Clinical Application Of Intracolonic Bypass Procedure For Protection Of The Low Rectal Anastomosis

Purpose: To assess the feasibility and safety of the Valtrac^TM-secured intracolonic bypass (VIB) in protecting the low rectal anastomosis, and to compare the efficacy and complications of VIB with those of loop ileostomy (LI).Methods: From January 2002 to April 2006, 44 patients with rectal cancer who underwent low anterior resection received VIB. Another 39 patients in the same period who underwent low anterior resection received LI. The demographics, clinical features, complication and operative data of two groups were analyzed and compared.Results: The demographics and clinical features of 2 groups were similar. There were 2 cases in Group VIB and 2 in Group LI presented anastomotic dehiscence without any clinical manifestation. Longer postoperative hospital stay (21. 3 ± 5. 8d) and higher cost incurred (25. 0±7. 2thousand yuan) were observed in Group LI than those (12. 5 ± 6. 3d, 35. 1±9. 3thousand yuan) in Group VIB(P<0.05). Earlier time of the first flatus and oral intake(77.2 ± 4.6h, 81.2 ± 5.6h) were observed in Group LI than those(97.2±8.6h, 108.2 ± 7.6h) in Group VIB (P<0.05). The stoma related complications included dermatitis(12.8%), stoma bleeding(2.6%) and intestinal obstruction after stoma closure(5.1%). None of VIB related complication occurred except forBAR discharging disturbance in 2 cases (4.5%).Conclusions: The VIB procedure is an established safe, feasible technique in protecting the low colorectal anastomosis, which can avoid the serious consequences of leakage. Compared with LI, VIB can avoid the stoma related complication and readmission for closure, it is also with advantages in postoperative hospital stay and cost.