Complete prevention of anastomotic leakage using total enteric flow diversion

doi:10.4240/wjgs.v17.i10.110017

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Oct 27, 2025 (publication date) through Oct 24, 2025

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Publication Name

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

Basic Study

World J Gastrointest Surg. Oct 27, 2025; 17(10): 110017
Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.110017

Complete prevention of anastomotic leakage using total enteric flow diversion

Tao Hu, Jing Wang, Nan-Hui Yu

Tao Hu, Jing Wang, Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China

Tao Hu, Department of Anesthesiology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410011, Hunan Province, China

Nan-Hui Yu, Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China

Co-first authors: Tao Hu and Jing Wang.

Author contributions: Hu T carried out sample collection, analysis, and data entry; Hu T and Wang J conducted animal anesthesia and other auxiliary procedures; Wang J and Yu NH drafted the main text, created the figures, and prepared the manuscript; Yu NH designed the study, prepared the research protocol, and performed the surgical operations. Hu T and Wang J contributed equally to this manuscript and are co-first authors. All the authors have read and approved the final manuscript.

Supported by the Fundamental Research Funds for the Central Universities of Central South University, No. 2024XQLH027.

Institutional animal care and use committee statement: All animal experiments were performed in compliance with the internationally accepted principles for the care and use of laboratory animals. The study was approved by the Institutional Animal Care and Use Committee of the Second Xiangya Hospital, Central South University [Laboratory Animal Use License No. SYXK (Xiang) 2021-0012; Approval No. 2021934].

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.

Data sharing statement: No additional data are available.

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: Nan-Hui Yu, PhD, Research Fellow, Department of Gastrointestinal Surgery, The Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Changsha 410011, Hunan Province, China. yunanhui@csu.edu.cn

Received: May 28, 2025
Revised: July 2, 2025
Accepted: August 13, 2025
Published online: October 27, 2025
Processing time: 149 Days and 10.7 Hours

Abstract

BACKGROUND

Colonic anastomotic leakage (AL) remains a feared complication of colorectal surgery. Usually, a defunctioning stoma or a proximal colostomy is performed to reduce the AL rate but cannot completely prevent AL. Moreover, defunctioning colostomy is associated with high morbidity. This study assessed the feasibility of completely preventing colonic AL using total enteric flow diversion without a defunctioning stoma in a pig model of colonic AL.

AIM

To determine the feasibility of preventing colonic AL via total enteric flow diversion in pigs.

METHODS

A total of 14 pigs underwent surgery to create colon anaesthesia with severe defects for establishing the AL model. The pigs were then randomized into the control group (n = 7), which received no further therapy, and a diversion group (n = 7), which underwent placement of a modified ileostomy tube to divert the enteric contents from the colon externally. The general condition, serum C-reactive protein level, white blood cell count, 5-day incidence of colon AL, and development of abdominal abscesses were evaluated.

RESULTS

A modified ileostomy tube with a balloon was placed and pressurized to 20 kPa at a distance of 10-20 cm proximal to the ileocecal valve, effectively obstructing the intestine without causing injury and efficiently diverting the enteric contents. In the diversion group, no cases of peritonitis or abscess were observed. In contrast, all pigs in the control group developed either abdominal abscesses or peritonitis.

CONCLUSION

Instead of ileostomy or colostomy, the total enteric flow diversion technique with the placement of a modified ileostomy tube and balloon in the ileum can effectively or completely prevent colon AL.

Keywords: Anastomotic leakage; Enteric flow diversion; Pig model; Modified ileostomy tube; Prevention strategy

Core Tip: This study evaluated a novel total enteric flow diversion technique using a modified ileostomy tube with balloon inflated to 20 kPa in a pig model of colonic anastomotic leakage (AL). Compared with the control group, the diversion group showed complete prevention of AL, no peritonitis or abscesses, and mild mucosal injury without necrosis. This technique may offer an effective alternative to traditional stomas for AL prevention.