Anastomotic leakage is a clinically important complication following laparoscopic low anterior resection. A protective defunctioning ileostomy may reduce the clinical consequences of leakage but is associated with stoma-related morbidity, dehydration, readmission and the need for a subsequent closure procedure.
This prospective study will evaluate the safety and clinical utility of a standardized postoperative surveillance pathway based on serial serum C-reactive protein measurements and selective computed tomography in patients undergoing laparoscopic low anterior resection in whom routine protective ileostomy is considered potentially avoidable.
Serum C-reactive protein will be measured at predefined postoperative time points. Contrast-enhanced computed tomography, with rectal contrast when clinically appropriate, will be performed when patients meet predefined biochemical or clinical criteria. The study will evaluate successful avoidance of a defunctioning ileostomy, clinically relevant anastomotic leakage, diagnostic performance of serial C-reactive protein, use of computed tomography, time to diagnosis, postoperative morbidity, reoperation, hospital stay and readmission.
Inclusion Criteria:
Exclusion Criteria:
Participants will undergo laparoscopic low anterior resection without routine protective ileostomy when predefined safety criteria are satisfied. Participants will subsequently undergo serial C-reactive protein measurement and selective computed tomography according to the study protocol.
Participants will undergo laparoscopic low anterior resection with routine protective ileostomy when predefined safety criteria are satisfied.
Alexandria, Please Select 21111, Egypt
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