Scheduled maturation in low colorectal and coloanal anastomoses

Abstract

Introduction Anastomotic dehiscence is the main complication after low colorectal and coloanal anastomoses. The techniques commonly used are the double-stapling and hand-sewn anastomoses, both are made with immediate maturation. These techniques do not prevent pelvic sepsis in many patients and are not feasible in all cases. Objective The study aim is to report the technical details and results with the use of scheduled maturation anastomosis in ten patients. Surgical technique The scheduled maturation anastomosis is done in two steps. The first step is the closure of colonic stump in a way that keeps the mucosa layer in everted position. The second step is the union of the colon and rectum ends by transanal access. All the sutures are made with 2/0 polyglactin. A diverting stoma must be done in all cases. After 30 days, begins spontaneous opening of the anastomosis. Results Ten patients underwent this technique. There were two cases of stenosis that were treated with digital dilatation in office. All patients had their diverting ostomy closed. Conclusion The scheduled maturation anastomosis is feasible in difficult cases and may prevent pelvic sepsis in low colorectal and coloanal anastomoses.