Abstract:
Introduction: Anastomotic leak is a feared complication of rectal surgery, causing considerable morbidity and mortality. Despite much research, the pathophysiology of this complication is not completely understood. Strategies to prevent anastomotic leaks are controversial and do not have routine uptake. Methods: A systemic review and meta-analysis of the literature was performed in regards to designs of trans-anal tubes. A feasibility study was conducted on a novel trans-anal tube which had been specifically designed to optimise faecal drainage. Feasibility studies were conducted using a fibreoptic manometer and then a modified intravaginal manometer combined onto a trans-anal tube to assess the role that intraluminal pressure has on anastomotic leak. Results: The systemic review and meta-analysis found that catheter type trans-anal tubes outperformed designed for purpose stent-type trans-anal tubes. The novel trans-anal tube design was found to be safe and feasible for use in human subjects. The high-resolution fibreoptic manometer combined with a trans-anal tube suffered a technical failure. Initial studies using an modified intra-vaginal manometer attached to a trans-anal tube proved to be safe in patients and provided reliable data. The data retrieved from these studies suggests that the pressure in the rectum is low following rectal resectional surgery and that trans-anal tubes may reduce this pressure. Conclusions: The novel transanal tube was feasible for human use and now requires testing to assess its efficacy. Potentially this device could replace the need to defunctioning stomas. Combining a fibre-optic manometry catheter with a trans-anal tube was not feasible. Combining a modified intra-vaginal manometer with a trans-anal tube is feasible and will be the basis of further study.