Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision

Low anterior resection with total mesorectal excision for rectal carcinoma is associated with a high anastomotic leakage rate, and the effectivenesss of a defunctioning stoma in preventing anastomotic leakage remains controve rsial, In this study a policy of selective defunctioning stoma for stapled colorectal anastomosis after low anterior resection with total mesorectal e xcision in 148 consecutive patients was evaluated prospectively. A defuncti oning stoma was performed in 61 patients (41%) considered at high risk of a nastomotic leakage. Clinical leakage occurred in 2 patients (3.3%) with a s toma and 11 patients (12.6%) without a stoma (p = 0.047). Among those witho ut a stoma, the Leakage rate among male patients (20.9%) was significantly higher than that for female patients (4.5%) (p = 0.022). Leakage subsided w ith conservative treatment in the two patients with a stoma, but seven pati ents without a stoma developed peritonitis requiring laparotomy. No deaths resulted from leakage, and there was one hospital death (0.6%) in the whole group. Median hospital stay was similar with and without a stoma (13.0 vs. 12.0 days) (p = 0.290). Closure of the stoma was associated with no mortal ity, a morbidity rate of 8.7%, and a median hospital stay of 6.0 days. In c onclusion, a defunctioning stoma is effective in preventing clinical anasto motic leakage after low anterior resection with total mesorectal excision. The relatively high incidence of leakage in the low risk group indicates th e difficulty of predicting anastomotic leakage and hence the need for more liberal use of a defunctioning stoma especially in male patients.