When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7. The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

中文翻译：

---

探索最佳检查以检测转移性造口患者直肠切除术后隐匿性吻合口漏。

在考虑“早期气孔闭合”时，标准化的纳入/排除标准和评估吻合的标准化方法对于降低隐匿性吻合口漏（AL）的风险都是必要的。但是，在术后即刻，既没有弄清转移性造口（DS）患者隐匿性AL的发生率和危险因素，也没有标准化评估吻合的方法。这项研究的目的是阐明行DS直肠切除术的隐匿性AL的发生率和危险因素，并评估水溶性造影剂灌肠（CE）后进行计算机断层扫描（CT）检测隐匿性吻合口漏的重要性。 。这是一项针对2019年5月至2019年10月间选择性使用DS的直肠切除患者的单一机构前瞻性观察性研究。15例患者在术后第7天（POD）接受了CE和CT检查以评估AL，并进行了CT在CE之后。进行单因素分析以评估术前变量与POD 7上隐匿性AL发生率之间的关系。术后7天的隐匿性AL发生率为15分之6（40％）。与缝合吻合术相比，手工缝合吻合术是重要的危险因素。CE后，CT可以发现另外5例CE无法检测到的隐匿性AL病例。仅CE一项就具有33％的假阴性放射结果率。手工缝制吻合术似乎是隐匿性AL的危险因素，仅CE就具有较高的假阴性放射结果率。考虑采用早期造口封闭术时，CE术后吻合钉吻合术和CT可能分别是合适的纳入标准和术前检查。