Modified four-quadrant enhanced coloanal anastomosis (fqeCAA) for patients receiving intersphincteric resection.

Abstract

e15620 Background: Intersphincteric resection (ISR) is a sphincter-preserving surgery for ultra-low rectal cancer (uLRC). The anastomosis techniques for ISR mainly includes immediate coloanal anastomosis (ICAA) and delayed coloanal anastomosis (DCAA), both approaches are related with high risks of anastomotic leakage (AL) and potential adverse effects on anal function. We propose the modified four-quadrant enhanced coloanal anastomosis (fqeCAA) technique, a modification of the hand-sewn coloanal anastomosis technique, to reduce tension at anastomotic site while attaching the new rectum to the anal by enhanced coloanal suture. The aim of the present study was to evaluate the safety of fqeCAA and its feasibility in reducing AL rate and exempting patients from protective stoma. Methods: uLRC patients underwent laparoscopic intersphincteric resection and fqeCAA between February 2024 and June 2024 were included. The simplified procedure for fqeCAA is as follows: 1) a four-quadrant discontinuous suture between the seromuscular layer of the colon and the external sphincter of the anus was performed to settle the bowel and reduce anastomotic tension; 2) the full-thick colon and the mucosal muscularis layer of the anal canal was sutured in a circle. Stoma was not routinely concepted after fqeCAA. Complication and postoperative anal function were estimated. Results: A total of 19 patients underwent intersphincteric resection and fqeCAA, including 15 (78.9%) male, 7 (36.8%) receiving neoradiochemotherapy, 4 (21.1%) receiving neochemotherapy, 7 (36.8%) ASA grade III. The median distance from tumor to anal edge was 3.6 [2.45-4.75] cm. All patients achieved R0 resection and finished fqeCAA procedure without stoma, with a median operation time of and 145 [120-155] and median blood loss 20 [10-50] ml. No intraoperative complications were observed. The mean distance from the anastomosis to the anal verge was 1.5 [1.0-2.0] cm. With a median follow-up of 8 mouths. Eight patients (42.1%) experienced perioperative complications, with only 1 (5.3%) patient requiring surgical intervention because of AL. The overall AL rate was 15.8% (3/19), among which only 1 need diversion stoma. The LARS score was 39 [36-41], while the Wexner score was 13 [10.5-14.5]. Conclusions: This single-center pilot study suggests that the fqeCAA technique is a safe procedure that allows selective patients to avoid temporary stoma formation. Long term anal function still need follow-up. Detail and treatment of complications. Complications Treatment of complications Neorectal prolapse Anal trimming Neorectal prolapse Anal trimming Anastomotic leakage（clinical） Diverting stoma Perianal infection Antibiotics, hip bath Anastomotic leakage（imageology） Antibiotics, hip bath uroschesis None Anastomotic leakage（ integrity of the anastomosis） Placing an anal draining tube Perianal infection Antibiotics, hip bath