A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery

Background: This study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application. Methods: A retrospective analysis was conducted on 80 patients who underwent laparoscopic radical resection（LAR） for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into two groups: 26 in the ileum group (using terminal ileal stents) and 54 in the in situ group (using rectal in situ covered stents). Preoperative, surgical, and postoperative data were compared between the two groups. Results: No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage (3.8% vs 0%, p=0.325) or other complications (23.1% vs 20.4%, p=0.782). However, the ileum group had a significantly longer total hospital stay (21.5±6.2 vs 17.6±5.0 days, p=0.003), longer postoperative stay (14.5±3.3 vs 12.6±3.7 days, p=0.031), higher hospitalization costs (59085.88±7460.79 vs 48903.58±7094.14 yuan, p<0.001), and longer extubation time (27.0±3.0 vs 8.7±1.4 days, p<0.001) compared to the in situ group. Conclusions: Both fecal diversion methods show acceptable rates of postoperative anastomotic leakage. However, the in situ covered stent method demonstrates advantages in hospital stay, costs, and postoperative management, suggesting it should be favored in clinical practice.