Intraluminal bypass tube across colorectal anastomosis: An alternative to stomas

Introduction: Colorectal anastomotic leakage is a serious complication of colorectal surgery with high morbidity and mortality rates. Anastomotic leakage accounts for prolonged hospital stay and compromised postoperative quality of life, with aided psychological and economical burden to one's life. Currently, the most commonly used method to prevent leakage is by diversion ileostomy procedure, which has its own complications and morbidities. In recent decades, various studies that aimed at lowering the incidence of anastomotic leakage have been tried including the use of intraluminal bypass tube. In our study, we have introduced an intraluminal bypass tube through the anal canal reaching upto the proximal colon across the anastomotic site.The distal end of the tube was fixed with perianal skin to prevent the dislodging of the tube, thereby reducing intraluminal pressure as flatus follows the path of least resistance. Furthermore, it helps to prevent gush of the fecal stream coming in contact with the anastomotic site to some extent. Thus, we found this method as potentially simple and effective in reducing anastomotic leakage. Background: Currently, the only clinically valid method to prevent morbidity and mortality related to colorectal anastomotic leak (AL) is by construction of protecting ileostomy. The intraluminal bypass tube might also be a possible way to protect the anastomosis. Aims: The study aims to evaluate the usage of intraluminal bypass tube for the reduction of anastomosis-related morbidity and stoma creation in colorectal surgeries. Design: This was a prospective and observational study. Materials and Methods: The present study was conducted between January 2019 and December 2019. Twenty patients who underwent colorectal surgeries were studied. After completion of anastomosis, the latex tube was implanted and removed after 5 ± 1 days. Patients were followed for 10 days. Information about adverse events, ALs, and tolerance was collected. Results: In our study, there were twenty patients who underwent colorectal surgery and most of them were operated on due to colorectal malignancy 16 (80%). The postoperative period was uneventful. No anastomotic complications (hematoma, stricture, or abscess) or any adverse effects of the tube (ulceration of colon) were observed. Moreover, patients were discharged after 11–16 days of the surgery. Conclusions: Intraluminal bypass tube may provide a safe alternative for fecal diversion over a newly created anastomosis without the complications related to stoma creation and closure. However, larger randomized prospective studies should be performed in the future to confirm these findings.