title: Multiple synchronous colonic anastomoses: are they safe?
abstract: OBJECTIVE
  To evaluate short-term outcomes after construction of synchronous colonic anastomoses without fecal diversion.
  
  
  METHODS
  Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992-2007 were identified. Demographics, operative techniques, and 30-day outcomes are reported. Results are number (percent) of patients or median (interquartile range).
  
  
  RESULTS
  Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45-76) years, BMI 25.3 (22.9-28.7) kg/m(2)]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean-contaminated 56 (81%). Ten (17%) cases were laparoscopic-assisted with a 44% conversion rate. Length of stay was seven (5-10) days. Overall 30-day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra-abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively.
  
  
  CONCLUSIONS
  Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Holubar
authors.forename: B G
authors.initials: BG
authors.lastname: Wolff
authors.forename: V P
authors.initials: VP
authors.lastname: Poola
authors.forename: M
authors.initials: M
authors.lastname: Soop
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome