Clinical using of innovative Biodegradable Stent with Extension Sleeve in TaTME for Low Rectal Cancer with high risk of anastomotic leakage

Abstract Objective: The objective of this paper is to observe and evaluate the safety and feasibility of using a degradable colorectal endoluminal stent with extension sleeve(DCESES) in patients at high risk of anastomotic leakage following low anterior resection (LAR) for rectal cancer using the transanal total mesorectal excision (Ta_tme) technique. Methods: Six patients with low rectal cancer undergoing Ta_tme surgery and identified as high risk for anastomotic leakage were selected. During surgery, the tumor was mobilized transanally and excised outside the anus. A suitable biodegradable stent was chosen and connected to a sterile extension sleeve. The stent was fixed with absorbable sutures 5 cm proximal to the intestinal cut end. Anastomosis was then completed at the anus, and the extension sleeve was pulled through the anus to externalize, diverting fecal matter and preventing contact with the anastomotic site. None of the six patients underwent a prophylactic ileostomy. Results: All six patients successfully underwent Ta_tme surgery with the implantation of the biodegradable colorectal endoluminal stent with an extension sleeve. Within 3-4 weeks postoperatively, the stent disintegrated into fragments and was expelled through the anus along with the plastic sleeve. All patients experienced no significant perianal discomfort, anastomotic leakage, anastomotic stricture, or other complications during the perioperative period. Conclusion: Fecal diversion using a biodegradable stent with an extension sleeve in high-risk patients for anastomotic leakage following Ta_tme is safe and feasible. This approach effectively prevents complications such as anastomotic leakage and stricture during Ta_tme, avoiding the need for prophylactic ileostomy and its associated complications, thereby reducing patient suffering, saving medical resources, lowering medical costs, and improving patient quality of life.