Intervention
fistula
RECTAL CANCER
The main concept for management of leak and fistula is draining the leaked gastrointestinal content (decontamination) that can be achieved surgically or endoscopically. We start with general measures including: bowel rest, intravenous fluid when clinically indicated, antibiotic coverage, nutritional status improvement, drainage of any peritoneal collection by Interventional Radiology, and hemodynamic monitoring.Patients involved in EG were firstly subjected to Interventional Radiology to drain any intra-peritoneal collection diagnosed by preoperative radiology, then were subjected either to Clips application (OTSC, OVASCO Endoscopy AG. Tubingen, Germany) or Endo-suturing (Overstitch, Apollo Endo-Surgery, TX, United States) to close the low output fistula or leak after anterior resection for rectal cancer. After colonic preparation (chemical & mechanical preparation), the endoscopic procedure was performed under sedation (no general anesthesia) in order to detect the size of fistula. Clips were used in cases with fistula's size was less than 10 mm, while Endo-suturing devices were used in cases with fistula's size more than 10 mm and up to 15 mm.Patients involved in SG were subjected to either open redo of resection anastomosis manually, by a circular stapler or primary repair of the defect with ileostomy. This was performed under general anesthesia after colonic preparation. No patients underwent temporary ileostomy at time of primary surgery for rectal cancer.