Omental Pedicle Graft to Protect Compromised Double-Stapled Anastomosis in Anterior Resection for Rectal Cancer

PURPOSE: The purpose of this study was to investigate the effects of omental pedicle graft (OPG) wrapping to limit leakage from compromised double-stapled anastomoses after anterior resection for rectal cancer. PATIENTS AND METHODS: Between 1994 and 1997, a prospective study was conducted on 80 consecutive patients who had undergone double-stapled anastomoses after anterior resection for rectal cancer. Decisions to perform OPG were made intraoperatively because of compromised doublestapled anastomoses. RESULTS: Twenty-one patients (26%) received OPG to protect anastomosis, the remainder of patients had no OPG. Ten of the 21 patients underwent OPG for stapler-related operative complications, 5 for rectal carcinoma with stenosis, 3 for obstructive colitis or diverticulitis in the sigmoid colon, and 6 for very low anterior resection with coloanal anastomosis after total mesorectal excision. Three of 21 patients had more than one indication for OPG. The two types of patients were comparable with respect to patient characteristics and operative procedures, although tumor diameter in the OPG patients was significantly larger than in the non-OPG patients. Anastomotic leakage was noted in 1 non-OPG patient (2%) but in none of the OPG patient. There were no statistically significant differences between the two types of patients with regard to postoperative course and anastomotic or other postoperative complications. CONCLUSION: We conclude that OPG wrapping provides an effective protection for a compromised anastomosis of anterior resection in selected patients with rectal cance