The outcome of primary anastomosis without diversion versus with diversion in colorectal cancer surgeries

Ahmed Sameh, Surgical oncology department, Oncology Center, Faculty of medicine, Mansoura UniversityFollow
Shams Nazem, Surgical oncology department, Oncology Center, Faculty of medicine, Mansoura University
Ahmed A Monem, Surgical oncology department, Oncology Center, Faculty of medicine, Mansoura University
Amr F Elalfy, Surgical oncology department, Oncology Center, Faculty of medicine, Mansoura University

Corresponding Author

Ahmed Sameh

Subject Area

General Surgery

Article Type

Original Study

Abstract

Background: Anastomotic leakage (AL) is the most feared complication after colorectal surgery. It is a very morbid consequence that is associated with higher morbidity, longer hospital stay, higher medical expenses, or even worse functional outcomes. The role of diverting ileostomy (DI) in reducing the incidence of anastomotic leakage is still debatable. Methods: Our study included 95 patients with left sided colon cancer and rectal cancer, 49 patients in the non-ileostomy group and 46 patients in the ileostomy group after resection anastomosis of the primary tumor. The analysis included the following variables: patient-related variables (age, sex, comorbid conditions, ASA score, smoking history, neo-adjuvant chemo-radiotherapy, body mass index (BMI), and serum albumin level), tumor-related variables (distance of the tumor from the anal verge (AV) and histopathologic grade), and surgery-related variables (laparoscopic or open surgery, handsewen or stapler anastomosis, blood loss, and operative time). Postoperative AL is assessed using clinical signs, laboratory tests and radiological assessment using CT scan and/or Ultrasound. Results: We found no difference in the incidence of AL between the 2 groups. In the non-ileostomy group, 3 cases had clinical AL versus 7 cases in patients with covering ileostomy (6.1% vs. 15.2%, p=0.149), but the clinical manifestations and complications were much more severe in patients without ileostomy, and re-intervention rate was higher in patients without ileostomy. Conclusion: Our results recommend the use of DI after identifying the risk factors highly associated with leakage. Although diverting ileostomy doesn't reduce the incidence of AL, it can mitigate the symptoms of leakage and lower the rate of reoperations.

Recommended Citation

Sameh, Ahmed; Nazem, Shams; Monem, Ahmed A; and Elalfy, Amr F (2026) "The outcome of primary anastomosis without diversion versus with diversion in colorectal cancer surgeries," Mansoura Medical Journal: Vol. 55 : Iss. 1 , Article 14.
Available at: https://doi.org/10.58775/2735-3990.1510

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