It was reported via journal article "title: controlled intraoperative water testing of left-sided colorectal anastomoses: are ileostomies avoidable?" authors: j m d wheeler, frcs; j m gilbert, frcs.Citation: ann r coll surg engl.1999; 81: 105-108.Anastomotic leakage is a major problem in colorectal surgery, and previous studies have suggested that intraoperative identification of leaks allows repair at the time of surgery.This study examined whether testing allowed a defunctioning ileostomy to be safely omitted.A series of 102 consecutive patients (52 male and 50 female patients; age range: 16 to 89 years old) underwent left-sided colorectal anastomosis and were studied prospectively.During the anterior resection procedure, the splenic flexure was mobilized and an end-to-end anastomosis was performed with randomization to either staples or sutures.There were 50 anastomoses stapled and 52 sutured (handsewn) with single layer nurolon 2-0 interrupted seromuscular inverting sutures (ethicon).In the handsewn group, reported complications included patient 1, an (b)(6) -year-old male patient with clinical leak, rectal bleeding, and pelvic abscess which required transverse colostomy, and drainage of pelvic abscess; patient 3, a (b)(6) -year-old female patient with clinical leak which was treated conservatively; patient 5, an (b)(6) -year-old male patient with clinical leak which was treated conservatively; patient 7, a (b)(6) -year-old male patient with late clinical leak which required loop ileostomy; failure of initial water test (n-10) which required strengthening of the anastomosis; failure of the second water test (n-3) which required loop ileostomy in 2 patients and tube caecostomy in 1 patient; and leak on water-soluble contrast enema (n-8) which were treated conservatively.In conclusion, controlled water testing of left-sided colorectal anastomoses at the time of surgery allowed incomplete anastomoses to be corrected intraoperatively.A defunctioning ileostomy was avoided in 98% of patients, and in 96% of low anastomoses.Intraoperative testing is helpful in anterior resection, but does not guarantee that an intact anastomosis will remain intact post-operatively.
|