[Colonic anastomoses: principles and early complications on the basis of a serie of 663 colectomies (author's transl)].
In this serie of 663 colectomies performed mainly for carcinoma (510 cases), all of the anastomoses were performed by single layer suture. Elective surgery was done routinely after intestinal preparation except in 19 emergency cases which include 13 obstructions. Terminal anastomoses were performed in 605 cases (91 per cent). Among ileo-transverse anastomoses (140 cases) there were 22 per cent of termino-lateral anastomoses, and out of 114 low rectal anastomoses 15 per cent of latero-terminal anastomoses. Since 1970, drainage tubes have been used in only seven cases, out of 518 colectomies. Among the 18 colostomies present at the time of operation, 13 could be closed at the same time as the colectomy. A diversity transverse colostomy was performed in seven cases only. In this series, there were ten postoperative haemorrhages without gravity and three cases of patent anastomotic dehiscence requiring reoperation. There was one death due to anastomotic dehiscence among the four postoperative deaths. Terminal anastomosis is the technique of choice in colonic surgery but must be avoided in cases of marked incongruence between the two ends. Intestinal preparation decreases the number of postoperative complications. Drainage after colectomy is useless when haemostasis is complete and there is no dead space around the anastomosis. A covering colostomy is very rarely indicated. The main factor in the prevention of colonic anastomosis complications, lies, in the preparation of the colonic sections and in the fashioning of the anastomosis.
D003082:Colectomy / Q000401:mortality; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors
Les anastomoses coliques: principes et complications précoces. A propos d'une série de 663 colectomies.