Long-term fecal diverting device for the prevention of sepsis in case of colorectal anastomotic leakage: an animal experiment.
BACKGROUND
A new fecal diverting device (FDD) was fabricated for fecal diversion from the proximal colon above the anastomosis to outside the anus for protecting the rectal anastomosis. The aim of the study is to evaluate the safety and effectiveness of the FDD.


METHODS
After a pilot study, a prospective observational trial was performed in 34 mongrel dogs. The experiment comprised of segmental resection and anastomosis of the colon, fixation of the FDD, and observation for 3 weeks (n = 15) and more than 3 weeks (n = 19) without initiation of parenteral nutrition.


RESULTS
Four cases of perioperative death unrelated to the FDD were excluded. Twenty-six (87 %) of the 30 dogs survived. Sixteen (53 %) dogs were able to retain the FDD for more than 3 weeks until 82 days. The autopsy findings revealed that four (15 %) dogs showed colonic wall erosions and mucosal scarring respectively at the band fixation area without evidence of serious septic complications. The surviving dogs retained the FDD for more than 6 days. Mortality occurred in four of the five dogs that expelled the FDD within three postoperative days. A closed abscess cavity as the evidence of anastomotic leakage was noted in seven (23 %) of the surviving dogs.


CONCLUSIONS
The newly designed fecal diverting device can be retained for more than 3 weeks until 82 days without any serious complications. The FDD may prevent sepsis in case of anastomotic leakage if it is retained for more than 6 days.
Department of Surgery, School of Medicine, Yeungnam University, Daegu, Korea. jhkimgs@ynu.ac.kr
Jae Hwang
JH
Kim
Sang Hun
SH
Jung
Yong-Jin
YJ
Kim
Se-Ll
SL
Park
Dae-Hwan
DH
Kim
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D000818:Animals; D001344:Autopsy; D003106:Colon / Q000473:pathology / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects*; D020878:Device Removal; D004285:Dogs; D005243:Feces; D008297:Male; D060489:Prosthesis Retention; D018805:Sepsis / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors