A 61-year-old man undergoes laparoscopic low anterior resection with total mesorectal excision for a mid-rectal cancer, with a coloanal anastomosis constructed 3 cm from the anal verge after neoadjuvant chemoradiotherapy. Which single manoeuvre has the best evidence for reducing clinically significant anastomotic leakage in this setting?

• A Defunctioning loop ileostomy ✓
• B Omental wrap around the anastomosis
• C Prolonged postoperative antibiotic prophylaxis
• D Routine pelvic drain placement for 10 days

Explanation

Randomised evidence, notably from the Dutch TME trial, shows that a defunctioning loop ileostomy significantly reduces clinically relevant anastomotic leakage and the need for reoperation after low rectal anastomoses, particularly those below about 6 cm in irradiated male pelvises. Omental wraps have not shown consistent benefit, prolonged antibiotics increase resistant infection without reducing leaks, and drains may help detect but not prevent leakage, with some data suggesting they delay recognition of sepsis.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.