Quantitative Assessment of Rectal Washout With Irrigation and Aspiration

Abstract

Local recurrence of rectal cancer is defined as any evidence of relapse within the small pelvis after surgical resection of the primary tumor. After removal of a rectal tumor, necrotic cellular debris and viable exfoliated cancer cells are present in the rectal lumen; using saline or povidone-iodine solution, many surgeons perform rectal washout beyond an occlusive clamp to remove these exfoliated malignant cells, which may lead to local recurrence. A meta-analysis showed that intraoperative rectal washout at the surgical anastomosis site can reduce the risk of local recurrence after rectal cancer resection. Therefore, intraluminal lavage is useful to prevent local recurrence. Although intraoperative rectal washing is considered to be important, there is probably room for improvement on this method. We described the idea of a new transanal irrigation and aspiration system for small rectal contents. The aim of this research was to investigate the effect of a new rectal washout system using a chemiluminescent imaging system. We attempted to evaluate and compare the washout efficiency between this new system and the conventional irrigation system using a cylindrical rectum model. Our results implied that, at the same volume of solution, the irrigation–aspiration rectal washout system was more effective than the irrigation washout system. This new rectal washout system was easy to use and allowed a good washout. To the best of our knowledge, this was the first report that evaluated the efficacy of a rectal washout system using quantitative data.