Abstract
Two hundred non-randomized left-sided colon and colorectal anastomoses were performed on 199 consecutive patients admitted over a 4-year period (107 men and 92 woman with a median age of 66 years). There were 117 high anastomoses (above the peritoneal reflection), 86 (74%) of which were hand sewn, and 83 low anastomoses, 78 (94%) stapled with an EEA instrument. Adequate blood supply was assessed with a Doppler ultrasound in all but 5 cases. In ten patients bowel edges to be anastomosed were recut because of a negative Doppler ultrasound reading. One hundred and eighty-nine anastomoses were radiologically controlled. In-hospital post-operative mortality was 2.5% and morbidity 20%. There were two (1%) clinical anastomotic leaks and three (1.5%) radiological leaks. Use of Doppler ultrasound is simple and safe to assess vascularization of the intestinal edges. It may have contributed to the low anastomotic complication rate observed in this series.
Résumé
Deux-cents anastomoses coliques gauches ou colo-rectales non randomisées ont été faites consécutivement chez 199 patients pendant une période de 4 ans (107 hommes et 92 femmes d'un âge médian de 66 ans). Cent dix-sept anastomoses étaient de localisation baute (au-dessus de la réflexion péritonéale) dont 86 (74%) ont été faites à la main et 83 anastomoses furent de localisation basse (au-dessous de la réflexion péritonéale) avec 78 (94%) faites à l'agrafeuse EEA. La qualité de la vascularisation des tranches à anastomoser fut confirmée dans tous les cas sauf 5 par l'ultrason Doppler. Dans 10 cas, nous avons procédé à une recoupe colique en raison de la négativité de l'ultrason Doppler. Cent quatre-vingt-neuf anastomoses furent contrôlées radiologiquement. La mortalité postopératoire hospitalière est de 2,5% et la morbidité de 20%. Nous relevons 2 fuites anastomotiques cliniques (1%) et 3 radiologiques (1,5%). L'utilisation de l'ultrason Doppler est simple et fiable pour confirmer la bonne qualité de la vascularisation. Elle peut probablement expliquer l'incidence réduite de complications anasromotiques observées dans cette série.
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References
Goligher JC, Graham NG, De Dombal FT (1970) Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 57:109–118
Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL (1988) Treatment of anastomotic leakage following low anterior colon resection. Arch Surg 123:968–971
Akyol AM, McGregor JR, Galloway DJ, Murray GD, George WD (1991) Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? J Colorect Dis 6:179–183
Tinker JH, Roberts SL (1986) Anesthesia risk. In: Miller RD (ed) Anesthesia, 2nd ed. Churchill Livingstone, New York pp 365–377
Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60:461–464
Morgenstern L, Yamakawa T, Ben-Shoshan M, et al (1972) Anastomotic leakage after low colonic anastomosis. Am J Surg 123:104–109
Shrock TR, Deveney CW, Dunphy JE (1973) Factors contributing to leakage of colonic anastomoses. Ann Surg 177:513–518
Turnbull RB, Fazio VW, Goldsmith H, et al (1978) The factory that make low colorectal anastomosis safe. Dis Colon Rectum 21:399–407
Smith SRG, Connolly JC, Gilmore OJA (1983) The effect of fecal loading on colonic anastomotic healing. Br J Surg 70:49–50
Ambrosetti P, Meyer P, Rohner A (1985) Comparison entre deux modes de préparation colique rapide. Médicine et Hygiène 43:2142–2145
Vacher B, Rodary M, Hay JM, Fingerhut A (1990) Préparation colorectale à la chirurgie d'exérèse. Evolution après 4 études multicentriques randomisées. Chirurgie 116:409–414
Goligher JC, Lee PW, Lintott DJ (1979) Experience with the Russian model 249 suture gun for anastomosis of the rectum. Surg Gynecol Obstet 148:517–524
Everett WG, Friend PJ, Forty J (1986) Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 73:345–348
Beart RW Jr, Kelly KA (1981) Randomized prospective evalutation of the EEA stapler for colorectal anastomoses. Am J Surg 141:143–147
West of Scotland and Highland Anastomosis Study Group (1991) Suturing or stapling in gastrointenstinal surgery: a prospective randomized study. Br J Surg 78:337–341
McGinn FP, Gartell PC, Clifford PC, Brunton FJ (1985) Staples or sutures for low colorectal anastomoses: a prospective randomized trial. Br J Surg 72:603–605
Heald RJ (1980) Towards fewer colostomies — the impact of circular stapling devices on the surgery of rectal cancer in a district hospital. Br J Surg 67:189–200
Smith LE (1981) Anastomosis with EEA stapler after anterior colonic resection. Dis Colon Rectum 24:236–246
Boley SJ, Schwartz SS, Williams LF (1971) Vascular disorders of the intestine. Appleton-Century-Crofts, New York p 516
Brolin RE, Semmlow JL, Sehonanda A, et al (1989) Comparison of five methods of assessment of intestinal viability. Surg Gynecol Obstet 168:6–12
Wright CB, Hobson RW (1975) Prediction of intestinal viability using Doppler ultrasound technics. Am J Surg 129:642–645
Cooperman M, Pace WG, Martin EW et al (1978) Determination of viability of ischemic intestine by Doppler ultrasound. Surgery 83:705–710
Wolmark N, Gordon PH, Fisher B et al (1986) A comparison of stapled and handsewn anastomoses in patients undergoing resection for Dukes B and C colorectal cancer. An analysis of disease-free survival and survival from the NSABP prospective clinical trials. Dis Colon Rectum 29:344–350
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Ambrosetti, P., Robert, J., Mathey, P. et al. Left-sided colon and colorectal anastomoses: doppler ultrasound as an aid to assess bowel vascularization. Int J Colorect Dis 9, 211–214 (1994). https://doi.org/10.1007/BF00292253
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DOI: https://doi.org/10.1007/BF00292253