# Transanal Intubation for Preventing Colorectal Anastomotic Failure

## TL;DR

This study compares transanal intubation and diverting stoma to prevent colorectal anastomotic failure, finding transanal intubation to be a promising alternative.

## Contribution

The study introduces transanal intubation as a potentially effective method for preventing anastomotic failure in colorectal surgery.

## Key findings

- Transanal intubation showed better borderline statistical significance in preventing anastomotic failure compared to diverting stoma.
- Anastomosis distance from the dentate line <60 mm was associated with a higher risk of anastomotic leakage.
- Diverting stoma is recommended for men due to lower anastomotic leakage risk in women.

## Abstract

Failure of low colorectal anastomosis remains challenging in surgical oncology, necessitating the exploration of new methods and improvements in existing preventive measures.

This prospective study was conducted in two stages: intraluminal pressure in the colon was monitored in 32 patients by manometry and sonography over a 5-day postoperative period; 213 patients who underwent anterior resection of the rectum were analyzed, of whom 126 and 87 underwent diverting stoma (DS) and transanal intubation (TAI), respectively.

The effectiveness of the recommended technique for applying and removing transanal intubation (TAI) to prevent pneumo hydro strike (≥15 kPa) on the anastomosis line was analyzed in 87 patients and compared with imposed DS. TAI showed better borderline statistical significance (p = 0.051). The incidence of repeat surgery for anastomotic failure (AL) was seven (5.55%) and four (4.59%) in the DS and TAI groups, respectively. The distance of the anastomosis from the dentate line <60 mm was associated with a higher risk of AL occurrence (odds ratio (OR), 1.012; 95% confidence interval (CI), 1.007–1.017; p < 0.001; area under the curve (AUC) = 0.82). DS is recommended for men, as the risk of AL is significantly lower among women (OR, 0.41; 95% CI, 0.16–1.04; p = 0.062; AUC, 0.61; 95% CI, 0.54–0.67).

Although TAI is advantageous over DS for preventing AL, surgeons select the method for the preventive approach based on the preoperative and intraoperative results.