementioned above, we had concluded that ileostomy could protect anastomosis<br>site but above mentioned complications associated with building the stoma should be<br>also prevented by careful surgical technique.<br>