[Concepts for recognition and securing anastomotic wound dehiscence of the gastrointestinal tract].
Esophagoenteric and gastroenteric anastomoses actually show insufficiency rates ranging from 4 to 10% and are combined with high lethality. Intraoperative testing should include tension free intraabdominal positioning, meticulous suturing technique and extensive inspection. In stapled anastomosis completeness of the dough-nuts should be regarded. In colon and rectum surgery anastomotic insufficiency is seen with 1-3% incidence. Intraoperative control is achieved by rectoscopy or endosonography and by rectal instillation of coloured solutions (methylenic blue, iodine) or air insufflation. Microcirculation in the anastomotic regions can be tested by complex technical methods (Doppler sonography, plethysmography, pH measurement, oxygen measurement) of which the oxygen sensitive electrode offers highest diagnostic accuracy (95%). Visual control by experienced surgeons achieves diagnostic accuracy near 87% so that the little advantage obtained can actually not justify high costs and time expense that is combined with the use of the outpointed techniques.
Zirngibl
H
H
Klinik und Poliklinik für Chirurgie, Universität, Regensburg.
Schmidt
J
J
D000714:Anastomosis, Surgical; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D016343:Monitoring, Intraoperative; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques