588 Can the Heald Anal Stent Help to Reduce Anastomotic or Rectal Stump Leak in Elective and Emergency Colorectal Surgery? a Case Series
M Jones, J Bunni, B Moran, B Heald- Surgery
Abstract
Aim
Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies report favourable outcomes for trans-anal drainage devices instead of a diverting stoma. Our aim was to analyse the outcome of a “Heald anal stent” in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery.
Method
This was a single centre retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for both benign and malignant pathology. Intra and post-operative outcomes were checked using clinical and radiological records.
Results
The Heald anal stent was used in 93 patients over 4 years. 46 (49%) cases had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. There were 56 (60%) elective and 37 (40%) emergency cases. In 54 (60%) patients the pathology was benign, and 39 (42%) had malignancy. High anterior resections and Hartmann’s procedures were the most common operations in which the stent was used, comprising 22 (24%) and 20 (22%) of the total. There were no anastomotic or rectal stump leaks.
Conclusions
The Heald anal stent is a simple and affordable adjunct in decreasing anastomotic and rectal stump leak, by reducing intraluminal pressure through facilitating drainage of fluid and gas. We recommend the stent in operations involving colorectal anastomoses and in patients with a residual rectal stump.