Li H, Huang HB, Xiang T, Yang L, Furnée EJB, Sun G, Chen WB. Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports. World J Gastrointest Surg 2025; 17(10): 109920 [PMID: 41178890 DOI: 10.4240/wjgs.v17.i10.109920]
Corresponding Author of This Article
Wen-Bin Chen, MD, Director, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wenbinchen@zju.edu.cn
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Surgery
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Nov 17, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li H, Huang HB, Xiang T, Yang L, Furnée EJB, Sun G, Chen WB. Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports. World J Gastrointest Surg 2025; 17(10): 109920 [PMID: 41178890 DOI: 10.4240/wjgs.v17.i10.109920]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 109920 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.109920
Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports
Hui Li, Hai-Bin Huang, Tao Xiang, Lu Yang, Edgar J B Furnée, Ge Sun, Wen-Bin Chen
Hui Li, Surgical Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Hai-Bin Huang, Department of General Surgery, The First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Tao Xiang, Lu Yang, Ge Sun, Wen-Bin Chen, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Edgar J B Furnée, Department of Abdominal Surgery, University Medical Center Groningen, Groningen 9713 GZ, Netherlands
Author contributions: Li H, Huang H, Xiang T, and Yang L collected the clinical data; Li H, Huang H, Xiang T, Yang L, and Sun G analyzed the data and drafted the manuscript; Xiang T, Sun G, and Chen WB contributed to study design; Furnée EJB, Sun G, and Chen WB provided critical revisions and intellectual input during manuscript preparation; and all authors thoroughly reviewed and endorsed the final manuscript.
Informed consent statement: The patients provided written informed consent prior to the surgical procedure and agreed to participate in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Bin Chen, MD, Director, Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wenbinchen@zju.edu.cn
Received: May 26, 2025 Revised: June 29, 2025 Accepted: September 4, 2025 Published online: October 27, 2025 Processing time: 151 Days and 23.9 Hours
Abstract
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.
Core Tip: This case series presents a novel, minimally invasive strategy for managing anastomotic leakage following low anterior resection for rectal cancer. By combining the transanal opening of the intersphincteric space technique with Kangfuxin liquid enemas, all three patients achieved complete healing with preserved anal function. This approach specifically targets leaks confined to the intersphincteric space and may serve as an effective adjunct to conventional protective measures, potentially enhancing patient outcomes and accelerating recovery.
