Anastomotic leakage following anterior resection is still a major problem in colorectal surgery. Temporary colostomy is still the best way to deal with it, even if related high morbity and mortality are a concern. Recently Ravo and Ger have succesfully introduced in the clinical practice the use of intracolonic by-pass (IB), a new technique for preventing leakage after sigmoid-rectal surgery. Nineteen patients with a diagnosis of sigmoid-rectal cancer were randomized to be treated with anterior resection (AR) (10 subjects) or anterior resection plus IB (ARIB) (9 subjects). A soft latex tube was inserted in the ARIB patients after completing intestinal resection and was sutured to the wall of the proximal colon above the colorectal anastomosis. The aim of the operation is to bring feces down to the rectum through the tube lumen, thus preventing the fecal stream from contacting the site of anastomosis. Two patients died. One (AR group) because of myocardial infarction seven days after operation, the other one (ARIB group) because of pulmonary embolism nine day postoperatively. The tube was delivered through the anus between the 10th and 22nd postoperative day. No leakage was observed in ARIB group. Four clinical and 1 radiological leaks occurred in AR group. The difference was statistically significant for both radiological plus clinical (Fisher test: P = 0.02) and just clinical leak (P = 0.05). No mortality was observed in these complicated cases. One ARIB patient had a rectal hemorrhage after tube elimination but no further clinical problem. In conclusion, intracolonic by-pass seems to be a reliable technique for preventing anastomotic leakage after anterior resection, its main advantage being the possibility to achieve this purpose without performing further operations.
|Number of pages||7|
|Publication status||Published - 1988|
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