Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument

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Abstract
The need for protective transverse colostomy in low anterior resection using the EEA [end-to-end anastomosis] stapler was tested in a randomized series of 50 patients, half of whom received peroperative protective colostomy. Gastrografin [meglumine diatrizoate] enema on the 10th postoperative day showed a leakage frequency of 30% in both groups. Clinical leakage was noted in 4% (1 patient) in the colostomy group and 12% (3 patients) in the noncolostomy group. Protective colostomy was followed by stenosis in 9 instances, compared with only 2 in the noncolostomy group. Routine protective colostomy should not be used in low anterior resection when the EEA stapling instrument is used. The occasional clinical leakage, which may appear in the postoperative period, can be revealed by close observation and successfully treated by an emergency colostomy. The majority of patients with anterior resection of the rectum, therefore, can be spared the inconvenience and cost of temporary colostomy.