Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports.

BACKGROUND

Anastomotic leakage (AL) is a serious and challenging complication following low anterior resection (LAR) for low rectal cancer. This case series presents the successful management of AL in three patients using a combined approach of transanal opening of the intersphincteric space (TROPIS) surgery and adjuvant Kangfuxin liquid enema therapy.

CASE SUMMARY: Three male patients underwent laparoscopic LAR with diverting ileostomy for low rectal cancer. Case 1: A 39-year-old, presented with fever and abdominal distension 2 weeks after discharge. A digital rectal examination revealed partial anastomotic separation. Case 2: A 74-year-old, developed abdominal pain and fever on postoperative day 5, with fecal discharge through the pelvic drain, and computed tomography scan confirmed AL. Case 3: A 51-year-old, was asymptomatic but diagnosed with AL 1 week after discharge; despite 1 year of conservative management, the leakage failed to heal. All three patients were subsequently treated with TROPIS surgery combined with twice-daily Kangfuxin liquid enemas, resulting in complete resolution of AL in each case.

CONCLUSION

The combination of TROPIS and Kangfuxin enema appears to be a safe and effective approach for managing AL following LAR. This minimally invasive strategy offers a promising alternative to conventional surgical interventions. Further studies with larger cohorts are warranted to validate these findings.